For. Planning and Research Related to Procurement of a Systems Integration, Enhancements to a MMIS, New Fiscal Agent, and a Replacement DSS

Transcription

1 Implementation ADVANCE PLANNING DOCUMENT For Systems Integrator/ Florida Medicaid Management Information System/ Fiscal Agent Operations/ Decision Support System For Planning and Research Related to Procurement of a Systems Integration, Enhancements to a MMIS, New Fiscal Agent, and a Replacement DSS State of Florida Agency for Health Care Administration Division of Medicaid June 2015

2 Table of Contents Section 1 Executive Summary... 1 Section 2 Summary of Planning Activities Planning Phase Budget and Expenditures Progress of Planning Activities Research and Options Development Project Management, Oversight, and DDI Support Independent Verification and Validation (IV&V) Subject Matter Expert (SME) Support User Acceptance Testing (UAT) Services Organizational Change Management (OCM) Services Procurement and Solicitation Activities... 9 Section 3 Statement of Needs and Objectives Statement of Need Agency Programs and Services Environment Agency Technical and Operational Environment MITA Maturity Capabilities Agency Goals and Objectives Statement of Objectives for Enhanced FMMIS and Replacement DSS Adherence to CMS Seven Conditions and Standards Section 4 Requirements and Alternatives Analysis Requirements Analysis FMMIS/FA and DSS Requirements Systems Integrator Requirements Alternatives Analysis Procurement Options Process of Ranking Procurement Options Alternatives Evaluation Criteria Cost Benefit Analysis Comparison of Alternatives and Recommended Solution Solution Choice and Potential Advantages ii

3 Section 5 Project Management Plan Project Scope FMMIS/FA Project DSS Project Project Organization and Resources Project Organization Chart Roles and Responsibilities of Key Project Governance Entities Internal and External Stakeholders Personnel Resource Statement Project Schedule Period of Use Section 6 Proposed Budget and Cost ALlocation Remaining Planning Period Budget Proposed DDI Period Budget Proposed DDI Phase Cost Allocation MMIS Detailed Budget Template (MDBT) for DDI Phase Section 7 Statements and Assurances Section 8 Attachments iii

4 Table of Exhibits Exhibit 2-1: Planning Budget and Expenditures To Date... 3 Exhibit 2-2: Research and Planning Milestones and Deliverables... 5 Exhibit 2-3: Project Management Office Milestones and Deliverables... 6 Exhibit 2-4: IV&V Milestones and Deliverables... 7 Exhibit 2-5: Contracted SME Leads Milestones and Deliverables... 8 Exhibit 2-6: UAT Milestones and Deliverables... 8 Exhibit 2-7: OCM Milestones and Deliverables... 9 Exhibit 2-8: Agency Solicitation Schedule Exhibit 3-1: Agency Values Exhibit 3-2: Growth in Medicaid Caseload Exhibit 3-3: Growth in Medicaid Service Expenditures Exhibit 3-4: MITA Business Areas Affected by FMMIS and DSS Exhibit 3-5: MITA and Agency Goals Alignment Exhibit 3-6: Agency Goals and Objectives Exhibit 3-7: CMS Seven Conditions and Standards Exhibit 4-1: FMMIS/FA and DSS Requirements Exhibit 4-2: Florida Medicaid Enterprise Exhibit 4-3: Summarized Score Combined Qualitative and Financial Exhibit 5-1: FMMIS/FA Project Major Activities Exhibit 5-2: FMMIS/FA Project Deliverables Exhibit 5-3: DSS Project Major Activities Exhibit 5-4: DSS Project Deliverables Exhibit 5-5: SI/FMMIS/FA/DSS Project Organization Chart Exhibit 5-6: SI/FMMIS/FA/DSS Project Governance Structure Exhibit 5-7: Project Governance Roles and Responsibilities Exhibit 5-8: Agency Executive Structure Exhibit 5-9: Major External Project Stakeholders Exhibit 5-10: Project Timeline and Milestones Exhibit 6-1: Remaining Planning Period Budget Detail Exhibit 6-2: DDI Period Budget Detail Exhibit 6-3: DDI Cost Allocation Exhibit 6-4: Cost Allocation MMIS Detailed Budget Template (MDBT) Exhibit 7-1: CMS Seven Conditions and Standards Compliance Matrix Exhibit 7-2: Procurement Assurances iv

5 SECTION 1 EXECUTIVE SUMMARY On February 5, 2015 the Centers for Medicare & Medicaid Services (CMS) approved the Florida Medicaid Planning Advance Planning Document (PAPD) for the Agency for Health Care Administration (AHCA or Agency) to contract with consultants to provide research and planning, project management office (PMO), and independent verification and validation (IV&V) services to assist with the procurement of a systems integrator (SI), new fiscal agent (FA) contract and enhancements to, or development of, the Florida Medicaid Management Information System (FMMIS) and Decision Support System (DSS). This project, related to the procurement, is referred to as the SI/FMMIS/FA/DSS Project. Because the FMMIS/FA and DSS efforts represent two separate initiatives, they are referred to as the FMMIS/FA Project and the DSS Project, respectively. The Agency expects both implementation phases to complete by July To support the definition and selection of a procurement approach, the Agency contracted with a Research and Planning Vendor to assist the Agency with business needs assessment through a MITA 3.0 State Self-Assessment update and requirements and alternatives analysis. Using the results of the Research and Planning Vendor s analyses (described in detail in Section 4.2: Alternatives Analysis) and influenced by the complexity of the current health care industry landscape and AHCA s many initiatives, especially the transition to statewide managed care, Florida selected a system takeover with upgrades and major enhancements as its FMMIS solution. This option involves significant modification or replacement of components of the existing FMMIS, and support of the existing solution is assumed or retained by the successful bidding vendor. Additionally, the Agency has selected the design, development, and implementation of a replacement DSS solution. The Agency will enlist the services of a systems integrator to ensure that both systems and any additional modular components function together appropriately. Current total estimates for the overall SI/FMMIS/FA/DSS Project indicate the 18 month DDI period to cost $60,078,154. Several factors contributed to the Agency s decision, including: Move toward modularity: The base operations of the current system, which was implemented in 2008, are adequate, yet there are opportunities to move the baseline FMMIS toward a more modular solution through major enhancements. Reduced implementation risk: The solutions selected by the Agency allows Florida to accomplish its FMMIS/FA and DSS objectives at far lower risk to the State versus, for example, custom built solutions. Composition of service delivery: Following the recent transition to statewide managed care for recipients, the need for enhanced data analytics may overtake the need for traditional capabilities inherent in the existing systems. MMIS Replacement/Modification Cost: The system takeover with enhancements option is estimated to have the least expense immediately, with a solid return on investment and a competitive break-even year. The financial performance of this Page 1 of 67

6 option is due to a small initial investment and savings associated with lowered operating costs. As can sometimes occur with large scale implementation projects, Agency goals for this procurement continued to develop and mature following the conclusion of the formal alternatives analysis, resulting in a procurement decision that may differ somewhat from the alternatives analyzed. The procurement option ultimately selected by the Agency takeover of the FMMIS with upgrades and enhancements and replacement of the DSS aligns most closely with, respectively, the Two-Phase Systems Integrator Option and Off the Shelf Complete Solution or COTS. The successful Vendor will serve in the important role of systems integrator for the SI/FMMIS/FA/DSS Project, responsible for bringing together the FMMIS, DSS, and any additional systems supporting the Medicaid program at their appropriate integration points. Additional information on systems integrator-related requirements can be found in Section Systems Integrator Requirements. Page 2 of 67

7 SECTION 2 SUMMARY OF PLANNING ACTIVITIES Subsequent to the approval of the PAPD, the Agency selected a system takeover with upgrades and enhancements as their FMMIS solution. As a result, changes to the project schedule were necessary as a system takeover takes less time and has less associated risk than a full-scale system replacement. The Agency elected to shorten the design, development, and implementation (DDI) phase of the project by six months and delay the SI/FMMIS/FA/DSS solicitation release to allow additional time to continue planning activities. These changes impacted the original due dates of key activities and milestones described in the approved PAPD. The sections below describe the impact of those changes. 2.1 PLANNING PHASE BUDGET AND EXPENDITURES The Agency made adjustments to the requested budget due to changes to the project schedule and approach, including the removal of User Acceptance Testing (UAT) and Organizational Change Management (OCM) services from the Independent Verification and Validation (IV&V) Vendor contract. Exhibit 2-1: Planning Budget and Expenditures To Date shows the requested funding by Vendor for the SI/FMMIS/FA/DSS Project, as approved by CMS on December 24, 2014 through the PAPD. These figures are compared with the planning period budget request revised for this IAPD, as well as the amounts expended until June RESOURCE PLANNING BUDGET REQUEST PAPD APPROVED (FFY ) IAPD REQUEST (FFY , Q1) EXPENDITURES TO DATE Research and Planning $2,177,303 $3,046,311 $1,620,880 PMO/DDI Support $11,478,861 $5,156,437 $989,200 IV&V $4,603,711 $1,450,365 $0 Contracted SME Leads $9,407,659 $1,372,328 $0 State staff increased FFP $821,873 $410,937 $0 State staff travel, legal costs $0 $290,000 $0 Overhead (Communications) $0 $91,693 $0 Overhead (Facilities) $0 $353,626 $198,472 TOTAL $28,489,407 $12,171,697 $2,808,552 Exhibit 2-1: Planning Budget and Expenditures To Date The PAPD-approved planning budget request encompassed Project costs from FFY 2014 through FFY 2019, which included the DDI period. The revised IAPD planning budget request encompasses costs from FFY 2014 through FFY 2017 Quarter 1. All costs from FFY 2017 Quarter 2 to Day One of Operations have been incorporated into the DDI budget. As of the submission of this Implementation Advance Planning Document (IAPD) in FFY 2015 Quarter 4, the remaining funds required to complete the planning activities are added to the IAPD request. The status of budgeted expenditures is: $2,808,552 has been expended Page 3 of 67

8 $25,680,855 remains unexpended in the current approved PAPD budget $9,363,145 remains unexpended per the revised IAPD planning request budget Full detail on planning budget and expenditures, including a breakdown by task, can be found in Attachment B. 2.2 PROGRESS OF PLANNING ACTIVITIES The following subsections summarize the status and progress of activities conducted in the planning phase of the project and funded through the approved PAPD. Milestones/Deliverables listed as NEW in the Approved Date column indicate activities that have been added since the approved PAPD. Revised Milestones in the following exhibits refer to those milestones that have been updated or changed since their inclusion in the approved PAPD to better align with the updated project schedule and the transition to electronic procurement activities RESEARCH AND OPTIONS DEVELOPMENT The Agency contracted with a Research and Planning Vendor, CSG Government Solutions (CSG), for a variety of services throughout the planning phase of the SI/FMMIS/FA/DSS Project. Additional details are included below in Exhibit 2-2: Research and Planning Milestones and Deliverables. RESEARCH AND PLANNING VENDOR MILESTONE/DELIVERABLE APPROVED DATE REVISED DATE COMPLETION STATUS Contract Start Up July 1, 2014 August 28, % Develop Draft Work Plan July 30, 2014 Comprehensive Review Of The Current MITA SS-A July 18, 2014 Updated MITA SS-A and Roadmap Conduct Needs Assessment And Complete Gap Analysis Based On SS-A Research of MMIS and DSS technologies and operations throughout the nation Recommend Solutions For Enhancement, Replacement, Or Modifications To FMMIS And DSS Based On Gap Analysis Develop Draft FMMIS, Fiscal Agent And DSS solicitation Technical Requirements Produce Major Enhancements Technical Requirements November 26, 2014 November 26, 2014 November 26, 2014 December 12, 2014 September 17, 2014 September 29, 2014 November 21, 2014 November 21, 2014 November 18, 2014 December 12, % 100% 100% 100% 100% 100% April 3, 2015 June 15, % NEW July 1, % Page 4 of 67

9 RESEARCH AND PLANNING VENDOR MILESTONE/DELIVERABLE APPROVED DATE REVISED DATE COMPLETION STATUS Crosswalk of Enhancement Requirements to Medicaid Enterprise Certification Toolkit (MECT) NEW September 24, % Financial Analysis for IAPD NEW April 27, % Develop Evaluation Criteria for MMIS/DSS Solicitation Develop Evaluation Manual April 15 August 31, 2015 Separated task June 15, % September 11, % Create Electronic Evaluation Tool NEW August 11, % Electronic Evaluation Tool Training Report NEW May 20, 2016 n/a Vendor Conference Support for Technical Requirements and Addenda Report September 15, 2015 February 5, 2016 n/a Lessons Learned and Research Phase Close Out January 21, 2016 July 11, 2016 n/a TBD Protest Support Services Report REVISED MILESTONE Develop Evaluation Criteria, Tools and Evaluator Manual for MMIS/DSS Solicitation Evaluator Training Plan Evaluator Training Summary Report Final Evaluation Summary And Recommendation Report TBD Tentative December 2016; Not in current contract RATIONALE Created separate deliverables for the evaluation criteria and the evaluation manual to reflect different due dates Deleted as separate deliverables as work was redefined to align with the solicitation vehicle and electronic evaluation tools and process Exhibit 2-2: Research and Planning Milestones and Deliverables PROJECT MANAGEMENT, OVERSIGHT, AND DDI SUPPORT The Agency contracted with a PMO Vendor, North Highland, to establish a PMO and deliver professional and comprehensive project management services during the planning phase of the project, the DDI of the FMMIS/FA and DSS solutions, and the turnover of fiscal agent operations. Additional details are included below in Exhibit 2-3: Project Management Office Milestones and Deliverables. PMO VENDOR MILESTONE/DELIVERABLE APPROVED DATE REVISED DATE Contract Start Up December 2014 December 17, 2014 COMPLETION STATUS 100% Establish PMO December 2014 January 26, % Provide Office Space and Electronic Repository And Training December 2014 January 26, % Final Make or Buy Analysis Report* Mid-January 2015 February 9, % Page 5 of 67

10 PMO VENDOR MILESTONE/DELIVERABLE APPROVED DATE REVISED DATE Develop federally required components of the Implementing Advance Planning Document(IAPD) Finalize non-technical requirements and liquidated damages of the SI/FMMIS/FA/DSS solicitation COMPLETION STATUS January 31, 2015 May 22, % April 20, 2015 June 15, % Manage completion of SI/FMMIS/FA/DSS Solicitation NEW August 28, % SI/FMMIS/FA/DSS Vendor conference support, Vendor non-technical solicitation requirement question research and prepare amendments written report. September 15, 2015 February 5, 2016 n/a Contract Management Plan Comprehensive Monthly Report Coordinate System and Operations Performance Standards Turnover and Post Implementation reporting Lessons Learned Report Report to Summarize All CMS Certification/State Oversight Activities Project Closeout Report NEW January 2015 November 2018 November 7, 2016 February 2015 November 2018 n/a Started February 2015 and ongoing Early June 2018 June 1, 2018 n/a July 1, 2017 December 15, 2018 September 30, 2018 November 2018 December 15, 2018 July 1, 2017 December 15, 2018 September 30, 2018 November 1, 2018 December 15, 2018 n/a n/a n/a n/a *Make or Buy Analysis is Florida State procurement regulation for large scale implementations Exhibit 2-3: Project Management Office Milestones and Deliverables INDEPENDENT VERIFICATION AND VALIDATION (IV&V) On February 24, 2015, the Agency issued a Request for Proposal (RFP) which included UAT and OCM tasks; however, a vendor protest was filed regarding the UAT and OCM tasks. Although CMS had initially approved this approach, subsequent guidance from CMS prompted the Agency to remove the UAT and OCM tasks through an addendum to the RFP, and agreement was reached to reissue the solicitation as a Request for Quote (RFQ) instead of an addendum to the RFP. The Agency released the RFQ on May , and will contract with an IV&V Vendor in August The selected IV&V Vendor will perform independent verification and validation of the FMMIS/FA/DSS Project s practices in planning, developing, implementing, and testing the systems. Additional details are included below in Exhibit 2-4: IV&V Milestones and Deliverables. Page 6 of 67

11 IV&V VENDOR MILESTONE/DELIVERABLE APPROVED DATE REVISED DATE Contract Start Up March 2015 August 2015 COMPLETION STATUS Develop IV&V Management Plan Mid-April 2015 Report on the SI/FMMIS/FA/DSS Procurement Solicitation Document(s) Report on SI/FMMIS/FA/DSS Vendor s Proposed Technical Solutions September 21, 2015 NEW October 16, 2015 October 16, 2015 April 26, 2016 Comprehensive Monthly Reporting May 2015 and ongoing October 15, 2015 Solicitation Compliance and Traceability Monitoring Methodology Implementation Planning Assessment November 2017 May 2016 August 15, 2016 November 27, 2017 Solicitation Pending System Testing Validation January 2018 January 17, 2018 Assess Operational Readiness May 2018 May 18, 2018 Lessons Learned Report January 2018 Project Closeout Report REVISED MILESTONE December 2017 May 2018 September 30, 2018 January 31, 2019 RATIONALE Develop and Execute User Acceptance Test Plan Organizational Change Management Plan and Execution Deleted based on CMS feedback Deleted based on CMS feedback Exhibit 2-4: IV&V Milestones and Deliverables SUBJECT MATTER EXPERT (SME) SUPPORT The Agency will contract with MMIS and DSS business, technical, and subject matter experts (SMEs) in June The contracted SME leads will be responsible for discussing and providing resolution to strategic business issues affecting implementation. They will be embedded in specified Agency organizational units to organize unit input to project activities, track down information from Agency SMEs, organize business unit review of deliverables, and consolidate business unit responses to Vendor deliverables. Additional details are included below in Exhibit 2-5: Contracted SME Leads Milestones and Deliverables. CONTRACTED SME LEADS MILESTONE/DELIVERABLE Provide Ongoing Project Guidance, Support, and Subject Matter Expertise ORIGINAL PLANNED DATE REVISED DATE January 2015 June 1, 2016 COMPLETION STATUS Solicitation TBD Page 7 of 67

12 Exhibit 2-5: Contracted SME Leads Milestones and Deliverables USER ACCEPTANCE TESTING (UAT) SERVICES The Agency will contract with an UAT Vendor in October The UAT Vendor will be responsible for independently verifying the FMMIS and DSS performs appropriately in realworld scenarios users will encounter. The UAT Vendor will work with the Agency to plan, design, develop, train users, test, review, and document results of user test cases to validate FMMIS and DSS functionality. Additional details are included below in Exhibit 2-6: UAT Milestones and Deliverables. UAT VENDOR MILESTONE/DELIVERABLE APPROVED DATE REVISED DATE COMPLETION STATUS Contract Start Up NEW October 9, 2017 Develop and Execute User Acceptance Test Plan January 25, 2018 December 4, 2017 UAT Protocols and Training Manual February 15, 2018 January 2, 2018 UAT Testing Execution and Status Reporting Mar 1 May 10, 2018 January 9, 2018 April 20, 2018 Solicitation TBD UAT Final Results Report June 1, 2018 May 7, 2018 REVISED MILESTONE RATIONALE UAT Plan UAT Protocols and Training Manual Separated from IV&V Vendor per guidance from CMS UAT Testing Execution and Status Reporting Exhibit 2-6: UAT Milestones and Deliverables ORGANIZATIONAL CHANGE MANAGEMENT (OCM) SERVICES The Agency plans to contract with an OCM Vendor in July The OCM Vendor will be responsible for managing the effect of potential changes to business processes, organizational structure, culture, etc., to maximize the benefits of change for the Agency (e.g., increased efficiency, improved service delivery, cost savings, etc.) while minimizing potential negative impact (e.g., employee resistance, increased cost, lost productivity, etc.). Additional details are included below in Exhibit 2-7: OCM Milestones and Deliverables. OCM VENDOR MILESTONE/DELIVERABLE APPROVED DATE REVISED DATE Contract Start Up NEW July 10, 2017 Organizational Change Management (OCM) Plan April 3, 2017 September 2017 OCM Delivery Schedule and Materials Report June 16, 2017 December 2017 COMPLETION STATUS Solicitation TBD Page 8 of 67

13 OCM VENDOR MILESTONE/DELIVERABLE OCM monthly reports: OCM Sessions and Assessment of OCM Effectiveness APPROVED DATE August 17, 2017 March 30, 2018 REVISED DATE December 2017 March 2, 2018 OCM Final Report NEW March 30, 2018 COMPLETION STATUS REVISED MILESTONE Organizational Change Management (OCM) Plan OCM Delivery Schedule and Materials Report RATIONALE Separated from IV&V Vendor per guidance from CMS OCM monthly reports Exhibit 2-7: OCM Milestones and Deliverables PROCUREMENT AND SOLICITATION ACTIVITIES The Agency will solicit via Invitation to Negotiate (ITN) a vendor or vendors to conduct a takeover of the Agency s MMIS/FA operations, and design, develop, and implement the desired enhancements. Via the same ITN, the Agency will seek a vendor or vendors to design, develop, and implement a replacement DSS solution for Florida. ITNs meet Florida s procurement regulations and are very similar to a Requests for Proposals (RFPs), but allow the state to negotiate certain terms of the contract in order to receive the best products for the best price. The Agency s solicitation activities are included in Exhibit 2-8: Agency Solicitation Schedule below. AGENCY PROJECT TEAM MILESTONE/DELIVERABLE APPROVED DATE REVISED DATE Submit PAPD to CMS November 22, 2013 November 22, 2013 Develop SOW for Consultant Contracts February 28, 2014 February 28, 2014 Issue Research Solicitation March 21, 2014 May 23, 2014 Award Research Contract June 2, 2014 July 10, 2014 Issue PMO Solicitation March 21, 2014 July 22, 2014 Research Contract Start Up July 1, 2014 August 27, 2014 Award PMO Contract June 2, 2014 October 10, 2014 PMO Contract Start Up July 1, 2014 December 4, 2014 Submit PAPD Update to CMS New November 21, 2014 Issue IV&V Solicitation November 24, 2014 February 24, 2015 Award IV&V Contract March 2015 August 2015 IV&V Contractor Start Up January 5, 2015 August 2015 Submit IAPD to CMS February 28, 2015 June 2015 Page 9 of 67

14 AGENCY PROJECT TEAM MILESTONE/DELIVERABLE Develop SOW For The FMMIS/DSS/FA Operations solicitation & Submit For Agency Review APPROVED DATE REVISED DATE February-March 2015 January-July 2015 Submit Solicitation Documents for CMS review April 2015 October 2015 CMS Approval of Solicitation Documents June 1, 2015 December 2015 Issue Solicitation July 2015 December 2015 Receive Responses September 1, 2015 April 2016 Evaluate Responses November 16, 2015 April-May 2016 Negotiations NEW May-June 2016 Award Contract January 4, 2016 July 2016 DDI Startup February 15, 2016 August 2016 if no protest January 2017 with protest Oversee Project Ongoing throughout life of the project Ongoing throughout life of the project Day One of Operations July 1, 2018 July 1, 2018 Lessons Learned September 30, 2018 September 30, 2018 Project Closeout (end of warranty period) September 30, 2018 July 1, 2019 Exhibit 2-8: Agency Solicitation Schedule Page 10 of 67

15 SECTION 3 STATEMENT OF NEEDS AND OBJECTIVES The State should summarize the current environment and the new system needs, objectives, and anticipated benefits. Needs may be expressed in terms of deficiencies in existing capabilities, new or changed program requirements, or opportunities for economies or efficiencies. 3.1 STATEMENT OF NEED The Agency coordinates and manages health care coverage for nearly 3.8 million Floridians in all sixty-seven (67) counties, and has enrolled more than 117,000 health care providers as part of the managed care organization (MCO) network. The FMMIS and DSS are the key elements of the Agency s management and operation of the Medicaid program. HP Enterprise Services (HPES) is the Agency s fiscal agent for the current contract period, July 2008 through June The planning, preparation and eventual transition of a fiscal agent contract is a costly and time intensive project that historically has spanned several years. The current Medicaid fiscal agent contract with HPES ends on June 30, 2018, thus requiring the Agency to procure a new fiscal agent contract. Historically, procurement of a new fiscal agent contract has signaled either enhancement of the existing FMMIS during the turnover to the new fiscal agent or a full design and implementation of a new FMMIS. Florida recently initiated significant changes impacting the operation of Florida Medicaid and it s MMIS: Florida s transition to full state-wide managed care: The Agency implemented the long term care managed care program in November 2013 and the managed medical assistance program in August Conversion to Diagnosis-Related Groups (DRG) inpatient hospital reimbursement methodology on July 1, The Agency anticipates additional activities associated with this critical methodology change to include outpatient services. Florida s planned partnership with Puerto Rico for MMIS/DSS operations. In addition to state projects, there are several critical federal initiatives affecting Florida Medicaid. Some of the more high-profile initiatives include: Installation of ACA-mandated operating rules necessary for the electronic exchange of information with the objective of realizing administrative simplification of Health Insurance Portability and Accountability Act (HIPAA) standard transactions. Enhancements needed to implement Transformed-Medicaid Statistical Information System (T-MSIS) which will provide CMS with expanded enrollment, utilization, and expenditure data for Medicaid and CHIP programs. New requirements for Medicaid as a result of the Affordable Care Act, including the concept of the health insurance exchange and increased provider enrollment and screening capability. Transition to the mandated ICD-10 codes. Page 11 of 67

16 As for the DSS, Florida expects support for a greater range of analytical capabilities beyond standard reporting of aggregated data. To meet these increased expectations, the Agency expects to integrate external data sources (e.g., immunization and public health records) into the Medicaid data warehouses and supply more advanced analytical tools to detect fraud and abuse and measure health outcomes. The Agency is looking for comprehensive databases allowing users to perform link analysis, predictive modeling, and anomaly detection across many disparate data sources on an ad hoc basis. Ideally, those comprehensive databases are securely hosted online (without the need for proxy access or multiple platforms), are structured and hosted with enough hardware to support several hundred users, and are designed to accommodate ad hoc querying, large volume data extraction, as well as canned state and federal reporting requirements. The Agency is committed to furthering a culture of business intelligence and data analytics facilitating an enhanced understanding of the delivery system and the opportunity for improved health outcomes for recipients. The MITA framework is intended to support improved systems development and health care management for the Medicaid enterprise. The Agency desires to leverage the FMMIS/FA and DSS procurement planning activities to fully understand the opportunities to establish more interconnected data systems to support the Medicaid enterprise. Integrating systems to create a single source of truth allows for near real time updates, enhanced monitoring of providers and prompt program exclusions. The MITA framework and the seven conditions and standards are being used throughout the project as a guide to the FMMIS and DSS solutions. 3.2 AGENCY PROGRAMS AND SERVICES ENVIRONMENT 1 The Agency is responsible for the administration of the Florida Medicaid program, licensure and regulation of Florida s health facilities, and for informing Floridians on the quality of care they receive, all of which further the Agency s mission to provide better health care for all Floridians via a health care system empowering consumers; rewarding personal responsibility; and where patients, providers, and payers work for better outcomes at the best prices. FMMIS and DSS are key elements of the Agency s management and operation of the Medicaid program. In order to accomplish its mission, the Agency adopted the four key values seen in Exhibit 3-1: Agency Values: 1 This information was sourced from the AHCA Long Range Program Plan (LRPP) for Fiscal Year through Fiscal Year Page 12 of 67

17 Exhibit 3-1: Agency Values Florida is the third most populous state in the country, with the U.S. Census Bureau reporting 19.9 million residents 2. Medicaid enrollment has seen a steady growth over the last decade in line with the increasing state population. Recently, due to poor economic conditions beginning with the national recession in 2009, the state s Medicaid enrollment has grown at a faster rate than in previous years. In State Fiscal Year (SFY) , it is estimated that Medicaid will have served more than 3.7 million beneficiaries. Medicaid caseloads in SFY were more than 65 percent higher than a decade ago. The caseload increased by 4.2 percent in SFY over the prior fiscal year and is projected to increase in SFY by 7.7 percent compared to SFY U.S. Census Bureau. (2014). Population Estimates: State Totals. Retrieved from Page 13 of 67

18 Exhibit 3-2: Growth in Medicaid Caseload With expenditures of $22.2 billion in SFY , Medicaid is the largest single program in the State, accounting for roughly 31 percent of the State s total budget. It is also the largest source of federal funding for the state. In the last ten years, expenditures in the Medicaid program grew from almost $13.1 billion in SFY to $22.2 billion in SFY , growing nearly 70 percent in that time period (Exhibit 3-3: Growth in Medicaid Service Expenditures). Page 14 of 67

19 Exhibit 3-3: Growth in Medicaid Service Expenditures The primary factors contributing to expenditure growth have been the cost of prescription drugs, an increase in the costs to provide medical services and long-term care, and an increase in enrollment. As a social safety net program, Medicaid enrollment and expenditures are closely tied and inversely related to economic performance. Even with improved economic conditions, Medicaid enrollment is likely to remain higher due to the federal insurance mandates at the federal level and the roll out of Statewide Medicaid Managed Care (SMMC) on the state level. Both have increased awareness of the availability of Medicaid, and many of those already eligible but not previously enrolled will likely join the Medicaid program. Increased enrollment is not the only factor that influences Medicaid expenditures. Health care cost inflation has surpassed cost increases in other economic sectors for years. Florida s Medicaid program was implemented as a Fee-for-Service (FFS) model more than four decades ago and since the beginning, had been primarily a FFS based program. Over the years, enrollment grew rapidly and costs soared until Medicaid expenditures were more than onefourth of the state budget. The rapid growth in enrollment and costs made it increasingly important to find ways to manage the diverse needs of the Medicaid population while also being able to better predict and plan for cost increases. Florida Medicaid recently implemented significant program changes resulting in improved efficiency, cost predictability and accountability for the program and enhanced service provision for program recipients. The most significant change, perhaps the single greatest change in Medicaid since the program was adopted, is the implementation of the SMMC program. Page 15 of 67

20 3.3 AGENCY TECHNICAL AND OPERATIONAL ENVIRONMENT In accordance with its mission and values, the Agency oversees and manages FMMIS, which manages recipient eligibility, provider enrollment, reimbursements, and other related services. The Agency contracts with HPES to provide FMMIS functionalities and services, which include provider enrollment, provider relations, claims authorization and processing, file exchange, and recipient eligibility management. HPES performs services to support the following areas of FMMIS operations: FMMIS Core Claims and Encounter Processing Supports editing, auditing and pricing of claims and encounters Claims Submission Provider application supporting claims submission, eligibility verification and claims status inquiry Automated Inquiry System (AIS) Supports phone inquiry of claims and eligibility related information for providers Online Interface Supports end-user functions for interaction with claims and related information Third Party Liability (TPL) System Supports third party recovery and liability processing conducted by a third party vendor Pharmacy Benefits Management (PBM) Supports payment processing and health quality program monitoring for pharmacy claims Medicaid Enterprise User Provisioning System (MEUPS) - Security application for user access Electronic Data Interchange (EDI) Provides Health Insurance Portability and Accountability Act (HIPAA)-compliant / EDI transaction routing Document Repository Supports system documentation and change/project management Provider Portal Web-based interface for providers to access information and perform eligibility verification and claims status inquiry Cash/Financial System Supports cash and financial processing Learning Management Supports state user and provider FMMIS training and system documentation Electronic Reporting and Image Management Provides reporting and imaging capabilities Recipient Management Supports recipient and eligibility management Provider Management Supports provider enrollment and information management Reference File Management Supports tables maintenance for edits and audits Provider Network Management Supports provider network management, credentialing, and enrollment for plans and providers Page 16 of 67

21 DSS Case Management/Health Education Supports case management and health education functions Member Management Supports member processing DSS Ad Hoc Query Platform through Business Objects Datamart for information management and analysis of data related to Medicaid claims and associated data Management and Administrative Reports Subsystem (MARS) Supports defined MARs and Statistical reporting Surveillance and Utilization Review Subsystem (SURS) Supports SUR analysis and reporting Drug Claim Information Supports specific reporting and analysis for Pharmacy Claims-related extracts and reports Encounters Datamart within the DSS Stores managed care encounter data from contracted Managed Care Organizations MITA MATURITY CAPABILITIES In 2012, Florida conducted a full MITA 3.0 SS-A of its Medicaid program, followed by a MITA SS-A Update in November According to the SS-A, while the FMMIS/DSS impacts most Medicaid business processes, it is most directly associated with those under the Care Management, Financial Management, Operations Management, Performance Management and Provider Management business areas. While these areas encompass certain business processes that were assessed as high as Level 2, the overall areas were all assessed at As-Is MITA Maturity Level 1. To-Be Maturity Level goals for these business areas remain at Level 1, with the exception of Operations Management and Provider Management at Level 2. Achieving these Level 2 goals will require a variety of improvements to the FMMIS and DSS capabilities, including implementing performance measures, a cloud environment, enhanced methods of sharing encounter information with other state agencies, and a method of tracking data on all current and past providers, including applications that have been received and are in process or have been declined. Streamlining the collection of data, establishing a single Master Provider Index that could be shared across all programs in the Enterprise; and using X transactions to reduce dependency on paper attachments associated with Medicaid transactions (i.e. claims submissions, prior authorizations and estate recovery) will also be required. In support of these goals, Florida Medicaid subject matter experts (SMEs) identified reprocuring or enhancing the FMMIS and DSS as the single most important activity required to increase MITA capabilities. The primary drivers for these capability increases include: Automating the input from outside systems that provide data to FMMIS Enhancing the automated collection of data to generate fiscal agent report cards Automating the reporting of Medicaid expenditures to the U.S. Department of Health and Human Services (HHS) Page 17 of 67

22 Modifying FMMIS to include eligibility information for recipients enrolled in waiver programs Eliminating the manual gross adjustment process where possible, and using an automated online system to eliminate paper processing and improve timeliness and accountability Centralizing or coordinating care plans and services between agencies Consolidating all relevant provider information Interfacing Florida Health Information Exchange (HIE) with the FMMIS Setting up more communication systems through various agencies to perform tasks more accurately and efficiently Facilitating data integration with sister agencies to achieve common goals Identifying and using Commercial Off-the-Shelf (COTS) and open-source solutions collaboratively with other state agencies and entities Exhibit 3-4: MITA Business Areas Affected by FMMIS and DSS shows the major business areas and supporting processes that will benefit from FMMIS upgrades and enhancements and DSS replacement, resulting in advancement along the MITA maturity continuum. Exhibit 3-4: MITA Business Areas Affected by FMMIS and DSS While the business processes that directly utilize the FMMIS/DSS will experience the greatest impact, many other processes are indirectly affected by the FMMIS/DSS and may also Page 18 of 67

23 advance in MITA maturity through improved automation, reporting, data sharing, and other efficiencies provided by an enhanced FMMIS/DSS. 3.4 AGENCY GOALS AND OBJECTIVES Besides the Agency s specific procurement goals, the Agency has developed comprehensive goals and objectives as part of its MITA SS-A Update, and aligned them with the MITA goals developed by CMS. These goals and objectives are described in more detail in Exhibit 3-5: MITA and Agency Goals : MITA GOAL Develop seamless and integrated systems that communicate effectively to achieve common Medicaid goals through interoperability and common standards Promote an environment that supports flexibility, adaptability, and rapid response to changes in programs and technology Promote an enterprise view that supports enabling technologies that align with Medicaid business processes and technologies Provide data that is timely, accurate, usable, and easily accessible in order to support analysis and decision making for health care management and program administration Provide performance measurement for accountability and planning Coordinate with public health and other partners, and integrate health outcomes within the Medicaid community FLORIDA S 2014 GOALS Allow no wrong door Expand flexibility and adaptability Improve accountability use of common standards Improve fraud and abuse prevention Safeguard public health through collaboration and system integration Expand flexibility and adaptability Improve accountability use of common standards Allow no wrong door Expand flexibility and adaptability Improve accountability use of common standards Improve fraud and abuse prevention Optimize health outcomes through the sharing of clinical information Safeguard public health through collaboration and system integration Expand flexibility and adaptability Improve accountability use of common standards Improve fraud and abuse prevention Improve data integrity, security, analytics, and reporting Improve health outcomes Improve accountability use of common standards Improve fraud and abuse prevention Improve data integrity, security, analytics, and reporting Allow no wrong door Optimize health outcomes through the sharing of clinical information Restructure Medicaid; organizational change; managed Care Exhibit 3-5: MITA and Agency Goals Alignment The strategic roadmap included as part of the MITA SS-A described the re-procurement or enhancement of the FMMIS and DSS as the top recommended activity for advancing Florida Medicaid along the MITA maturity continuum over the course of the next five years. This activity was aligned to the Care Management, Financial Management, Operations Management, Provider Management, and Performance Management MITA business areas; however, the breadth of capabilities associated with an enhanced FMMIS and replacement DSS is such that the Agency will likely see benefits that contribute to most Medicaid business processes. Page 19 of 67

24 3.5 STATEMENT OF OBJECTIVES FOR ENHANCED FMMIS AND REPLACEMENT DSS The Agency developed a comprehensive Statement of Objectives for the purpose of encouraging innovative FMMIS and DSS solutions from potential vendors and aligning procurement directly with achieving those objectives. The Statement of Objectives, which will be incorporated into the FMMIS/FA/DSS Project procurement document, provides the overarching framework for what the enhanced FMMIS and replacement DSS will accomplish. Exhibit 3-6: Agency Goals and Objectives describes the high level objectives that the FMMIS and DSS must meet, categorized into four key areas: Functionality, Technology, Operations, and Project Delivery. CATEGORY Functionality Technology COMMON (BOTH MMIS AND DSS) 1) Advance MITA Functionality Maturity 2) Federal Certification 3) Consolidate Functionality/Data within the Medicaid Enterprise 4) Leverage Assets and Data across the Medicaid Enterprise 5) Expand Automated Processes with a Focus on Communications, Workflow, and Electronic Records 6) Robust Fraud and Abuse Targeting, Detection and Prevention 7) Integration with Consolidated Case Management Functionality 8) Integration with Enhanced Customer Relationship Management (CRM) Functionality 1) Advance MITA Technology Maturity 2) Federal Standards and Guidance Compliance 3) Florida Standards and Mandates Compliance 4) Consistent, Predictable, and Repeatable Data Storage and Use 5) System Agility/Ease of Modification 6) Expand Ability for Integration with Enterprise Initiatives 7) Technology Refresh MMIS 1) Baseline MMIS Functionality 2) Enhanced Provider Enrollment and Management 3) Enhanced Pharmacy Services Functionality 4) Integration with Enhanced Recipient Support Functionality 5) Integration with Replacement DSS 1) Baseline MMIS Functionality 2) Enhanced Encounter Processing Rules 3) Enhanced Testing Environment 4) Enhanced System Documentation Tools DSS 1) End-User Analytics Enablement 2) Timely and Useful Data and Metrics 3) Transparency into Health Plan Information 4) Enhanced Encounter Analytics 5) Enhanced Quality Analytics 6) Enhanced Fiscal Management and Federal Reporting 7) Enhanced Fiscal Modeling and Forecasting 1) Access Anywhere 2) Secure Role-Based Access to Tools and Data 3) On-Demand Access to Medicaid Enterprise Data 4) Integrated Data 5) Visibility to Sources of Data 6) Compliance and Integration with Data Access and Analytics Standards Page 20 of 67

25 CATEGORY Operations Project Delivery COMMON (BOTH MMIS AND DSS) 1) Advance MITA Operations Maturity 2) Agility in Organization Structures and Processes 3) Support Transition to Managed Care 4) Innovations in Medicaid Program Operations 5) Business Continuity and Disaster Recovery 1) Ensure Federal Standards (CMS) Compliance for Project Delivery 2) Ensure Florida (AST) Compliance for Project Delivery 3) Realistic Project Schedule 4) Central Readiness/Issue Management During Transition to Operations 5) Integrated Project Management MMIS 1) Baseline MMIS Operations with Enhancements 2) Enhanced Operations Support for Manual Processes 3) Enhanced Pharmacy Clinical Support 4) Documentation Cleanup and Maintenance 5) Enhanced Agility in MMIS System Support 1) Risk Management in MMIS Takeover Transition Activities 2) Support Migration to and Integration with the Replacement DSS Exhibit 3-6: Agency Goals and Objectives DSS 1) Medicaid Enterprise Data Governance 2) Data Cleansing, Validation, Normalization Support 3) Analytics Services Support 4) Data Hosting 1) Data Migration from Current Data Warehouse 3.6 ADHERENCE TO CMS SEVEN CONDITIONS AND STANDARDS As the Agency intends to request enhanced FFP to help fund its FMMIS and DSS efforts, the systems are being planned to comply with the Seven Conditions and Standards as outlined by CMS and described in Exhibit 3-7: CMS Seven Conditions and Standards. These Seven Conditions and Standards played a major role in the alternatives assessment to evaluate viable MMIS solutions, as well as in the development of the Statement of Objectives. The Seven Conditions and Standards are also currently being incorporated into the evaluation criteria within the SI/FMMIS/FA/DSS Project procurement document. Following a successful award, this section will be updated with specific descriptions as to how the winning solutions align with the conditions and standards below. Page 21 of 67

26 Modularity Standard States must use a modular, flexible approach to systems development MITA Condition States must advance increasingly in MITA maturity for Business, Information and Technical Architecture Industry Standards Condition States must ensure alignment with standards such as HIPAA Leverage Condition States must promote sharing, leveraging and reuse of technology Business Results Condition State systems must support claims, adjudications and effective communications Reporting Condition States must produce transaction data, reports and performance standards Interoperability Condition State IT systems must ensure seamless coordination and integration with the other entities Exhibit 3-7: CMS Seven Conditions and Standards Page 22 of 67

27 SECTION 4 REQUIREMENTS AND ALTERNATIVES ANALYSIS The regulation at 45 CFR (2) requires that the IAPD include a summary of the results of the requirements analysis, feasibility study, and alternatives analysis. Note that copies of these documents are not required; their submission may delay action on the APD due to increased review time. 4.1 REQUIREMENTS ANALYSIS The requirements section should describe the functional and technical needs, including system interface requirements. System interface requirements may relate to IV-A, IV-D, IV-E, Medicaid, Federal Parent Locator Service (FPLS), Child Care, State Labor and Employment, IRS, and others as needed. The requirements gathering and approval process allowed for multiple, iterative reviews of requirements by the Agency personnel at multiple levels, using a Requirements Traceability Matrix (RTM). To facilitate requirements analysis, the Research and Planning Vendor (R&P Vendor) created a RTM for each Requirement Analysis and Development (RAD) area. The RTM allowed the R&P Vendor to categorize each requirement by MITA business area and relevant sections in the 2005 and 2015 SI/FMMIS/FA/DSS solicitations, to identify a requirement s status as a system upgrade or major enhancement, and to record meeting notes and comments to explain changes to the requirements or discussions that occurred during RADs or other meetings. For each RAD area, the RTM was initially populated with requirements from the 2005 Florida Medicaid Fiscal Agent Procurement RFP. For business areas for which no 2005 requirements could be identified, the RTM also included relevant requirements from the MMIS Baseline Requirements spreadsheet that was compiled by the R&P Vendor s SMEs from their research of common or typical MMIS requirements used in other implementations. In addition, Agency SME s developed new requirements to address specific areas of concern to the state and requirements from customer service requests (CSR s) were incorporated in the RTM. Through a series of meetings and other communication, input from Medicaid Fiscal Agent Operations (MFAO) personnel, SMEs, and the Agency executive leadership was collected through: Requirement Analysis and Development (RAD) sessions Technical RAD sessions Requirement Validation sessions Enhancement executive direction sessions Enhancement Requirements Finalization meetings Upgrade Review sessions Disposition of ongoing customer service requests (CSRs) MFAO requirements development Page 23 of 67

28 4.1.1 FMMIS/FA AND DSS REQUIREMENTS Exhibit 4-1: FMMIS/FA and DSS Requirements categorizes and summarizes the high-level requirements gathered for both systems. Comprehensive and detailed requirements are currently being finalized. Any substantive changes to the summary requirements will be communicated via an IAPD-U. Exhibit 4-1: FMMIS/FA and DSS Requirements Upgrades are defined as those requirements that represent minor improvements to features or functionality within the existing FMMIS. Enhancements are defined as those requirements that represent major improvements to modules within the existing FMMIS. Enhancements will require separate pricing from potential bidders. Page 24 of 67

29 Cross-functional modules are considered Support Module Alternatives, indicating that the Vendor is permitted to suggest alternative solutions. The Vendor may propose either a takeover of the existing system functionality, software, or COTS products with all defined upgrades; or could propose an alternative solution such as employing their own software or a different COTS product. In situations where an existing module cannot be taken over, the Vendor must propose an appropriate solution to meet all requirements SYSTEMS INTEGRATOR REQUIREMENTS Included as part of the procurement of the FA, the Agency requires the FA to fulfill a systems integrator function that will bring together the FMMIS, DSS, and any additional systems supporting the Medicaid program at their appropriate integration points. The systems integrator will ensure that all systems required to be interoperable with Medicaid function together appropriately and have the ability to share and receive data. The term Medicaid Enterprise is defined in this ITN as the business, data, and technical processes and systems necessary for the administration of the Florida Medicaid program, as well as collaborations and touch points of processes and systems that reside outside of the Agency. The Florida Medicaid Enterprise is illustrated in Exhibit 4-2: Florida Medicaid Enterprise Exhibit 4-2: Florida Medicaid Enterprise The systems integrator will be required to deploy the activities, architecture, and tools necessary for achieving consistent access to data across the Medicaid enterprise in order to Page 25 of 67

30 meet the data needs of Florida Medicaid and its business processes. The FA will be uniquely accountable for the interoperability of the MMIS and DSS with other Medicaid support systems. In addition, the Agency requires a Systems Integrator to address several goals: Deliver business results through effective and efficient business processes Leverage Code and Technology reuse Support interoperability between systems inside and outside the Agency, continuing to incorporate industry standards (e.g. HIPAA) By utilizing a systems integrator, the Agency hopes to increase the return on the state s investment in the activities and systems needed to administer the Florida Medicaid program. The systems integrator will assist in the preservation and optimization of enhanced Federal Financial Participation (FFP) through oversight and enforcement of the Seven Conditions and Standards found in sections 1903(a)(3)(A)(i) and 1903(a)(3)(B) of the Social Security Act. The systems integrator will establish a single view of the Florida Medicaid architecture, promote component reuse, and look for ways to modularize the MMIS and supporting systems 4.2 ALTERNATIVES ANALYSIS This section should also identify each of the alternatives analyzed for the system project and the considerations and conclusions reached regarding each one. It should also identify which alternatives were selected for evaluation of costs and benefits and provide the rationale for selection of the chosen alternative. If applicable, system transfer is addressed, summarizing which State systems were assessed for possible transfer and the results of the assessment. As can sometimes occur with large scale implementation projects, Agency goals for this procurement continued to develop and mature following the conclusion of the formal alternatives analysis, resulting in a procurement decision that does not align directly with the procurement options analyzed. The procurement options ultimately selected by the Agency takeover of the FMMIS with upgrades and enhancements and replacement of the DSS align most closely with, respectively, the Two-Phase Systems Integrator Option and Off the Shelf Complete Solution or COTS PROCUREMENT OPTIONS The procurement options established by the SI/FMMIS/FA/DSS Project State Management Team and evaluated as part of the alternatives analysis are: Existing, which entails a takeover of the current FMMIS with minor enhancements to keep the system up to date with federal regulations. Enhance Existing System, involving significant modification or replacement of portions of the existing FMMIS. Off the Shelf Complete Solution or COTS, the replacement of the current FMMIS with one that is installed by a successful bidding vendor. The solution must have been certified as a whole by CMS for at least one state. Page 26 of 67

31 Modular Complete Solution in which the current FMMIS is replaced by a combination of components that have not been certified as a whole by CMS. The successful bidder serves as a systems integrator for the DDI effort, and is independent from the vendor supplying the claims engine component. Custom Development that may include a complete integrated solution or an assembly of multiple components. The Agency or vendor(s) code/integrate a system to the specifications of the state. Hybrid with Multiple Prime Vendors, with the Agency acting as a systems integrator overseeing multiple prime vendors who provide a variety of components that may be CMS certified individually, but may not have been certified in combination. Two-Phase Systems Integrator Option, comprising Phase 1: a takeover of the current MMIS with enhancements and/or replacements of current functions with oversight from a systems integrator and Phase 2: migration of existing functionality to new modules, managed by the systems integrator at the Agency s direction PROCESS OF RANKING PROCUREMENT OPTIONS In addition to the findings of the MITA SS-A Update, Report on the Research Task and GAP Analysis Report, the ranking of procurement options in this report were based on the Alternatives Assessment Matrix (AAM) and the financial analysis. The AAM is a tool to facilitate the comparison of possible solutions to be considered for enhancement or replacement of an MMIS. After being adapted to the requirements of Florida Medicaid, the AAM allowed the weighting, scoring and financial analysis of possible solutions in discrete steps: Step 1 - The AAM procurement options were established by the SI/FMMIS/FA/DSS State Management Team and seven procurement options were considered. Step 2 - Evaluation criteria were established by the SI/FMMIS/FA/DSS State Management Team and then weighted based on the priorities of the SI/FMMIS/FA/DSS Project governance committee. (Medicaid priorities and goals are detailed in the Updated SS-A and Gap Analysis Report). The evaluation criteria are described in Section 4.2.3: Alternatives Evaluation Criteria. Step 3 - Based on the business needs identified in the Gap Analysis and the findings in the Research Report, each criterion was scored for each option. A 1 to 5 score was applied to each of the criteria, rating the option s ability to adhere to or support each of the particular criteria. Step 4 - The weights determined in Step 2 were combined with the scores in Step 3 to derive a weighted score. Calculations were performed by the AAM without financial considerations to produce qualitative scores. Step 5 - The three options with highest qualitative weighted scores were selected for financial analysis. The SI/FMMIS/FA/DSS Project Management (PM) Team confirmed the three top-scoring options for financial analysis. Step 6 - Financial analysis using historical Florida Medicaid data, as well as marketplace data to model anticipated costs, potential savings and financial risk was conducted for the three options confirmed by SI/FMMIS/FA/DSS PM Team. Page 27 of 67

32 Step 7 - Final calculations were performed within the AAM to generate final scores for the three selected options ALTERNATIVES EVALUATION CRITERIA A standard set of evaluation criteria in the AAM allowed the seven procurement options to be evaluated. The evaluation criteria include items related to the CMS Seven Conditions and Standards. First the criteria were grouped into categories, and each of the categories was weighted by State executive leadership to reflect Florida Medicaid s priorities. The criteria categories are: Flexibility including criteria for longevity, interoperability, and maintainability. Usability for all audiences, including providers, members, and internal users. Delivery Time time projected for building and implementing the option. Delivery Risk - based on the demonstrated success and complexity of the solution and burden on State staff. Technology including usage of COTS, adherence to industry standards, and modularity. Feasibility including marketplace availability, CMS compliance, and applicability to Florida. Financial Analysis compilation of financial data based on ROI, break-even year and financial risk. 4.3 COST BENEFIT ANALYSIS The enhancement of the FMMIS and replacement of the DSS, with solutions that will not only comply with the MITA standards set forth by CMS but will also be flexible enough to accommodate the changing landscape of Medicaid, will require a significant investment and a dedicated effort. It is necessary to consider the benefits that will ensue from an enhanced/reprocured system and compare them to the expected costs. The scoring of a simple takeover of the existing system served as a baseline and provided a contextual measuring stick that the seven options described in Section 4.2.1: Procurement Options were compared against. After the completion of the analysis, the three highest ranked options are as follows: Two-Phase Systems Integrator Option - This option represents a plan to migrate from the existing solution to one that represents an assembly of multiple components. In the first phase, the successful bidder takes over the existing system with a targeted set of enhancements to be defined by the Agency during the requirements gathering phase. In the second phase, existing system functionality is replaced with new components from various vendors. The successful bidder serves as systems integrator for this phase. Enhance Existing This option considers making significant changes to modify or replace portions of the FMMIS solution currently in production. Support of the existing solution is assumed or retained by the successful bidding vendor. Page 28 of 67

33 Off the Shelf Complete Solution or COTS - A replacement of the current FMMIS/DSS is done with one that is proposed and installed under the management of a successful bidding vendor. The solution may contain multiple components, but the combination of components must have already been installed certified by CMS in at least one state. Financial analysis is the final step in the assessment of proposed FMMIS solutions. Below is a description of the financial analysis performed on the top three options identified in the AAM and selected by the Agency. These options are evaluated with respect to projected financial performance for a period of years after each option is placed in production. The cost/benefit technique used in this analysis follows the guidelines and recommendations of the federal Office of Management and Budget (OMB) Circular A-94 Guidelines and Discount Rates for Benefit-Cost Analysis of Federal Programs. In line with OMB Circular A-94, simulation analysis was used to derive financial estimates based on constant 2013 dollars. The financial estimates include: Total Cost: The total cost of DDI of the option Return on Investment (ROI) at Latest Break-Even Year: The cumulative net present value (cost or benefit) of the option (DDI and Operations) divided by the cumulative investment in the option at furthest break-even year of all the alternatives. If two alternatives break even in 2027 and one in 2029, the ROI for 2029 is used. Break Even Year: The year when the project ROI goes from negative to positive, indicating project investment has been paid off and expected benefits will start to accrue Financial Down-side Risk Relative to Return: A measure of uncertainty in the budget due to variability in implementation times and the expected market cost of implementing a system and engaging a fiscal agent, relative to the ROI at the latest break-even year of all alternatives. It represents the risk of over-running the budget for DDI, while taking the potential return on investment into consideration. Historical trends in Florida s fiscal agent operations (FA Operations) were used to forecast expenditures through The team leveraged cost data from both the CMS-published Medicaid Budget and Expenditures System (MBES) and the State s internal CMS quarterly submissions. The Kaiser Family Foundation site, was the source for beneficiary and the Affordable Care Act (ACA) population estimates and projections were made with the assumption that no Medicaid expansion under ACA will occur in Florida. MBES information provided gross amount data for DDI and Maintenance and Operations across various levels of federal financial participation for the years Prior period adjustment and base form detail from CMS line items for the years provided the opportunity to carve out expenditures specific to FMMIS and FA operations. Kaiser provided actual beneficiary counts up to 2011 with projections for 2014 and 2022 to include ACA expansion population. The number of beneficiaries in between 2011 and 2020 was estimated assuming that no ACA expansion using linear interpolation, which is a method of constructing new data points within the range of a discrete set of known data points. Page 29 of 67

34 Detailed invoice and advance planning document (APD) information was used to determine which CMS line items (beyond FMMIS maintenance and operations) contribute to FA Operations costs. In addition, this information was used to determine the FA Operations amounts to be carved out of the All Other FFP line item in reporting expenditures. With respect to financial performance, the Enhance Existing option is estimated to have the least expense immediately, with a good return on investment (given even a slight increase in payment accuracy) and a competitive break-even year. This is because of the small initial investment The Off-the-Shelf-Complete Solution option has the highest DDI cost and provides the least return on investment, but has inherently less risk relative to return on investment. The Two-Phase Systems Integrator option is expected to have the highest return versus the other two alternatives. In terms of risk relative to return, it is significantly better than the other two options because the return will offset a significant portion of the implementation risk should it go over budget. 4.4 COMPARISON OF ALTERNATIVES AND RECOMMENDED SOLUTION Combining the qualitative alternative assessment and the financial performance analysis in the AAM provides the final combined scores. The qualitative assessment is worth 75% of the final score, and the financial performance is worth 25% of the final score. Exhibit 4-3: Summarized Score Combined Qualitative and Financial presents a summary qualitative analysis and combines the financial performance for the final composite scores. CRITERIA Flexibility Score (Weighted) Usability Score (Weighted) Delivery Time Score (Weighted) Delivery Risk Score (Weighted) Technology Score (Weighted) Feasibility Score (Weighted) TOTAL QUALITATIVE SCORE (WEIGHTED) Total Financial Performance TOTAL COMBINED SCORE (WEIGHTED) OFF THE SHELF TWO-PHASE ENHANCE COMPLETE SYSTEMS EXISTING SOLUTION INTEGRATOR Exhibit 4-3: Summarized Score Combined Qualitative and Financial The top three procurement options that resulted from the evaluation are: Page 30 of 67

35 The Two-Phase Systems Integrator Option received the highest qualitative score and provides the best financial performance of the three top-scoring options. The Enhance Existing System Option is the next alternative and provides similar financial performance and meets many of Florida s needs. The Off-the-Shelf Complete Solution Option is also a possible option, from a qualitative perspective, but financially may not perform as well as the other two alternatives. 4.5 SOLUTION CHOICE AND POTENTIAL ADVANTAGES The Agency will pursue a takeover of the FMMIS with upgrades and enhancements, as well as the full design, development, and implementation of a replacement DSS solution. The successful Vendor will serve as the systems integrator for this effort. This approach aligns most closely with the top ranked Two-Phase Systems Integrator Option. In the first phase, the Vendor will take over the existing FMMIS system and design, develop, and implement a targeted set of enhancements. Simultaneously, the Vendor will design, develop, and implement a replacement DSS. In the second phase a more long term timeframe set to occur over the life of the fiscal agent contract the Agency will work with the Vendor to replace system functionality with new, more modular components. Potential benefits and advantages of this approach include: Improved system flexibility Improved ease of use for all audiences, including providers, members, and internal users Low risk relative to overall return on investment Allows the Agency to take advantage of current and future technological innovations in a budget constrained environment The advantages of the FMMIS/FA and DSS solutions chosen by the Agency will be expanded upon following contract award. Page 31 of 67

36 SECTION 5 PROJECT MANAGEMENT PLAN The Project Management Plan summarizes the project activities, deliverables, and products; project organization; State and contractor resource needs; and anticipated system life. Any significant differences from the Project Management Plan submitted with the Planning APD should be explained. The basis for developing the Agency s FMMIS/FA/DSS Project Management Plan is centered on the preparation, maintenance, and use of quality deliverables to meet the requirements and expectations of the project s strategies and plans. The project will follow a well-structured, clearly defined project plan applied in a disciplined manner. A project team consisting of state and contract staff will employ industry standards and best practices for project management throughout the project life cycle. 5.1 PROJECT SCOPE This section of the Project Management Plan describes in narrative and graphics how and when the project activities will be conducted and sets forth the resulting project documentation and contractor deliverables. The purpose of this project is to successfully procure a vendor for the takeover, upgrade, and enhancement of Florida s existing MMIS, assumption of FA operations and the design, development, implementation, and operation of a replacement DSS. In order to meet the Agency s goals for this project, there are several high level objectives that must be met: 1. Effectively manage the FMMIS/FA/DSS Vendor for the duration of the project to ensure that all products and deliverables are completely in a timely manner and of acceptable quality. 2. Comply with the applicable federal guidelines in the timeframes required. 3. Complete the project within the agreed budget and timeframe. 4. Deploy a federally certifiable MMIS and DSS designed to operate a managed care centric system rather than a solely Fee-For-Service centric system. The Scope of Work (SOW) for this project will encompass all project activities related to both initiatives, ensuring along the way that they are MITA compliant and satisfy the design objectives as communicated in the CMS Seven Conditions and Standards. The SOW for both FMMIS/FA and DSS projects will be fully defined within the ITN. The FMMIS/FA and DSS efforts represent two distinct projects, and the activities and deliverables listed in the following subsections below reflect this; however, the Vendor may choose to combine certain activities and/or deliverables where it is efficient (e.g., Kickoff Meeting). The decision to combine specific activities and/or deliverables will be at the discretion of the Vendor and will be subject to Agency approval. The Agency executed contracts with contractors for research and planning activities, project management services, DDI support, and contract preparation and execution. The Agency plans to contract for IV&V services by August Page 32 of 67

37 5.1.1 FMMIS/FA PROJECT Overview The FMMIS/FA Project will be conducted in the following phases, which may be adjusted based on the successful Vendor s approved plan for these phases: Initiation During this phase, the foundation for the successful takeover of the FMMIS takeover and the design, development, and implementation of enhancements will be established. This phase also includes finalization and Agency approval of project management documents. The Initiation Phase is anticipated to run from January 1, 2017 through March 31, Takeover This phase will include all of the tasks to transition the FMMIS, operations and Fiscal Agent responsibilities to the new Vendor. These activities will occur simultaneously with the Design and Development of Enhancements Phase activities. During the Planning sub-phase, the Vendor will review the Takeover requirements as provided by the contract and conduct the necessary planning activities to make sure the project will be successfully executed. These planning activities will include developing requirements validation documents, technical design documents that define hardware and software specifications, data conversion and migration planning documents, and all necessary test plans. The incumbent Vendor will provide training to acclimate the staff of the new MMIS/FA Vendor to the HPES system installation. Many of the required plans will have been submitted with the contractor s original proposal and will only require updating to complete. Requirements included in the takeover of the current system that require minor changes or upgrades will have been identified and described in the ITN. The Transfer and Install sub-phase involves transferring the incumbent vendor s supporting data and procedures to the new Vendor and installing it on the Vendor s equipment in their data center. The transferred system must then be tested to ensure it is in an operational state. During the Data Management sub-phase, the Vendor will conduct data conversion and migration activities, testing, reporting, and training on a routine basis through the Implementation phase. During the Procedure Development and Documentation sub-phase, the Vendor will develop and/or update manual procedures and documentation as required by the contract. Required training of Agency staff and other stakeholders will also be developed and delivered during this phase. During the System Test and Evaluation sub-phase, the Vendor will conduct and document the results of testing of the transferred MMIS application. These testing phases will include Software Unit and Component Testing, Integration Testing, Functional Testing, System Performance Testing, System Stress Testing, Acceptance and Parallel Testing and End-to-end Page 33 of 67

38 Testing. The Vendor will correct deficiencies identified during testing, updating the system and user documentation During the Takeover Implementation sub-phase, the Vendor will ensure that all necessary tasks are completed to ensure a timely start of Fiscal Agent operations, including training of staff, providers, and users. The Takeover Phase is anticipated to run from March 1, 2017 through December 31, Design and Development of Enhancements After the contract execution, the Vendor provides a project plan for each of the FMMIS enhancements, giving a graphic overview of the timeline relationship of the design and development for each enhancement. The Agency is requesting a number of specific enhancements to the FMMIS to be developed prior to implementation of the DSS. All enhancement projects listed in this phase are mandatory. Planned major enhancements to the system include: Pharmacy Benefit Management Provider Enrollment and Management Enhanced Encounter Processing Rules The Design and Development of Enhancements Phase is anticipated to run from March 1, 2017 through December 31, Implementation The Vendor will begin Implementation Planning during which, the vendor will plan and prepare to assume all responsibilities of the Florida Medicaid Fiscal Agent contract as well as the planning to implement the takeover of FMMIS and all of the required enhancements and upgrades. This phase includes all of the testing and readiness activities necessary for the vendor to assume the full responsibility of FA activities. The Implementation Phase will end upon successful assumption of all fiscal agent responsibilities and resolution of startup issues. The Implementation Phase is anticipated to run from October 1, 2017 through August 1, The scheduled Go-Live date will be on or before July 1, 2018 with Implementation activities continuing for 30 (thirty) calendar days after day one of operations to resolve any remediation activities. Operations The Operations Phase constitutes all operations or production processing work required of the Vendor, and begins at the set point in time when the Vendor receives the first claim for production processing. Operations includes, but is not limited to, the processing of claims and encounters for payment, maintenance and/or upgrading of all components of the claims process system, and support of all elements of the provider relations operations. Page 34 of 67

39 The Operations Phase is anticipated to run from July 1, 2018 through the end of the contract on June 30, Federal Certification Federal certification of the FMMIS using the CMS MECT criteria is a mandated requirement. The Vendor, for the purpose of obtaining federal certification, must plan to cooperate fully with the Agency and its stakeholders, including all Medicaid Enterprise Vendors and sub- Contractors whose products and/or ancillary services interface with the FMMIS. Upon the contract effective date, the Vendor will be provided with updated information regarding the MITA SS-A, the Medicaid Enterprise Toolkit Checklists, and the MITA Traceability Matrix. These documents, all of which have been developed to reflect Floridaspecific business processes, mapped to specific solicitation document requirements, and included on the MITA Traceability Matrix for measurement and reporting purposes, will provide the information and tools necessary for the Vendor s development of processes to achieve CMS certification. While some certification activities will occur directly after the contract is signed, the primary tasks for the Federal Certification Phase are anticipated to run from January 1, 2018 through March, Turnover The Vendor must prepare for turning over responsibilities and operations at the end of the contract. The Vendor must cooperate with the successor fiscal agent, other Vendors, and the Agency in the planning and transfer of operations. The Vendor must dedicate special additional resources to this phase. This phase will begin about twelve months before the end of the contract period and end about six months after the end of the contract period, or as extended by the exercise of contract provisions or amendments to the contract. Turnover will consist of three sub-phases: Turnover Preparation Post-Turnover Support Transfer of Vendor Operations The Turnover Phase is anticipated to run from July 1, 2022 through December 31, Major Activities The Vendor shall set the schedule of major activities for Agency review during each phase in the work plan. All key dates are contingent upon Agency approval. All deliverables dates and key dates are contingent upon State approval. Exhibit 5-1: FMMIS/FA Project Major Activities below contains a general overview of the major activities to occur during each FMMIS/FA Project phase. Page 35 of 67

40 PHASE MAJOR ACTIVITY Contract Execution Initiation Kick-Off Meeting Operational Primary Project Site (temporary or permanent) Hardware and Equipment Installation Complete Software Installation Complete Takeover Data Management Conversion and Migration Start Takeover Testing Start Agency Approval Takeover Complete Approved Requirements Validation Document Approved Enhancement Data Conversion and Migration Plan Design and Development of Enhancements Data Conversion Tools in Place Approved Enhancement Test Management Plan Testing Environment Ready and Loaded with Data Reviewed Test Results Final Enhancement Reports Data Conversion and Migration Completed Training Completed Implementation User Acceptance Testing Completed Operational Readiness Testing/Submitted Letter of Readiness to Agency Go Live/Day One of Operations Operations Submission of Pre-Operations Deliverables Delivery of CMS Certification Management Plan, including Schedule of Activities Delivery of the completed MECT checklists and supporting documentation. Delivery of CMS Certification Readiness Testing Results Federal Certification Delivery of the Certification Readiness Letter to Agency Pre-Certification meeting with CMS Completion of the CMS Certification Review Vendor completion of any remediation activities Final Certification of the FMMIS Agency approval of Turnover Plan Turnover Agency approval of FMMIS requirement statement Completion of Turnover training Page 36 of 67

41 PHASE Completion of Turnover phase MAJOR ACTIVITY Exhibit 5-1: FMMIS/FA Project Major Activities Deliverables The Vendor shall set the schedule of dates for submittal of major deliverables for Agency review during each phase in the work plan. All deliverables dates and key dates are contingent upon Agency approval. Exhibit 5-2: FMMIS/FA Project Deliverables below contains a general overview of the deliverables associated with each FMMIS/FA Project phase. PHASE DELIVERABLE Project Charter Project Management Plan Project Work Schedule and Work Breakdown Structure Staffing Management Plan Subcontractor Management Plan Initiation Quality Management Plan Security Management Plan Facilities and Equipment Management Plan Hardware and Software Management Plan Configuration Management Plan Business Process Management Plan Primary Project Site Requirements Validation Document Technical Design Document Hardware and Equipment Acquisition and Installation Plan Hardware/Software Inventory Takeover Software Installation Plan Deliverable Takeover Data Management Plan Takeover Data Management Balancing Reports Takeover Test Plan Takeover Test Results Agency Approval Takeover Complete Design and Development of Enhancements Requirements Validation Documents for Pharmacy Benefit Management Requirements Validation Documents for Provider Enrollment and Management Page 37 of 67

42 PHASE DELIVERABLE Requirements Validation Documents for Enhanced Encounter Processing Rules Business Design Document for Pharmacy Benefit Management Business Design Document for Provider Enrollment and Management Business Design Document for Enhanced Encounter Processing Rules Technical Design Document for Pharmacy Benefit Management Technical Design Document for Provider Enrollment and Management Technical Design Document for Enhanced Encounter Processing Rules Enhancement Data Management Plan Enhancement Data Management Balancing Reports Enhancement Test Management Plan Enhancement Test Results Final Enhancement Completion Report for Pharmacy Benefit Management Final Enhancement Completion Report for Provider Enrollment and Management Final Enhancement Completion Report for Enhanced Encounter Processing Rules Detailed Implementation Plan Disaster Recovery and Business Continuity Plan Comprehensive Test Management Plan Implementation Comprehensive Data Management Plan Comprehensive Training Plan Special Contingency Plan Operational Readiness Letter Approved Post Implementation Evaluation Report Quality Assurance Procedures and Standards Manual Communications Plan Weekly Status Reporting Operations Training Plan Staffing Management Plan Documentation Management Plan Monthly Report Card CMS Certification Management Plan Federal Certification CMS Certification Readiness Plan Completed MECT Checklists and Supporting Documentation Page 38 of 67

43 PHASE DELIVERABLE CMS Certification Readiness Testing Results CMS Certification Readiness Letter Turnover Plan FMMIS requirement statement Turnover Financial Reconciliation Report FMMIS software, files, and system, and user and operations documentation in hard and soft copy format Turnover Results Report Exhibit 5-2: FMMIS/FA Project Deliverables DSS PROJECT Overview The DSS Project will be conducted in the following phases: Initiation During this phase, the foundation for successful design, development and implementation should be established for the DSS Project. This phase also includes finalization and Agency approval of project management documents. The Initiation Phase is anticipated to run from January 1, 2017 through March 31, Design and Development The Agency is requesting a number of specific design and development activities prior to implementation of the DSS. All design and development activities listed in this phase are mandatory. The Vendor will provide a mature and accessible product, including commercial-off-the-shelf (COTS) products where appropriate, that addresses the data conversion requirements with one comprehensive tool suite and that also interfaces with agencies, departments, and divisions. The product shall be configurable and interface with complex data navigation and manipulation tools, and support an advanced decision support dashboard and predictive modeling and analytics. The Vendor will also develop and deliver user training to educate the Agency on the new tools and the processes for transitioning their existing work to the new system. In addition to general enhancements to the DSS, the Agency requires the following features that include: Encounter Data Use Federal Financial Reporting Quality Reporting Page 39 of 67

44 The Design and Development Phase is anticipated to run from March 1, 2017 through June 30, Conversion The Vendor will provide the planning, development, testing, and coordination of all data and file conversions required to support the operation of the replacement DSS system. This will include a Conversion Plan that includes: narratives and diagrams of the enterprise data models (including logical and physical), metadata, data dictionaries, and pre-configured business rules for computing environment initialization. The information architecture may include files, databases, repositories, operational data stores, reporting repositories, parameter files, reference files, and reference information. The Vendor will identify and secure the legacy systems data, data definitions, conversion rules, and migration approaches best suited to initialize and populate the Vendor s project components architectures. The Vendor will assume responsibility for all legacy system data, data definitions, data cleansing, and data migrations based upon the requirements set forth to the Agency. The Vendor s planned data conversion and migration activities will be documents, reviewed, and communicated to the Agency for approval as the requirements for a nondisruptive transition. The Conversion Phase is anticipated to run from August 1, 2017 through January 31, Testing The Vendor s testing methodology and approach for validating and verifying the DSS in accordance with the test plan approved as part of the Project Plan will include: A testing system that meets all detailed requirements presented in the ITN Test cases and scripts A dedicated test environment that will be developed and maintained A dedicated User Acceptance Testing (UAT) test environment that will be developed and maintained A Testing Summary Report Their testing approach will include: System Testing Interface Testing Performance/Volume Testing Parallel Testing Security and Confidentiality Testing User Acceptance Testing (UAT) Page 40 of 67

45 The Vendor s approach will describe the methodology to be used for measuring the successful execution of all testing, including the approach to retesting in situations where initial tests fail, and how the system is tested and monitored through the equivalent of at least three (3) consecutive months of successful load, validation and reconciliation cycles. The approach will include how the results are jointly reviewed between the Vendor and the Agency, how the criticality of defects is ranked, and how the Vendor plans to support the Agency during UAT. The Vendor s approach will also describe the Test Summary that is provided to the Agency prior to each phase of Testing. Components of the Test Summary will include: Confirmation that all earlier testing has been performed in accordance with the approved Test Plan. Documentation that the test environment has been loaded with test data. Confirmation that all defects discovered in previous testing and ranked as critical are resolved to the best of the Vendor s knowledge. The methodology for documenting and ranking defects and deficiencies discovered during Testing. The process for updating and finalizing the Test Summary prior to moving onto the next phase of Testing. Documented final testing results The Testing Phase is anticipated to run from August 1, 2017 through January 31, Implementation Upon receipt of the Contract Execution, the Vendor will begin Implementation planning during which the Vendor will plan and prepare to assume all responsibilities of the Florida DSS required by the procurement. The Implementation Phase will end upon successful assumption of all DSS responsibilities and resolution of startup issues. The Implementation Phase is anticipated to run from October 1, 2017 through August 1, The scheduled Go-Live date will be on or before July 1, 2018 with Implementation activities continuing for 30 (thirty) calendar days after day one of operations to resolve any remediation activities. Operations The Vendor must host, operate, maintain, and enhance the DSS and execute all responsibilities described in the procurement until each function is turned over to the successor Vendor at the end of the contract, including any optional additional periods or extensions. The Agency requires that the Vendor provide suitably qualified personnel resources and any software necessary to support the production and operation of the DSS and also meet performance requirements and performance standards described in the ITN. The Operations Phase is anticipated to run from July 1, 2018 through the end of the contract on June 30, Page 41 of 67

46 Federal Certification Federal Certification of the DSS using the CMS MECT criteria is a mandated requirement. Federal Certification of the DSS will be conducted as a single operation, as a series of computing platforms operating seamlessly within the Agency s designated computing environments. The Vendor, for the purpose of obtaining Federal Certification, will cooperate fully with the Agency and its stakeholders, including all Medicaid Enterprise Vendors and sub- Vendors whose products and/or ancillary services interface with the DSS. The Federal Certification Phase is anticipated to run from January 1, 2018 through March, Turnover The Vendor will prepare for turning over responsibilities and operations at the end of the contract. The Vendor will cooperate with the successor Vendor, other Vendors, and the Agency in the planning and transfer of operations. The Vendor will dedicate special additional resources to this phase. This phase will begin twelve (12) months before the end of the contract period and end six (6) months after the end of the contract period, or as extended by the exercise of contract provisions or amendments to the contract. The Turnover Phase is anticipated to run from July 1, 2022 through December 31, Major Activities The Vendor shall set the schedule of major activities for Agency review during each phase in the work plan. All key dates and deliverables are contingent upon Agency approval. Exhibit 5-3: DSS Project Major Activities below contains a general overview of the major activities to occur during each DSS Project phase. PHASE Initiation Contract Execution Kick-Off Meeting Project Charter MAJOR ACTIVITY Operational Primary Project Site (temporary or permanent) Vendor Temporary Office Space Approval of the Management Plan Completion of Requirements Validation Document Completion of Business Design Document Design and Development Completion of Detailed System Design Document Completion of Architectural Design Document Completion of Enterprise Data Model Completion of System Documentation Delivery Page 42 of 67

47 PHASE Conversion Plan MAJOR ACTIVITY Conversion Testing Conversion Results Final Conversion Report at Implementation Balancing Report A test system environment ready to be used for testing prior to commencement of system testing A UAT environment ready to be used for UAT and fully loaded with current production data prior to the commencement of UAT Conduct Agency and UAT Vendor training for DSS prior to UAT Test scripts and cases prior to commencement of each phase of testing An initial Test Summary at the conclusion of each phase of testing A final Test Summary prior to commencement of implementation readiness activities Agency approval of the Detailed Cutover Plan and Schedule Agency approval of Contingency Plan Implementation Agency approval to begin Operations Monitor & Measure System Assumption of Operations Phase Agency approval of Post Implementation Evaluation Report Operations Start Up Deliver Updated Communication Plan for Review and Approval Deliver Operational Training Plan for Review and Approval Operations Deliver Data and Document Management Plan for Review and Approval Deliver System Modification Plan for Review and Approval Execute Initial Weekly Reports for Review and Approval Deliver Annual White-Paper for Review and Approval Delivery of CMS Certification Management Plan, including Schedule of Activities Day One (1) of Operations Delivery of the completed MECT checklists and supporting documentation Delivery of CMS Certification Readiness Testing Results Federal Certification Delivery of the Certification Readiness Letter to Agency Pre-Federal Certification meeting with CMS Completion of the CMS Certification review Vendor completion of any remediation activities Final Certification of the DSS Page 43 of 67

48 PHASE Turnover MAJOR ACTIVITY Agency approval of Turnover Plan Agency approval of DSS Resource Requirement Statement Completion of Turnover training Completion of Turnover Exhibit 5-3: DSS Project Major Activities Deliverables The Vendor shall set the schedule of dates for submittal of major deliverables for Agency review and approval during each phase in the work plan. Exhibit 5-4: DSS Project Deliverables below contains a general overview of the deliverables associated with each DSS Project phase. PHASE DELIVERABLE Kickoff Meeting Project Charter Certification letter that a Project Management Office (PMO) has been established per the DED. Project Management Plan Project Work Schedule and Work Breakdown Structure Staffing Management Plan Subcontractor Management Plan Initiation Quality Management Plan Security Management Plan Facilities and Equipment Management Plan Hardware and Software Management Plan Configuration Management Plan Business Process Management Plan Operational Primary Project Site Vendor Temporary Office Space Setup Detailed Management Plan to include a Detailed Schedule and Work Breakdown Structure (WBS) Requirements Validation Document (RVD) Design and Development Business Design Document (BDD) Detailed System Design Document (DSD) Architectural Design Document (ADD) Enterprise Data Model (EDM) Page 44 of 67

49 PHASE Conversion System Documentation Data Conversion Plan (DCP) Balancing Reports Final Conversion Report DELIVERABLE Comprehensive System Testing Plan and Summary Deliverables Comprehensive Interfaces Testing Plan and Summary Deliverables Comprehensive Performance Testing Plan and Summary Deliverables Testing Implementation Comprehensive Parallel Testing Plan and Summary Deliverables Comprehensive Security and Confidentiality Testing Plan and Summary Deliverables Comprehensive User Acceptance Testing Plan and Summary Deliverables Conduct a capacity analysis of the traffic the system can handle and still meet performance requirements Detailed Cutover Plan and Schedule Contingency Plan Post Implementation Evaluation Report Communication Plan Operations Training Plan Data and Document Management Plan System Modification Plan CMS Certification Management Plan CMS Certification Readiness Plan Federal Certification Completed MECT Checklists and Supporting Documentation CMS Certification Readiness Testing Results CMS Certification Readiness Letter Turnover Plan DSS Resource Requirement Statement Turnover Financial Reconciliation Report DSS software, files, and system, and user and operations documentation in hard and soft copy format Turnover Results Report Exhibit 5-4: DSS Project Deliverables Page 45 of 67

50 5.2 PROJECT ORGANIZATION AND RESOURCES The State's project organization is described in overview in terms of staff, responsibility, and relationships. The project organization, preferably shown by organization chart: Identifies the project manager and other key staff by name and title Identifies the relationship of the project team to the project steering committee (if applicable) Identifies interrelationships with user groups and contractors. A common understanding of the project organization, governance, and resources is a key component of effective project management. This purpose of this section is to provide a high level overview of the project structure and framework for providing overall control and direction setting for the Project PROJECT ORGANIZATION CHART Exhibit 5-5: SI/FMMIS/FA/DSS Project Organization Chart represents the Agency staff, Agency external stakeholders and the contractors currently planned for the SI/FMMIS/FA/DSS Project. Centers for Medicare and Medicaid Services (CMS) Independent Verification & Validation MES Governance Committee MES Steering Committee Executive Sponsor MES Project Governance MMIS State Management Team MMIS Project Consulting Teams External Stakeholders Project Sponsor Agency External Stakeholders Project Director Project Admin Project Advisors Subject Matter Expert (S.M.E.) Leads MITA MOD I Lead Contract Management, Training (LMS), Field Reps. Deputy Project Director Project Management Office Design, Development & Implementation (DDI) MITA MOD II Lead MITA MOD V Lead Research & Planning MITA MOD III Lead MITA MOD VI Analyst MITA Coordination MITA MOD IV Lead MITA MOD VII Lead Security Coordination MITA MOD VIII Lead Exhibit 5-5: SI/FMMIS/FA/DSS Project Organization Chart Page 46 of 67

51 Key state staff overseeing the projects are: Executive Sponsor: David Rogers AHCA Assistant Deputy Secretary for Medicaid Operations Mr. Rogers has nearly 12 years of experience with State Medicaid Agencies, and 20 years of experience working on Medicaid-related implementation projects. Mr. Rogers served as an Executive Sponsor for the Idaho Medicaid MMIS Replacement Project from Project Sponsor: Gay Munyon Bureau Chief, Medicaid Fiscal Agent Operations Ms. Munyon has worked for AHCA for two years, and has 16 years of experience working on a variety of Medicaid-related implementation projects. Additionally, Ms. Munyon served as the Economic Self-Sufficiency Director of the Florida Department of Children and Families from Ms. Munyon served as the vendor s Executive Program Director for the District of Columbia, leading the DC MMIS replacement project from Project Director: Angela Ramsey Senior Management Analyst Supervisor Ms. Ramsey has been with AHCA for 36 years, and has 18 years of experience working on Medicaid-related implementation projects, including the most recent MMIS/DSS implementation. Ms. Ramsey served as the Project Director for the ICD-10 Transition from Deputy Project Director: Terri Fuller Procurement Unit, Medicaid Fiscal Agent Operations Ms. Fuller has been with AHCA for nearly 30 years, and has 15 years of experience working on a variety of Medicaid-related implementation projects. Ms. Fuller served as the Project Director for the MMIS/DSS Electronic Health Record Pilot from PROJECT GOVERNANCE STRUCTURE Project governance is a framework for how decisions about the project will be made. Well defined governance is critical to project success in that it establishes the roles and responsibilities of all parties involved in the project and determines, in advance, clear decisionmaking processes and authority. As events unfold throughout the project lifecycle, there may be impacts to project scope, timeline, budget or quality that require decisions. Decision making authority is aligned with the severity and potential impact of the situation at hand. There are five tiers of governance. It is important to understand each tier s level of decision making authority and the resulting escalation path. This enables the team to move issues though the governance framework without jeopardizing scope, schedule, budget or quality of the overall project. The project governance organization structure has five decision-making tiers: Tier 1 SI/FMMIS/FA/DSS Project Management Team (PMT), comprised of the Project Director, Deputy Director and State Management and contractors team leads, including PMO, Research and Planning, IV&V, and SMEs Tier 2 Project Sponsor Tier 3 Executive Sponsor Page 47 of 67

52 Tier 4 Medicaid Enterprise Systems (MES) Steering Committee Tier 5 MES Governance Committee These tiers are further illustrated in Exhibit 5-6: SI/FMMIS/FA/DSS Project Governance Structure. Centers for Medicare and Medicaid Services (CMS) MES Governance Committee Tier 5 Tier 4 Tier 3 Tier 2 MES Governance Committee MES Steering Commitee Executive Sponsor Project Sponsor Independent Verification & Validation MES Steering Committee Tier 1 PMT Project Director Project Management Team Other Other Project Teams & Stakeholders Executive Sponsor Project Sponsor Agency External Stakeholders Project Director Project Advisors Project Admin Subject Matter Expert (S.M.E.) Leads PM MITA MOD I Lead Contract Management, Training (LMS), Field Reps. Lead Deputy Project Director Project Management Office, PM Design, Development & Implementation, PM MITA MOD II Lead MITA MOD V Lead Research & Planning PM MITA MOD III Lead MITA MOD VI Lead MITA Coordination MITA MOD IV Lead MITA MOD VII Lead Security Coordination MITA MOD VIII Lead Exhibit 5-6: SI/FMMIS/FA/DSS Project Governance Structure The roles and responsibilities for the governance structure are as follows: Tier 1 - SI/FMMIS/FA/DSS Project Management Team (PMT): Comprised of the MMIS Project Director, Deputy Director, and contractor Team Leads. The PMT will work throughout the term of the project to monitor and control project performance and will coordinate, as needed, with other Agency staff, state agencies, the legislature, and federal Medicaid administrators to provide input to decision making, contribute to project work products, and perform departmental planning, management, and coordination with regard to this project. Escalation: The Project Director will have authority for Tier 1 decision making. The Project Director will work with the PMT for Low priority/impact items. Low Page 48 of 67

53 priority refers to items that do not impact critical path items, key deliverables, scope, functionality or budget. Tier 2 - Project Sponsor: The Project Sponsor has project ownership and provides guidance on the project activities throughout the duration of the project. The Project Sponsor keeps abreast of major project activities, and is a decision-maker for the project. The Project Sponsor will also resolve major issues, problems, and policy questions, and review major deliverables. Escalation: Project Sponsor with guidance from the PMT for Medium priority/impact items. Medium priority refers to items that do not materially impact major issues, problems, and policy questions. Tier 3 - Executive Sponsor: The Executive Sponsor will provide leadership and guidance on the overall strategic direction of the project and has overall programmatic responsibility for the successful development and implementation of the project. The Executive Sponsor is ultimately responsible for securing spending authority and resources for the project. Escalation: Executive Sponsor for High priority/impact items. High priority items impact critical path, key deliverables, scope, functionality, or budget. Tier 4 - AHCA MES Steering Committee: The Agency s MES Steering Committee will provide overall guidance and direction to ensure the project achieves the business objectives for scope, time and budget. The Steering Committee decides when issues and decisions require escalation to the MES Governance Committee with a recommended approach for resolution. Escalation: MES Steering Committee for items regarding schedule, scope, or budget that necessitates a contractual change and, contingent upon these, for determining whether to proceed with any major project deliverable. Tier 5 AHCA MES Governance Committee: The Agency s MES Governance Committee will provide visionary and policy guidance to ensure project alignment with Agency-wide strategic policy and program initiatives. It has the authority to reset the direction of the project if deemed appropriate. The Governance Committee may make decisions without the recommendation of the Steering Committee if the circumstances require swift action. Escalation: MES Governance Committee for High priority/impact items regarding Federal, State and Agency legislation, policy and procedure that necessitate a change and or impact the critical path, key deliverables, scope, functionality or budget. In addition to the project governance structure, select teams of project stakeholders meet weekly to review and discuss the status of the project and individual project work streams. The status meeting members consider key issues and actions related to aligning project activities and mutually providing incentives to various stakeholders on the project to achieve the common goal of a quality and timely delivery of the solution. Timing for decision making is: Tier 1 escalations should be addressed at the working team level as a course of the normal day-to-day activities. Page 49 of 67

54 Tier 2 escalations should be addressed during the weekly project status meetings or as appropriate. Tier 3 escalations require action at the Executive Sponsor level, either immediately or as appropriate. Tier 4 escalations require action at the MES Steering Committee level as needed. Tier 5 escalations require action at the MES Governance Committee level as needed ROLES AND RESPONSIBILITIES OF KEY PROJECT GOVERNANCE ENTITIES Exhibit 5-7: Project Governance Roles and Responsibilities describes the roles and responsibilities for each Project governance entity. The table below includes the Project governance entities role and their associated responsibilities as part of the AHCA Medicaid Enterprise System governance and steering committees and the project management teams. ROLE RESPONSIBILITY ASSIGNED STAFF MES Governance Committee Provides visionary and policy guidance to ensure project alignment with agency-wide strategic policy and program initiatives Has the authority to reset the direction of the project if deemed appropriate Secretary, Agency for Health Care Administration Chief of Staff, Agency for Health Care Administration Deputy Secretary, Division of Medicaid Deputy Secretary, Division of Health Quality Assurance Director, Division of Information Technology General Counsel, General Counsel s Office Inspector General, Inspector General s Office Chief, Medicaid Fiscal Agent Operations Assistant Deputy Secretary for Medicaid Policy and Quality Assistant Deputy Secretary for Medicaid Operations Assistant Deputy Secretary for Medicaid Finance and Analytics Assistant Deputy Secretary, Division of Operations AHCA Administrator Project Director, MMIS/DSS/FA Procurement Project Page 50 of 67

55 ROLE RESPONSIBILITY ASSIGNED STAFF MES Steering Committee Executive Sponsor Project Sponsor Ensures the project meets the business objectives Provides management direction and support to the Project Management Team (PMT) Reviews and approves any changes to the project s scope, schedule and budget Reviews, approves and determines whether to proceed based on regular reporting Recommends project suspension or termination if it is determined the project will not meet its objectives Appoints the Project Management Team, which will work under the direction of the MES Steering Committee Provides overall project leadership and guidance in support of the overall strategic direction of the project Has compliance review and programmatic responsibility for successful development and implementation of the system Oversees budget and resources for the project Champions the project and legitimizes the project s goals and objectives Oversees major project activities, risks, and issues, and is final approver of all scope changes before MES Steering Committee review Secures spending authority and resources for the project Oversees all key areas of the project including but not limited to: budget, staffing, work assignments, vendor management, risk identification, and mitigation Resolves major issues, problems, and policy Approves scope changes for escalation Chief, Medicaid Fiscal Agent Operations Project Director, SI/FMMIS/FA/DSS Procurement Chief, Bureau of Strategic Information Technologies Administrator, Medicaid Third Party Liability Director, Budget Office Assistant Deputy Secretary for Medicaid Policy and Quality Assistant Deputy Secretary for Medicaid Operations Assistant Deputy Secretary for Medicaid Finance and Analytics Chief of Medicaid Plan Management Operations Chief, Bureau of Medicaid Policy Chief, Medicaid Quality Chief, Bureau of Medicaid Data Analytics Chief, Bureau of Medicaid Program Finance Chief of Medicaid Program Integrity Field Office Manager, Enrollment Broker Operations Deputy Director, SI/FMMIS/FA/DSS Procurement Project Senior Management Analyst Supervisor AHC Administrator Senior Management Analyst II Assistant Deputy Secretary for Medicaid Operations Chief, Medicaid Fiscal Agent Operations Page 51 of 67

56 ROLE RESPONSIBILITY ASSIGNED STAFF Project Management Team Project oversight and management Coordinates day-to-day project activities with the project team Deliverable reviews and approval recommendation Process and procedure knowledge sharing. Stakeholder coordination Risk and issue management, escalation, and resolution/mitigation Provides policy expertise Oversees project management processes, including: Time/schedule management Scope and requirements management Performance management Deliverable management Integration management Communications management Scope Change management Configuration management Document Management Status management and reporting Project Director Project Deputy Director IV&V Manager Project Manager, Project Management Office Project Manager, Research & Planning Team Lead, Organizational Change Management Project Manager, SME Leads Team Project Advisors Exhibit 5-7: Project Governance Roles and Responsibilities INTERNAL AND EXTERNAL STAKEHOLDERS Stakeholders are defined as key individuals or groups that will be impacted by or can impact a project. The stakeholders described in the following sections are either directly involved in the performance and/or outcomes of FMMIS/FA and DSS related programs, services, and/or business processes. Stakeholders, on an as needed basis, will be included in project communications of the PMO Vendor as well as the communications plan of the designated Organizational Change Management provider for the duration of the project. Agency for Health Care Administration The Agency is responsible for the administration of the Florida Medicaid program, licensure and regulation of Florida s health facilities, and for providing information to Floridians about the quality of care they receive. The Agency is the project and system owner. As a stakeholder group it is comprised of several stakeholder sub-groups. These include, but are not limited to the AHCA Governance Committee, the AHCA Steering Committee, and the various individuals who serve on these committees. Agency leadership and staff will be ultimately responsible for successful procurement, deployment and operation of the enhanced system and oversight of the fiscal agent and system maintenance and operations contractors. Exhibit 5-8: Agency Executive Structure illustrates the high level organizational and executive structure of the Agency: Page 52 of 67

57 Elizabeth Dudek Secretary Molly McKinstry Deputy Secretary Division of Health Quality Assurance Tonya Kidd Deputy Secretary Division of Operations Justin Senior Deputy Secretary Division of Medicaid Jenn Ungru Chief of Staff Stuart Williams General Counsel General Counsel s Office Eric Miller Inspector General Inspector General s Office Elizabeth Kidder Asst. Deputy Secretary Medicaid Operations Katherine Riviere Communications Director Stacy Lampkin Asst. Deputy Secretary Medicaid Finance Josh Spagnola Director Legislative Affairs Office David Rogers Asst. Deputy Secretary Medicaid Health Systems Scott Ward Director Division of Information Technology Major External Stakeholders Exhibit 5-8: Agency Executive Structure Exhibit 5-9: Major External Project Stakeholders lists the major external stakeholders that have been identified to-date, followed by a summarization of how each will be affected by, or will participate in, the SI/FMMIS/FA/DSS Project. MAJOR STAKEHOLDERS ROLE Department of Children and Families (DCF) Department of Health (DOH) Agency for Persons with Disabilities (APD) Department of Education (DOE) Vocational Rehabilitation (VR) Department of Elder Affairs (DOEA) Florida Healthy Kids (FHK) Veterans Affairs (VA) DCF is the agency responsible for determining eligibility for many of the state s public assistance programs, including Medicaid. DCF s Office of Economic Self Sufficiency and Office of Substance Abuse and Mental Health share data and multiple interfaces with AHCA. DOH is a provider of children s Medicaid related medical services and is responsible for licensing health care practitioners. County Health Departments are also providers of Medicaid related medical services. Among other information, DOH systems house immunization records of interest to the Medicaid program. There are numerous system interfaces and data exchanges between DOH and AHCA. APD supports individuals with developmental disabilities in living, learning, and working in their communities. They are a provider of Medicaid related medical services and a gateway into the Medicaid program. APD and AHCA share data and several system interfaces. In addition to its statewide education related responsibilities, DOE is a provider of school-based Medicaid related medical services. DOE shares data with AHCA. VR is administratively housed in the Department of Education and is a provider of Medicaid related medical services. DOEA plays a part in determining medical eligibility for long-term care clients. DOEA shares data and interfaces with AHCA and is a frequent user of DSS data. FHK is Florida s State Children s Health Insurance Program (SCHIP) organization and has a role in determining eligibility for non-medicaid children s insurance and medical assistance programs. FHK shares data and interfaces with AHCA. VA is a provider of nursing home Medicaid related medical services. At this time VA does not share any interfaces with AHCA, but does provide data to AHCA. Exhibit 5-9: Major External Project Stakeholders Page 53 of 67

58 5.2.4 PERSONNEL RESOURCE STATEMENT This section succinctly describes in narrative form the resource needs for which funding support may be requested by the State. These needs may relate to State and contractor staff costs, computer time, hardware and commercially available software, depreciation, travel, space, supplies, telephones, photocopying, office equipment, furniture, and so forth. This information serves as a narrative explanation of the budget (which is addressed in the next section of the Implementation APD). The budget presented in Section 6.2: Proposed DDI Period Budget is intended to provide for all funding needed by the project. This includes State staff salaries and benefits; project overhead including rent, supplies, communications, travel and training. In addition, it provides for contracted services support, including the DDI, IV&V, Subject Matter Expert Leads, and PMO vendors. 5.3 PROJECT SCHEDULE As previously mentioned in Section 5.1: Project Scope, the FMMIS/FA Project will be conducted in seven phases: Initiation Takeover Design and Development Implementation Operations Certification Turnover The DSS Project will be conducted in eight phases: Initiation Design and Development Conversion Testing Implementation Operations Certification Turnover While the start and ends dates for each phase will be specified by the Vendor, Exhibit 5-10: Project Timeline and Milestones below illustrates the general phase sequencing and overlap for each project and their respective project phases. Also included are three major milestones: Contract Execution, which occurs January 1, 2017; System Go Live, which occurs on July 1, Page 54 of 67

59 2018; and Contract End, which occurs on June 30, This timeline is purely notional pending the schedules proposed by the two Vendors. Following the awards, this timeline will be updated and resubmitted in an IAPD-U. Exhibit 5-10: Project Timeline and Milestones A detailed preliminary project schedule will be provided in Attachment D following award to the successful Vendor via an IAPD-U. The PMO schedule management process will be used to manage updates and changes to the master project schedule. 5.4 PERIOD OF USE This section describes the anticipated system life for the required resources, inclusive of planning, implementation, and operational phases. All new contracts resulting from this procurement will be in effect from the date of contract award through June 30, The state will consider the possibility and advantage of longerterm contracts based on optional extensions under good performance by the contractor(s). It will be the state s intent that resulting enhanced systems be durable and flexible enough to be transferred to successive vendors and have a useful life of ten to twenty years. Page 55 of 67