Exhibit 300 (BY2009) for Center for Medicare and Medicaid Services, Part B Claims Processing

1. Date of Submission:

2008-02-04

2. Agency:

009

3. Bureau:

38

4. Name of this Capital Asset:

CMS Part B Claims Processing

5. Unique Project Identifier:

009-38-01-02-01-1140-00

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?

FY2001 or earlier

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 Multi Carrier System (MCS) is a critical component of the Fee For Service (FFS) program, processing millions of Medicare claims a year, supporting Medicare's mission to provide quality health care to beneficiaries. The MCS software directly supports the PMA Improved Financial Performance, as it is an essential component for ensuring that accurate Part B payments are made for medically necessary services and are provided to eligible beneficiaries by qualified providers of care. The impact of not funding MCS would be detrimental to Medicare, causing harmful delays in processing/ payment of Part B claims, reducing the access, availability, and provision of health care services to Medicare beneficiaries. The MCS is one of the shared systems used to process Medicare Part B claims for physician care, durable medical equipment, and other outpatient services nationwide. It interfaces directly with the Common Working File (CWF) System for verification, validation, and payment authorization. Claims are entered, corrected, adjusted, or canceled. Inquiries for status of claims, additional development requests, or eligibility and various codes are processed. MCS meets CMS' core requirements for processing Medicare Part B claims, to include: data collection and validation, claims control, pricing, adjudication, correspondence, on-line inquiry, file maintenance, reimbursement, and financial processing. The FFS claims processing environment is distributed across four claims processing modules and one integrated testing module. The MCS has four quarterly releases that control, implement, and update software changes due to legislative mandates that dictate the amount of payment for services or coverage levels. Additionally, MCS must also implement changes needed to support the Medicare Administrative Contractor (MAC) authority for the Medicare FFS Program. Software changes for the claims processing operations are managed in quarterly releases developed through a change control process that begins with the Medicare Change Control Board (MCCB) review and prioritization of pending requests. The FFS Operations Board approves the quarterly releases with oversight by the FFS Governance Council and manages/integrates day-to-day operations of the FFS program across CMS. Error-free releases that implement legislative mandates with minimal interruption to processing ensure that beneficiaries receive the correct service and providers receive the correct payment.

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)?

no

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
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?)

The Part B claims processing system directly supports the PMA goal Improved Financial Performance by reducing erroneous payments through accurate and timely claims processing for millions of beneficiaries, increasing health care service availability/accessibility, and improving health care quality, safety, cost and value. This system is essential to ensure that accurate payments are made for only medically necessary services, provided to eligible beneficiaries by qualified providers of care.

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?

2003: CMS - Medicare Program

14.c. If yes, what rating did the PART receive?

Moderately 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	0
Software	0
Services	100
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	Director, Division of 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?

yes

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	15.564	15.919	9.750	20.743
Government FTE Cost	0.377	0.194	0.200	0.212
# of FTEs	4	2	2	2

2. Will this project require the agency to hire additional FTE's?

no

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	Health Care Administration	Cumulative variance in number of estimated hours vs actual hours for coding per release	5%	10%	5.7%
2	2006	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Cumulative percentage of release hours per problem	10%	1%	3.5%
3	2006	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within the specified time frame	4	4	4
4	2006	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Availability	Percentage that system is available for processing	96%	98%	98%
5	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Cumulative variance in number of estimated hours vs actual hours for coding per release	5.7%	10%	TBD
6	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Cumulative percentage of release hours per problem	3.5%	2%	TBD
7	2007	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within the specified time frame	4	4	TBD
8	2007	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Availability	Percentage that system is available for processing	98%	98%	TBD
9	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Cumulative variance in number of estimated hours vs actual hours for coding per release	TBD	8%	TBD
10	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Cumulative percentage of release hours per problem	TBD	2%	TBD
11	2008	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within the specified time frame	TBD	4	TBD
12	2008	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Availability	Percentage that system is available for processing	TBD	98%	TBD
13	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Cumulative variance in number of estimated hours vs actual hours for coding per release	TBD	8%	TBD
14	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Cumulative percentage of release hours per problem	TBD	2%	TBD
15	2009	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within the specified time frame	TBD	4	TBD
16	2009	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Availability	Percentage that system is available for processing	TBD	98%	TBD
17	2010	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Cumulative variance in number of estimated hours vs actual hours for coding per release	TBD	7%	TBD
18	2010	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Cumulative percentage of release hours per problem	TBD	2%	TBD
19	2010	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within the specified time frame	TBD	4	TBD
20	2010	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Availability	Percentage that system is available for processing	TBD	98%	TBD
21	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Cumulative variance in number of estimated hours vs actual hours for coding per release	TBD	7%	TBD
22	2011	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Cumulative percentage of release hours per problem	TBD	2%	TBD
23	2011	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within the specified time frame	TBD	4	TBD
24	2011	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Availability	Percentage that system is available for processing	TBD	98%	TBD
25	2012	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Cumulative variance in number of estimated hours vs actual hours for coding per release	TBD	6%	TBD
26	2012	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Cumulative percentage of release hours per problem	TBD	2%	TBD
27	2012	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within the specified time frame	TBD	4	TBD
28	2012	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Availability	Percentage that system is available for processing	TBD	98%	TBD
29	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Administration	Cumulative variance in number of estimated hours vs actual hours for coding per release	TBD	6%	TBD
30	2013	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Accuracy of Service or Product Delivered	Cumulative percentage of release hours per problem	TBD	2%	TBD
31	2013	S.O. 1.2 - Increase health care service availability and accessibility	Processes and Activities	Timeliness	Number of software releases implemented within the specified time frame	TBD	4	TBD
32	2013	S.O. 1.2 - Increase health care service availability and accessibility	Technology	Availability	Percentage that system is available for processing	TBD	98%	TBD

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 Part B claims Processing

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	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	25
2	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	25
3	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	50

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	Data Exchange	Service Interface and Integration	Integration	Enterprise Application Integration	Connect:Direct
3	Information Sharing	Component Framework	Data Interchange	Data Exchange	Connect:Direct, FTP File Transfer Protocol
4	Information Retrieval	Component Framework	Data Interchange	Data Exchange	Connect:Direct, FTP File Transfer Protocol
5	Data Exchange	Service Access and Delivery	Service Transport	Service Transport	File Transfer Protocol (FTP)
6	Information Sharing	Component Framework	Data Management	Database Connectivity	MDCN
7	Information Retrieval	Component Framework	Data Management	Database Connectivity	MDCN

6. Will the application leverage existing components and/or applications across the Government (i.e., FirstGov, Pay.Gov, etc)?

no

1. Does the investment have a Risk Management Plan?

yes

1.a. If yes, what is the date of the plan?

2007-06-07

1.b. Has the Risk Management Plan been significantly changed since last year's submission to OMB?

no

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 operational analysis was completed to validate that the project's principal goals were done in a timely manner and within budget. The systems continue to perform at an acceptable level for CMS users and contractors.

1.c. If no, please explain why it was not conducted and if there are any plans to conduct operational analysis in the future.

Not Applicable.