| | Exhibit 300 (BY2009) - Centers for Medicare and Medicaid Services CMS, Medicare Program Integrity (MIP)PART ONE
OVERVIEW
- 1. Date of Submission:
- 2008-02-04
- 2. Agency:
- 009
- 3. Bureau:
- 38
- 4. Name of this Capital Asset:
- CMS Medicare Integrity Program (MIP)
- 5. Unique Project Identifier:
- 009-38-01-06-01-1010-00
- 6. What kind of investment will this be in FY2009?
- Operations and Maintenance
- 7. What was the first budget year this investment was submitted to OMB?
- FY2003
- 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 MIP Systems investment is designed to eliminate improper payments and improve financial performance by taking advantage of e-government and other existing technological capabilities. MIP closes the performance gap in large part between paying Medicare claims efficiency and paying Medicare claims accurately. Without MIP CMS could not insure that critical program integrity safeguards were in place and would not have the capability to partner with other Federal agencies in efforts to identify fraud and abuse in CMS programs and assess the payment accuracy of the Medicare program through e-government and other technologies. MIP is an investment in the control phase of the CPIC life-cycle. MIP is comprised of the following components: Health Care Information Systems (HCIS) HCIS is a next-generation desktop tool for viewing summary information about Medicare claims utilization and enrollment data. It provides a wide variety of pre-defined summary views of CMS data. HCISMod helps users identify data trends and aberrations, perform comparisons and rankings. HCISMod is used primarily by OFM's Program Integrity Group, Program Safeguard Contracts, OIG, and DOJ for payment investigation issues. Provider Statistical & Reimbursement Report (PS&R) The PS&R Report is a key component in the Medicare payment cycle. It is the only tool used by Fiscal Intermediaries (FIs) to accumulate the statistical and reimbursement data applicable to the Medicare claims processed. It summarizes the claims processing activities and payments made to participating Medicare providers by fiscal intermediaries for all Medicate covered services. This PS&R data is subsequently utilized to effectuate final settlement of a provider's Medicare cost report. The PS&R Report summarizes these data on reports that are used by providers and FIs to complete key elements of the Medicare cost report. Limited Online Access System Currently, paid claims history (42 months) for seven Fiscal Intermediaries is consolidated in a DB2 UDB data warehouse deployed on Unix-based servers maintained in the Mutual of Omaha Data Center. The integrated JAVA client Decision Support Application (DSA) provides a user-friendly interface to the warehouse and includes security rules that limit user access to only their FI claims. This DSA application allows users to select required data elements to satisfy their informational requirements, with query results returned to users in a Microsoft Access database.
- 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.
- yes
- 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 | Expanded E-Government | Financial Performance |
- 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?)
- MIP Systems support the financial performance initiative by improving payment processes and preventing/detecting fraud/abuse. MIP enables CMS to insure critical program integrity safeguards are in place by providing systems to collect /tabulate savings and other measures, assist in reducing the Medicare payment error rate by identifying aberrant billing practices when they occur, and provide increased control over expenditures by consolidating/tabulating cost data.
- 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)
- (1) Project manager has been validated as qualified 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)?
- no
- 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 | 22 | Software | 34 | Services | 44 | 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?
- no
- 22. Contact information of individual responsible for privacy related questions.
Name | Maribel Franey | Phone Number | 410-786-0757 | Title | Director, Privacy Compliance | 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?
- no
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 | 0.000 | 0.000 | 0.000 | Acquisition Budgetary Resources | 0.000 | 0.000 | 0.000 | 0.000 | Maintenance Budgetary Resources | 28.162 | 10.546 | 19.095 | 20.618 | Government FTE Cost | 2.250 | 1.250 | 1.300 | 1.400 | # of FTEs | 32 | 16 | 16 | 16 |
- 2. Will this project require the agency to hire additional FTE's?
- no
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 | 2006 | S.O. 1.3 - Improve health care quality, safety, cost and value | Mission and Business Results | Payments | Improve financial performance by monitoring the percent of payment types covered | 50% | 75% | Percent of payment types covered is 75% | 2 | 2006 | S.O. 1.3 - Improve health care quality, safety, cost and value | Customer Results | Service Efficiency | Integrate budget and performance by measuring the percent of contractors using system | 0% | 18% | 18% | 3 | 2006 | S.O. 1.3 - Improve health care quality, safety, cost and value | Processes and Activities | Efficiency | Improve financial performance by measuring the percent of new contractors covered | 50% | 70% | 100% | 4 | 2006 | S.O. 1.3 - Improve health care quality, safety, cost and value | Technology | Compliance and Deviations | Expand e-government by measuring the percent of systems converted | 0% | 25% | 25% | 5 | 2007 | S.O. 1.3 - Improve health care quality, safety, cost and value | Mission and Business Results | Payments | Improve financial performance by monitoring the percent of payment types covered | 75% | 90% | TBD | 6 | 2007 | S.O. 1.3 - Improve health care quality, safety, cost and value | Customer Results | Service Efficiency | Integrate budget and performance by measuring the percent of contractors using system | 18% | 40% | TBD | 7 | 2007 | S.O. 1.3 - Improve health care quality, safety, cost and value | Processes and Activities | Efficiency | Improve financial performance by measuring the percent of new contractors covered | 70% | 90% | TBD | 8 | 2007 | S.O. 1.3 - Improve health care quality, safety, cost and value | Technology | Compliance and Deviations | Expand e-government by measuring the percent of systems converted | 25% | 50% | TBD | 9 | 2008 | S.O. 1.3 - Improve health care quality, safety, cost and value | Mission and Business Results | Payments | Improve financial performance by monitoring the percent of payment types covered | 90% | 95% | TBD | 10 | 2008 | S.O. 1.3 - Improve health care quality, safety, cost and value | Customer Results | Service Efficiency | Integrate budget and performance by measuring the percent of contractors using system | 40% | 90% | TBD | 11 | 2008 | S.O. 1.3 - Improve health care quality, safety, cost and value | Processes and Activities | Efficiency | Improve financial performance by measuring the percent of new contractors covered | 90% | 95% | TBD | 12 | 2008 | S.O. 1.3 - Improve health care quality, safety, cost and value | Technology | Compliance and Deviations | Expand e-government by measuring the percent of systems converted | 50% | 75% | TBD | 13 | 2009 | S.O. 1.3 - Improve health care quality, safety, cost and value | Mission and Business Results | Payments | Improve financial performance by monitoring the percent of payment types covered | 95% | 98% | TBD | 14 | 2009 | S.O. 1.3 - Improve health care quality, safety, cost and value | Customer Results | Service Efficiency | Integrate budget and performance by measuring the percent of contractors using system | 90% | 95% | TBD | 15 | 2009 | S.O. 1.3 - Improve health care quality, safety, cost and value | Processes and Activities | Efficiency | Improve financial performance by measuring the percent of new contractors covered | 95% | 98% | TBD | 16 | 2009 | S.O. 1.3 - Improve health care quality, safety, cost and value | Technology | Compliance and Deviations | Expand e-government by measuring the percent of systems converted | 75% | 90% | TBD | 17 | 2010 | S.O. 1.3 - Improve health care quality, safety, cost and value | Customer Results | Service Efficiency | Integrate budget and performance by measuring the percent of contractors using system | 95% | 98% | TBD | 18 | 2010 | S.O. 1.3 - Improve health care quality, safety, cost and value | Technology | Compliance and Deviations | Expand e-government by measuring the percent of systems converted | 90% | 95% | TBD | 19 | 2010 | S.O. 1.3 - Improve health care quality, safety, cost and value | Processes and Activities | Efficiency | Improve financial performance by measuring the percent of new contractors covered | 98% | 98% | TBD | 20 | 2010 | S.O. 1.3 - Improve health care quality, safety, cost and value | Mission and Business Results | Payments | Improve financial performance by monitoring the percent of payment types covered | 98% | 98% | TBD | 21 | 2011 | S.O. 1.3 - Improve health care quality, safety, cost and value | Mission and Business Results | Payments | Improve financial performance by monitoring the percent of payment types covered | 98% | 98% | TBD | 22 | 2011 | S.O. 1.3 - Improve health care quality, safety, cost and value | Processes and Activities | Efficiency | Expand e-government by measuring the percent of systems converted | 98% | 98% | TBD | 23 | 2011 | S.O. 1.3 - Improve health care quality, safety, cost and value | Technology | Compliance and Deviations | Expand e-government by measuring the percent of systems converted | 95% | 98% | TBD | 24 | 2011 | S.O. 1.3 - Improve health care quality, safety, cost and value | Customer Results | Service Efficiency | Integrate budget and performance by measuring the percent of contractors using system | 98% | 98% | 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?
- yes
- 2.a. If yes, provide the investment name as identified in the Transition Strategy provided in the agency's most recent annual EA Assessment.
- CMS Medicare Integrity Program (MIP) Systems. Renamed for FY08.
- 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 | Standardized / Canned | Defines the set of capabilities that support the use of pre-conceived or pre-written reports. | Reporting | Standardized / Canned | | | No Reuse | 10 | 2 | Ad Hoc | Defines the set of capabilities that support the use of dynamic reports on an as needed basis. | Reporting | Ad Hoc | | | No Reuse | 4 | 3 | Forensics | Defines the set of capabilities that support the analysis of physical elements using science and technology for investigative and legal purposes. | Analysis and Statistics | Forensics | | | No Reuse | 30 | 4 | Graphing / Charting | Defines the set of capabilities that support the presentation of information in the form of diagrams or tables. | Visualization | Graphing / Charting | | | No Reuse | 1 | 5 | Data Warehouse | Defines the set of capabilities that support the archiving and storage of large volumes of data. | Data Management | Data Warehouse | | | No Reuse | 10 | 6 | 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 | 10 | 7 | Loading and Archiving | Defines the set of capabilities that support the population of a data source with external data. | Data Management | Loading and Archiving | | | No Reuse | 20 |
- 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 | Forensics | Component Framework | Business Logic | Platform Independent | Excel, SAS, COGNOS | 2 | Graphing / Charting | Component Framework | Presentation / Interface | Static Display | Excel, SAS, COGNOS | 3 | Data Exchange | Service Access and Delivery | Delivery Channels | Intranet | Internet Explorer | 4 | Data Exchange | Service Access and Delivery | Access Channels | Web Browser | Internet Explorer | 5 | Data Exchange | Service Access and Delivery | Delivery Channels | Internet | Internet Explorer, Email | 6 | Data Exchange | Component Framework | Data Interchange | Data Exchange | Network Data Mover (NDM) | 7 | Standardized / Canned | Component Framework | Presentation / Interface | Content Rendering | ORACLE, DB2 | 8 | Data Exchange | Component Framework | Data Management | Database Connectivity | ORACLE, DB2 | 9 | Forensics | Component Framework | Data Management | Reporting and Analysis | ORACLE, DB2 | 10 | Data Warehouse | Service Platform and Infrastructure | Database / Storage | Database | SAS, COGNOS | 11 | Loading and Archiving | Service Platform and Infrastructure | Database / Storage | Database | SAS, COGNOS | 12 | Ad Hoc | Component Framework | Presentation / Interface | Dynamic Server-Side Display | SAS, Cognos |
- 6. Will the application leverage existing components and/or applications across the Government (i.e., FirstGov, Pay.Gov, etc)?
- no
PART THREE
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?
- 2006-12-01
- 1.b. Has the Risk Management Plan been significantly changed since last year's submission to OMB?
- no
COST & SCHEDULE
- 1. Was operational analysis conducted?
- yes
- 1.a. If yes, provide the date the analysis was completed.
- 2007-08-31
- What were the results of your operational analysis?
- The systems are performing as expected. Data that respondents input is generally (95% of submissions) on time. Reports the systems produce are generally meet program needs, and where reports do not meet user needs because of changing program needs, reports are modified to meet new needs. Costs are justified and do not exceed plans; in fact, costs are sometimes (10% of the time) below expectations because of improvements in contractor efficiency, acquisition of equipment, or quality of system equipment.
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