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Exhibit 300 (BY2009) - Centers for Medicare and Medicaid Services (CMS) Common Working File (CWF)

PART ONE


OVERVIEW


1. Date of Submission:
2008-02-04
2. Agency:
009
3. Bureau:
38
4. Name of this Capital Asset:
CMS Common Working File (CWF)
5. Unique Project Identifier:
009-38-01-02-01-1110-00
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 Common Working File (CWF) is a single data source for Fiscal Intermediaries and Carriers to verify beneficiary eligibility and conduct prepayment review and approval of claims from a national perspective. It is the only place in the fee for service (FFS) claims processing system where full individual beneficiary information is housed. CWF meets CMS' core requirements for claims processing: 1) beneficiary entitlement to Part A/B, 2) accurate deductible & coinsurance, 3) appropriate services, 4) benefits on the claim are available, and 5) Medicare Secondary Payer information is correct. CWF also performs limited part A/B crossover editing to insure services are not paid twice on different types of claims. CWF has four quarterly releases that control, implement, and update software changes due to legislative mandates. 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 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. The FFS claims processing environment is distributed across 4 claims processing modules and 1 integrated testing module. This investment also funds the Single Testing Contractor (STC), the only entity responsible for: 1) independently testing the base FFS shared systems and CWF, and 2) validating that Medicare requirements are correctly implemented. Testing is performed in an integrated, production-like environment allowing CMS to monitor and control system testing, costs, standardization, communication, and flexibility across systems. This investment directly supports the PMA Improve Financial Performance, as it is an essential component ensuring that accurate payments are made for medically necessary services and are provided to eligible beneficiaries by qualified providers of care. The impact of not funding CWF & STC would be detrimental to Medicare, introducing system errors, causing harmful delays in claims processing and payment, and reducing the access, availability, and provision of health care services to Medicare beneficiaries. 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.
no
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 CWF directly supports the PMA "Improve Financial Performance" because it is an essential component to ensuring that accurate payments are made for only medically necessary services and are provided only to eligible Medicare beneficiaries by qualified providers. CWF also is vital to minimizing fraud and abuse in the Medicare program and ensuring quality of care is provided to Medicare beneficiaries.
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%)
AreaPercentage
Hardware0
Software1
Services99
Other0
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.
NameMaribel Franey
Phone Number410-786-0757
TitleDirector, Division of Privacy Compliance
EmailMaribel.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 TypePy-1 & Earlier
-2006
PY
2007
CY
2008
BY
2009
Planning Budgetary Resources0.0000.0000.0000.000
Acquisition Budgetary Resources0.0000.0000.0000.000
Maintenance Budgetary Resources19.67419.24520.51937.592
Government FTE Cost2.5001.5000.5000.530
# of FTEs8455
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.
RowFiscal YearStrategic Goal SupportedMeasurement AreaMeasurement GroupingMeasurement IndicatorBaselinePlanned Improvement to the BaselineActual Results
12006S.O. 1.2 - Increase health care service availability and accessibilityMission and Business ResultsHealth Care AdministrationCumulative percentage of errors detected by testing contractor prior to release90%100%91%
22006S.O. 1.3 - Improve health care quality, safety, cost and valueCustomer ResultsAccuracy of Service or Product DeliveredAverage score of CWF Host Survey following a production release45 (scale of 1 to 5, 5 = excellent, 1 = failure)4.78
32006S.O. 1.2 - Increase health care service availability and accessibilityProcesses and ActivitiesTimelinessNumber of software releases implemented within the specified time frame4 of 44 of 44 of 4
42006S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recoveryTechnologyAccessibilityPercentage of system availability during processing hours96%98%98%
52007S.O. 1.2 - Increase health care service availability and accessibilityMission and Business ResultsHealth Care AdministrationCumulative percentage of errors detected by testing contractor prior to release91%100%TBD
62007S.O. 1.3 - Improve health care quality, safety, cost and valueCustomer ResultsAccuracy of Service or Product DeliveredCumulative percentage of release hours per problem4.785 (scale of 1 to 5, 5 = excellent, 1 = failure)TBD
72007S.O. 1.2 - Increase health care service availability and accessibilityProcesses and ActivitiesTimelinessNumber of software releases implemented within specified time frame4 of 44 of 4TBD
82007S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recoveryTechnologyAccessibilityPercentage of system availability during processing hours98%98.5%TBD
92008S.O. 1.2 - Increase health care service availability and accessibilityMission and Business ResultsHealth Care AdministrationCumulative percentage of errors detected by testing contractor prior to releaseTBD100%TBD
102008S.O. 1.3 - Improve health care quality, safety, cost and valueCustomer ResultsAccuracy of Service or Product DeliveredCumulative percentage of release hours per problemTBD5 (scale of 1 to 5, 5 = excellent, 1 = failure)TBD
112008S.O. 1.2 - Increase health care service availability and accessibilityProcesses and ActivitiesTimelinessNumber of software releases implemented within specified time frameTBD4 of 4TBD
122008S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recoveryTechnologyAccessibilityPercentage of system availability during processing hoursTBD98.5%TBD
132009S.O. 1.2 - Increase health care service availability and accessibilityMission and Business ResultsHealth Care AdministrationCumulative percentage of errors detected by testing contractor prior to releaseTBD100%TBD
142009S.O. 1.3 - Improve health care quality, safety, cost and valueCustomer ResultsAccuracy of Service or Product DeliveredCumulative percentage of release hours per problemTBD5 (scale of 1 to 5, 5 = excellent, 1 = failure)TBD
152009S.O. 1.2 - Increase health care service availability and accessibilityProcesses and ActivitiesTimelinessNumber of software releases implemented within specified time frameTBD4 of 4TBD
162009S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recoveryTechnologyAccessibilityPercentage of system availability during processing hoursTBD98.5%TBD
172010S.O. 1.2 - Increase health care service availability and accessibilityMission and Business ResultsHealth Care AdministrationCumulative percentage of errors detected by testing contractor prior to releaseTBD100%TBD
182010S.O. 1.3 - Improve health care quality, safety, cost and valueCustomer ResultsAccuracy of Service or Product DeliveredCumulative percentage of release hours per problemTBD5 (scale of 1 to 5, 5 = excellent, 1 = failure)TBD
192010S.O. 1.2 - Increase health care service availability and accessibilityProcesses and ActivitiesTimelinessNumber of software releases implemented within specified time frameTBD4 of 4TBD
202010S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recoveryTechnologyAccessibilityPercentage of system availability during processing hoursTBD98.5%TBD
212011S.O. 1.2 - Increase health care service availability and accessibilityMission and Business ResultsHealth Care AdministrationCumulative percentage of errors detected by testing contractor prior to releaseTBD100%TBD
222011S.O. 1.3 - Improve health care quality, safety, cost and valueCustomer ResultsAccuracy of Service or Product DeliveredCumulative percentage of release hours per problemTBD5 (scale of 1 to 5, 5 = excellent, 1 = failure)TBD
232011S.O. 1.2 - Increase health care service availability and accessibilityProcesses and ActivitiesTimelinessNumber of software releases implemented within specified time frameTBD4 of 4TBD
242011S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recoveryTechnologyAccessibilityPercentage of system availability during processing hoursTBD98.5%TBD
252012S.O. 1.2 - Increase health care service availability and accessibilityMission and Business ResultsHealth Care AdministrationCumulative percentage of errors detected by testing contractor prior to releaseTBD100%TBD
262012S.O. 1.3 - Improve health care quality, safety, cost and valueCustomer ResultsAccuracy of Service or Product DeliveredCumulative percentage of release hours per problemTBD5 (scale of 1 to 5, 5 = excellent, 1 = failure)TBD
272012S.O. 1.2 - Increase health care service availability and accessibilityProcesses and ActivitiesTimelinessNumber of software releases implemented within specified time frameTBD4 of 4TBD
282012S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recoveryTechnologyAccessibilityPercentage of system availability during processing hoursTBD98.5%TBD
292013S.O. 1.2 - Increase health care service availability and accessibilityMission and Business ResultsHealth Care AdministrationCumulative percentage of errors detected by testing contractor prior to releaseTBD100%TBD
302013S.O. 1.3 - Improve health care quality, safety, cost and valueCustomer ResultsAccuracy of Service or Product DeliveredAverage score of CWF Host Survey following a production releaseTBD5 (scale of 1 to 5, 5 = excellent, 1 = failure)TBD
312013S.O. 1.2 - Increase health care service availability and accessibilityProcesses and ActivitiesTimelinessNumber of software releases implemented within specified time frameTBD4 of 4TBD
322013S.O. 2.3 - Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recoveryTechnologyAvailabilityPercentage of system availability during processing hoursTBD98.5%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 Common Working File (CWF)
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.
RowAgency Component NameAgency Component DescriptionService TypeComponentReused Component NameReused UPIInternal or External Reuse?Funding %
1Information SharingDefines 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 ManagementInformation Sharing  No Reuse25
2Information RetrievalDefines the set of capabilities that allow access to data and information for use by an organization and its stakeholders.Knowledge ManagementInformation Retrieval  No Reuse25
3Data ExchangeDefines the set of capabilities that support the interchange of information between multiple systems or applications; includes verification that transmitted data was received unaltered.Data ManagementData Exchange  No Reuse50
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.
RowSRM Component>Service AreaService CategoryService StandardService Specification (i.e., vendor and product name)
1Data ExchangeComponent FrameworkData InterchangeData ExchangeConnect:Direct
2Information SharingComponent FrameworkData ManagementDatabase ConnectivityConnect:Direct
3Information RetrievalComponent FrameworkData InterchangeDatabase ConnectivityConnect:Direct
4Data ExchangeService Interface and IntegrationIntegrationEnterprise Application IntegrationConnect:Direct
5Information SharingComponent FrameworkData ManagementDatabase ConnectivityMedicare Data Center Network (MDCN)
6Information RetrievalComponent FrameworkData InterchangeDatabase ConnectivityMedicare Data Center Network (MDCN)
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?
2007-07-31
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?
Establishment of contract performance metrics to monitor effectiveness in meeting program objectives.
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.