Establishment Review Process
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1 Establishment Review Process DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS for MEDICARE & MEDICAID SERVICES Center for Consumer Information and Insurance Oversight Health Insurance Exchange System-Wide Meeting May 21-23, 2012
2 Objectives Review the Purpose of Establishment Reviews and Cross-Functional Team Participation Discuss the Linkages of Establishment Review to Enterprise Life Cycle (ELC) Gate Reviews Introduce the Establishment Review Evidence and Alignment to the Blueprint Detail the Evidence and Expectations for Design Reviews 2
3 Purpose of Establishment Reviews Establishment Reviews are intended to: Monitor progress to ensure a glide path to Exchange Approval Assess progress under the Establishment grant program leveraging the ELC Gate Review Provide feedback to States in a collaborative environment Review specific evidence to ensure that required Exchange activities operate effectively Identify State technical assistance follow up needs Required for all Establishment grantees and optional for non-grantees 3
4 Cross-Functional Team Participation in Reviews State Officer (Leads the Operational Subject Matter Experts * Establishment Review) o Eligibility and Enrollment CCIIO State Exchange Team o o Plan Management Financial Management Office of Information Systems o Consumer Support and Outreach Team * o Quality CMCS Team * o SHOP CMS Regional Staff * IRS and HHS * Team members will vary at each review depending on the required expertise 4
5 Establishment Review Process and Linkage to ELC Gate Reviews The Establishment Review Process aligns with CMS IT lifecycle requirements and is customized to incorporate an expedited review schedule with consultations to meet State needs for review and support 5
6 Establishment Review Framework The Establishment Review Framework is comprised of: Activities Evidence 6
7 Establishment Review and Exchange Blueprint Alignment Establishment Reviews are intended to serve as a glide path to Exchange Approval Establishment Review evidence (particularly Design Review evidence) is directly aligned to the requirements of the Exchange Blueprint If the State has successfully completed an activity as demonstrated through Establishment Reviews, State may waive out of submitting supporting documentation requested as part of Exchange Blueprint 7
8 Establishment Review #1 Planning Review Set the framework for future guidance and assessment of the State s progress Demonstrated State progress toward building the foundation and framework of the Exchange Focused on review of preliminary documentation (e.g., project management plan, concept of operations, architectural diagrams) The building block to establish ongoing dialogue and ramp to the next set of Reviews 8
9 Establishment Review #2 Design Review Entails assessment of Exchange activities on a modular basis in order to meet States where they are in the design phase of lifecycle may result in multiple Design Reviews or Consultations Involves review of operational and IT design documentation (e.g., business requirements, system design documentation, test plans) that address key Exchange activities Aligns with requirements set forth in the Exchange Blueprint 9
10 Design Review: Evidence/ Documents Requested Types of evidence/documents* requested for Design Review: Project Management documentation IT documentation Operational documentation Evidence/documents should be uploaded on Collaborative Application Lifecycle Tool (CALT) 2 weeks prior to Design Review: *See Overview of Documents Requested for Design Review handout for complete listing of documents *See Design Review Evidence handout for assessment criteria related to evidence/ documentation 10
11 Establishment Review #3 Implementation Review Will occur at the completion of development and implementation of the Exchange Will involve review of final evidence (e.g., testing summaries/results, standard operating procedures), which can exhibit an Exchange s operational readiness 11
12 Best Practices and Lessons Learned 12
13 Questions and Suggestions 13
14 If you have further questions, comments, concerns please reach out to: Sarah Summer, Susan Lumsden, or your State Officer 14
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