| | Exhibit 300 (BY2009) - Centers for Medicare and Medicaid Services CMS, ICD-10 InitiativePART ONE
OVERVIEW
- 1. Date of Submission:
- 2008-02-04
- 2. Agency:
- 009
- 3. Bureau:
- 38
- 4. Name of this Capital Asset:
- CMS ICD-10 Initiative
- 5. Unique Project Identifier:
- 009-38-01-02-01-2110-00
- 6. What kind of investment will this be in FY2009?
- Full-Acquisition
- 7. What was the first budget year this investment was submitted to OMB?
- FY2009
- 8. Provide a brief summary and justification for this investment, including a brief description of how this closes in part or in whole an identified agency performance gap.
- The ICD-10 project supports the PMA initiative of improper payments. There is a critical need to move from the 28 year old ICD-9 coding system to ICD-10. Dramatic advances in medicine have occured for which ICD-9 codes are not specific enough to adequately capture diagnoses and the appropriate services delivered, there is a lack of space for expansion, an insufficient structure to capture new technology, and a lack of codes for preventative services. As a result, the potential exists for improper payments due to miscoding. A report by the National Committee on Vital and Health Statistics noted that there is a concern that the ICD-9-CM classification system may be stressed to a point where the quality of the system may soon be compromised. CMS predicts that at the current rate of adding new medical procedures, the healthcare industry will run of of ICD-9 procedure codes by 2009. CMS is requesting this funding to procure a project integrator for this project, perform a detailed impact analysis, develop the project documentation required to manage the project, make the necessary systems changes to incorporate ICD-10 codes into its business processes, and conduct the necessary outreach in order for Medicare providers and trading partners to be ready to submit the proper codes. This is a complex project and needs to be carefully phased to avoid negatively impacting current claims processing and other functions while these changes are made. A precurser to this project is 5010. 5010 is the HIPAA suite of transactions that must be updated in order to accomodate the ICD-10 code set. The goal of the ICD-10 project is to upgrade an existing code set. CMS is not building new systems but is making changes to data elements in approximately 20 existing systems including the Medicare FFS Claims Processing Systems. Once code conversion is completed this investement will be terminated and the maintenance of the codes will resume within the respective systems investments (Medicare FFS Claims Processing Part A, Part B, DMERC) according to the current maintenance schedule/process.
- 9. Did the Agency's Executive/Investment Committee approve this request?
- yes
- 9.a. If "yes," what was the date of this approval?
- 2007-06-26
- 10. Did the Project Manager review this Exhibit?
- yes
- 11.a. What is the current FAC-P/PM certification level of the project/program manager?
- TBD
- 12. Has the agency developed and/or promoted cost effective, energy-efficient and environmentally sustainable techniques or practices for this project.
- no
- 12.a. Will this investment include electronic assets (including computers)?
- yes
- 12.b. Is this investment for new construction or major retrofit of a Federal building or facility? (answer applicable to non-IT assets only)
- no
- 13. Does this investment directly support one of the PMA initiatives?
- yes
- If yes, select the initiatives that apply:
Initiative Name |
---|
Eliminating Improper Payments |
- 13.a. Briefly and specifically describe for each selected how this asset directly supports the identified initiative(s)? (e.g. If E-Gov is selected, is it an approved shared service provider or the managing partner?)
- ICD-10 provides a more robust, granular, modern, and accurate code set. ICD-10 will improve the quality of information reported on claims. This information will provide for more accurate payments and will improve quality monitoring, coverage, risk adjustment, research, and statistical reporting. We will not begin to realize the benefits from ICD-10 until FY 2012 when ICD-10 is implemented.
- 14. Does this investment support a program assessed using the Program Assessment Rating Tool (PART)?
- yes
- 14.a. If yes, does this investment address a weakness found during the PART review?
- yes
- 14.b. If yes, what is the name of the PARTed program?
- 2002: CMS - Medicare Integrity Program
- 14.c. If yes, what rating did the PART receive?
- Effective
- 15. Is this investment for information technology?
- yes
- 16. What is the level of the IT Project (per CIO Council's PM Guidance)?
- Level 3
- 17. What project management qualifications does the Project Manager have? (per CIO Council's PM Guidance)
- (2) Project manager qualification is under review for this investment
- 18. Is this investment identified as high risk on the Q4 - FY 2007 agency high risk report (per OMB memorandum M-05-23)?
- yes
- 19. Is this a financial management system?
- no
- 20. What is the percentage breakout for the total FY2009 funding request for the following? (This should total 100%)
Area | Percentage |
---|
Hardware | 0 | Software | 18 | Services | 82 | Other | 0 |
- 21. If this project produces information dissemination products for the public, are these products published to the Internet in conformance with OMB Memorandum 05-04 and included in your agency inventory, schedules and priorities?
- n/a
- 22. Contact information of individual responsible for privacy related questions.
Name | Maribel Franey | Phone Number | 410-786-0757 | Title | Privacy Officer | Email | maribel.franey@cms.hhs.gov |
- 23. Are the records produced by this investment appropriately scheduled with the National Archives and Records Administration's approval?
- yes
- 24. Does this investment directly support one of the GAO High Risk Areas?
- yes
SUMMARY OF SPEND
- 1. Provide the total estimated life-cycle cost for this investment by completing the following table. All amounts represent budget authority in millions, and are rounded to three decimal places. Federal personnel costs should be included only in the row designated Government FTE Cost, and should be excluded from the amounts shown for Planning, Full Acquisition, and Operation/Maintenance. The total estimated annual cost of the investment is the sum of costs for Planning, Full Acquisition, and Operation/Maintenance. For Federal buildings and facilities, life-cycle costs should include long term energy, environmental, decommissioning, and/or restoration costs. The costs associated with the entire life-cycle of the investment should be included in this report.
All amounts represent Budget Authority
Note: For the cross-agency investments, this table should include all funding (both managing partner and partner agencies).
Government FTE Costs should not be included as part of the TOTAL represented. Cost Type | Py-1 & Earlier -2006 | PY 2007 | CY 2008 | BY 2009 |
---|
Planning Budgetary Resources | 0.000 | 0.250 | 0.000 | 0.000 | Acquisition Budgetary Resources | 0.000 | 0.000 | 0.000 | 15.600 | Maintenance Budgetary Resources | 0.000 | 0.000 | 0.000 | 0.000 | Government FTE Cost | 0.000 | 0.000 | 0.000 | 1.550 | # of FTEs | 0 | 0 | 0 | 12 |
- 2. Will this project require the agency to hire additional FTE's?
- no
- 3. If the summary of spending has changed from the FY2008 President's budget request, briefly explain those changes.
PERFORMANCE In order to successfully address this area of the exhibit 300, performance goals must be provided for the agency and be linked to the annual performance plan. The investment must discuss the agency's mission and strategic goals, and performance measures (indicators) must be provided. These goals need to map to the gap in the agency's strategic goals and objectives this investment is designed to fill. They are the internal and external performance benefits this investment is expected to deliver to the agency (e.g., improve efficiency by 60 percent, increase citizen participation by 300 percent a year to achieve an overall citizen participation rate of 75 percent by FY 2xxx, etc.). The goals must be clearly measurable investment outcomes, and if applicable, investment outputs. They do not include the completion date of the module, milestones, or investment, or general goals, such as, significant, better, improved that do not have a quantitative measure.
- Agencies must use the following table to report performance goals and measures for the major investment and use the Federal Enterprise Architecture (FEA) Performance Reference Model (PRM). Map all Measurement Indicators to the corresponding Measurement Area and Measurement Grouping identified in the PRM. There should be at least one Measurement Indicator for each of the four different Measurement Areas (for each fiscal year). The PRM is available at www.egov.gov. The table can be extended to include performance measures for years beyond FY 2009.
Row | Fiscal Year | Strategic Goal Supported | Measurement Area | Measurement Grouping | Measurement Indicator | Baseline | Planned Improvement to the Baseline | Actual Results |
---|
1 | 2008 | S.O. 1.3 - Improve health care quality, safety, cost and value | Mission and Business Results | Health Care Administration | All available training materials analyzed to determine gaps | 10% | 100% | TBD | 2 | 2008 | S.O. 1.3 - Improve health care quality, safety, cost and value | Customer Results | Customer Training | All providers/vendors identified for training | 10% | 100% | TBD | 3 | 2008 | S.O. 1.3 - Improve health care quality, safety, cost and value | Processes and Activities | Costs | All cost estimates validated | 0% | 100% | TBD | 4 | 2008 | S.O. 1.3 - Improve health care quality, safety, cost and value | Technology | Data Standardization or Tagging | All systems analyzed for impact | 10% | 100% | TBD | 5 | 2009 | S.O. 1.3 - Improve health care quality, safety, cost and value | Mission and Business Results | Health Care Administration | % providers/vendors initiating systems analysis | 0% | 30% | TBD | 6 | 2009 | S.O. 1.3 - Improve health care quality, safety, cost and value | Customer Results | Customer Impact or Burden | % providers/vendors trained | 0% | 30% | TBD | 7 | 2009 | S.O. 1.3 - Improve health care quality, safety, cost and value | Processes and Activities | Risk | All components have identified key risks and mitigation strategies | 10% | 100% | TBD | 8 | 2009 | S.O. 1.3 - Improve health care quality, safety, cost and value | Technology | Data Standardization or Tagging | All systems documentation completed to prepare for changes | 0% | 100% | TBD | 9 | 2010 | S.O. 1.3 - Improve health care quality, safety, cost and value | Customer Results | Customer Training | % of providers/vendors trained | 30% | 50% | TBD | 10 | 2010 | S.O. 1.3 - Improve health care quality, safety, cost and value | Processes and Activities | Risk | All components are monitoring and readjusting risks on a weekly basis | 0% | 100% | TBD | 11 | 2010 | S.O. 1.3 - Improve health care quality, safety, cost and value | Technology | Data Standardization or Tagging | % of CMS systems ready for testing | 0% | 10% | TBD | 12 | 2010 | S.O. 1.3 - Improve health care quality, safety, cost and value | Mission and Business Results | Health Care Administration | % providers/vendors ready to submit ICD-10 codes | 0% | 10% | TBD | 13 | 2011 | S.O. 1.3 - Improve health care quality, safety, cost and value | Processes and Activities | Risk | All components are monitoring and readjusting risks on a weekly basis | 0% | 100% | TBD | 14 | 2011 | S.O. 1.3 - Improve health care quality, safety, cost and value | Customer Results | Customer Training | % providers/vendors trained | 50% | 95% | TBD | 15 | 2011 | S.O. 1.3 - Improve health care quality, safety, cost and value | Mission and Business Results | Health Care Administration | % providers/vendors ready to submit ICD-10 codes | 0% | 100% | TBD | 16 | 2011 | S.O. 1.3 - Improve health care quality, safety, cost and value | Technology | Data Standardization or Tagging | % of CMS systems ready for implementation | 35% | 95% | TBD | 17 | 2012 | S.O. 1.3 - Improve health care quality, safety, cost and value | Processes and Activities | Savings and Cost Avoidance | % of reduction in improper claims | 0% | 3% | TBD | 18 | 2012 | S.O. 1.3 - Improve health care quality, safety, cost and value | Technology | Data Standardization or Tagging | % of CMS systems ready for implementation | 95% | 100% | TBD | 19 | 2012 | S.O. 1.3 - Improve health care quality, safety, cost and value | Mission and Business Results | Help Desk Services | % of increase in provider inquiries due to coding questions | 0% | 5% | TBD | 20 | 2012 | S.O. 1.3 - Improve health care quality, safety, cost and value | Customer Results | Customer Training | % of identified providers/vendors trained | 95% | 100% | TBD |
Enterprise Architecture In order to successfully address this area of the business case and capital asset plan you must ensure the investment is included in the agency's EA and Capital Planning and Investment Control (CPIC) process, and is mapped to and supports the FEA. You must also ensure the business case demonstrates the relationship between the investment and the business, performance, data, services, application, and technology layers of the agency's EA. - 1. Is this investment included in your agency's target enterprise architecture?
- yes
- 2. Is this investment included in the agency's EA Transition Strategy?
- no
- 2.b. If no, please explain why?
- Investment identified after the most recent transition plan and will be included in the next release
- 3. Is this investment identified in a completed (contains a target architecture) and approved segment architecture?
- no
- 4. Identify the service components funded by this major IT investment (e.g., knowledge management, content management, customer relationship management, etc.). Provide this information in the format of the following table. For detailed guidance regarding components, please refer to http://www.whitehouse.gov/omb/egov/.
Component: Use existing SRM Components or identify as NEW. A NEW component is one not already identified as a service component in the FEA SRM.
Reused Name and UPI: A reused component is one being funded by another investment, but being used by this investment. Rather than answer yes or no, identify the reused service component funded by the other investment and identify the other investment using the Unique Project Identifier (UPI) code from the OMB Ex 300 or Ex 53 submission.
Internal or External Reuse?: Internal reuse is within an agency. For example, one agency within a department is reusing a service component provided by another agency within the same department. External reuse is one agency within a department reusing a service component provided by another agency in another department. A good example of this is an E-Gov initiative service being reused by multiple organizations across the federal government.
Funding Percentage: Please provide the percentage of the BY requested funding amount used for each service component listed in the table. If external, provide the funding level transferred to another agency to pay for the service. Row | Agency Component Name | Agency Component Description | Service Type | Component | Reused Component Name | Reused UPI | Internal or External Reuse? | Funding % |
---|
1 | Record Linking / Association | Defines the set of capabilities that support the correlation between logical data and information sets. | Records Management | Record Linking / Association | | | No Reuse | 25 | 2 | Information Sharing | Defines the set of capabilities that support the use of documents and data in a multi-user environment for use by an organization and its stakeholders. | Knowledge Management | Information Sharing | | | No Reuse | 15 | 3 | Information Retrieval | Defines the set of capabilities that allow access to data and information for use by an organization and its stakeholders. | Knowledge Management | Information Retrieval | | | No Reuse | 20 | 4 | Data Exchange | Defines the set of capabilities that support the interchange of information between multiple systems or applications; includes verification that transmitted data was received unaltered. | Data Management | Data Exchange | | | No Reuse | 25 |
- 5. To demonstrate how this major IT investment aligns with the FEA Technical Reference Model (TRM), please list the Service Areas, Categories, Standards, and Service Specifications supporting this IT investment.
FEA SRM Component: Service Components identified in the previous question should be entered in this column. Please enter multiple rows for FEA SRM Components supported by multiple TRM Service Specifications.
Service Specification: In the Service Specification field, Agencies should provide information on the specified technical standard or vendor product mapped to the FEA TRM Service Standard, including model or version numbers, as appropriate. Row | SRM Component | >Service Area | Service Category | Service Standard | Service Specification (i.e., vendor and product name) |
---|
1 | Data Exchange | Component Framework | Data Interchange | Data Exchange | Connect:Direct | 2 | Information Sharing | Component Framework | Data Interchange | Data Exchange | Connect:Direct | 3 | Information Retrieval | Component Framework | Data Interchange | Data Exchange | Connect:Direct | 4 | Data Exchange | Component Framework | Data Interchange | Data Exchange | FTP File Transfer Protocol | 5 | Information Sharing | Component Framework | Data Interchange | Data Exchange | FTP File Transfer Protocol | 6 | Information Retrieval | Component Framework | Data Interchange | Data Exchange | FTP File Transfer Protocol | 7 | Data Exchange | Component Framework | Data Management | Database Connectivity | Medicare Data Center Network (MDCN) | 8 | Information Sharing | Component Framework | Data Management | Database Connectivity | Medicare Data Center Network (MDCN) | 9 | Information Retrieval | Component Framework | Data Management | Database Connectivity | Medicare Data Center Network (MDCN) | 10 | Record Linking / Association | Component Framework | Data Management | Reporting and Analysis | Medicare Data Center Network (MDCN) |
- 6. Will the application leverage existing components and/or applications across the Government (i.e., FirstGov, Pay.Gov, etc)?
- yes
- 6.a. If yes, please describe.
- This investment leverages: Federal Health Architecture (FHA)
PART TWO
RISK You should perform a risk assessment during the early planning and initial concept phase of the investment's life-cycle, develop a risk-adjusted life-cycle cost estimate and a plan to eliminate, mitigate or manage risk, and be actively managing risk throughout the investment's life-cycle.
Answer the following questions to describe how you are managing investment risks. - 1. Does the investment have a Risk Management Plan?
- yes
- 1.a. If yes, what is the date of the plan?
- 2007-08-31
- 3. Briefly describe how investment risks are reflected in the life cycle cost estimate and investment schedule:
- While this investment is still in the planning stages, the cost estimates were developed based on input from experienced project managers whose areas will be affected by the implementation of ICD-10 codes. The project managers assumed low funding risks and applied inflationary factors to develop out year costs. A full risk analysis is under way which may impact cost estimates. Costs will be revisited once we have the complete results of the impact analysis.
COST & SCHEDULE
- 1. Does the earned value management system meet the criteria in ANSI/EIA Standard 748?
- yes
- 2. Is the CV% or SV% greater than ± 10%?
- no
- 3. Has the investment re-baselined during the past fiscal year?
- no
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