DEPARTMENT OF HUMAN RESOURCES MARYLAND HEALTH BENEFIT EXCHANGE DEPARTMENT OF HEALTH AND MENTAL HYGIENE. Panel Discussion.

Transcription

1 DEPARTMENT OF HUMAN RESOURCES MARYLAND HEALTH BENEFIT EXCHANGE DEPARTMENT OF HEALTH AND MENTAL HYGIENE Panel Discussion August 22, 2012

2 Maryland Approach to Health Insurance Exchange (HIX) Technology Enablement Phased Development Phase 1A MAGI Eligibility Determinations Phase 1B SHOP, Hosting, Operations, Call Center Phase 2 Non-MAGI Eligibility Determinations Phase 3 Social Services Programs (SNAP, TANF, etc.) COTS Based Solution Systems Integrator (Noridian Administrative Services) on-boarded in March Partners include COTS vendors and other specialized IT service providers: Social services eligibility, enrollment, and customer relationship management (Curam), Plan Management and online Plan Comparison and Enrollment (Connecture). Provides the robust operational, technical, and data management capabilities required by the State: Large scale social service technical and administrative management (Noridian), The EXACT Service Oriented Architecture (SOA) platform (Noridian), Integration with federal data hub and state eligibility sources (EngagePoint) Solution and licenses are extensible to later implementation phases: SHOP (Phase 1B), Non- MAGI determinations (Phase 2), & other social services (Phase 3) - 1 -

3 Exchange To-Be Architecture - 2 -

4 Exchange HIX System - 3 -

5 High Level Architectural Approach Architecture goals: Built-to-Last Platform and technology-agnostic Standards-based Built-to-Scale Multi-zoned deployment architecture Design with redundancy Built-to-Fit Separation of Concerns Loose-coupling Leverage SOA best practices - 4 -

6 Layered Architectural Approach - 5 -

7 Overall IT Governance Structure DOIT Elliott Schlanger Secretary DOIT Exchange Rebecca Pearce Exec. Director MHBE Secretaries and Leadership DHMH Joshua Sharfstein Secretary DHMH DHR Ted Dallas Secretary DHR MIA Therese Goldsmith Commissioner MIA Coordinating Committee DOIT Exchange DHMH DHR MIA TBD TBD Kevin Yang CIO Saleem Sayani CIO Kenyatta Powers A-CIO DHR TBD TBD Program Directors Program Directors Program Directors Program Directors Program Directors Core Team Supporting Team Sunny Raheja Program Manager IT Vendors and Projects - 6 -

8 IT Vendor Starts Complete Gap Analysis Start 2-path Sprint Approach Receive CMS Certification (Conditional) Complete all development Completed Tested System Start Enrollment Project Timeline and Milestone Update Following is illustration of the MD HIX Milestones and Timeline superimposed with bubbles on tasks / phases that have been completed until now. 1 st QTR 12 2 nd QTR 12 3 rd QTR 12 4 th QTR 12 1 st QTR 13 2 nd QTR 13 3 rd QTR 13 4 th QTR 13 CMS ELC Gate Reviews Planning Review Design Review Implement Review CMS ILC Gate Reviews DDR FDDR PORR ORR Validate Knowled ge Transfer Planning & Rqmt Artifacts NFRD Sprint Order Architect ure Plan COTS Demo Design Prioritize Rqmts & activities required for Certificat ion on 1/1/13 Implementation & Test Sprint Execution for requirements required for CMS Certification 1/1/13 Core Requirements Federal Requirements SP1 SP2 SP3 SP4 SP5 Non-Functional / Technical Requirement Development Architecture Development Certification Process Test Other Requirement Development State Requirements SP6 SP7 SP8 Integrated Testing End-to-End Testing, including: Functional and Technical Testing Deployment & Disposition Deployment to Production Training Fix any Production bugs, etc. Warrant / Maintena nce Key: DDR Detail Design Review; FDDR Final Detail Design Review; PORR Preliminary Operational Readiness Review; ORR Operation Readiness Review Complete

9 Building Blocks of Verification Following is a potential illustration of how the MD HIX State Data Services HUB will connect to all other State systems, MMIS and CARES. Additionally, it will also be the single connection point to Federal Data HUB, which in turn also serves as single integration point to all other federal sources and legacy state sources. State Boundary CURAM Eligibility & Enrollment CONNECTURE Plan Management SSA DHS EXACT State Data Services HUB Federal Data HUB MMIS CARES Other State Systems Other Federal Systems IRS Key: New State System Existing State System Not a State System State Boundary State Web Service Federal Web Service - 8 -

10 Example of Verification Minimum Essential Coverage This verification is performed to verify household is not getting dual benefit (Medicaid) coverage: S 1 2 State will use the MMIS to check if someone is currently receiving MA This verification will be done via a 270 transaction that is currently a batch process but can be turned into a real time web service. Analysis is underway. S 1 2 Minimum Essential Coverage process is triggered in Curam, flows through Exact (State HIX Data Services HUB) and then flows to the Federal Data HUB Data for MMIS is retrieved for the household (analysis for criteria to matching household member(s)). HIX is preparing for both the current and new MMIS interface. Other federal data sources Tricare, etc. are potential integration points

11 Tier 1 Reuse: Documents, Process and Knowledge Reusable Artifacts Research and Analyses Business Requirements Wire-Frames / Storyboards / Workflows Procurement-Related Documents Test Documents Project Management Documents Best Practices / Lessons Learned Mechanisms for Reuse Document Repositories CALT State to State collaborations

12 Maryland (short-list) of Artifacts on CALT Procurement Information: HIX Phase 1A RFP (Final) IV&V RFP (Final) SHOP Statement of Work (Draft) Requirements Artifacts: HIX BRD 2.0 SHOP BRD (Draft) Design Review Documentation Financial Disclosures Legal Authority Board & Governance Structure COI and Financial Disclosure process MHBE Bios MHBE Board Meeting agenda Stakeholder meeting agendas Call center information Navigator information Web site information Agents and Brokers Overview Web Brokers Navigator Advisory Committee Charter Continuity of Care Announcement Communication Plan Stakeholder Analysis Financing Committee Members Navigator Advisory Committee Agenda Navigator Advisory Committee Presentation MD Exchange Environmental Scan MHBE Brand Report Outreach Stakeholder Consultation Plan Stakeholder Analysis Overview Eligibility and Enrollment Overview PCIP Transition Plan Design Review (continued) Coordinating Committee Kick-Off Coordinating Committee Presentation HIX and Medicaid Interface Analysis Plan Management Authority Plan Certification Plan Management System Features and Functions Plan Management System Portal Screenshots Plan Management System Issuer Oversight Issuer Plan Management Screenshots Issuer Support Recertification Decertification Appeals and Decertification Accreditation Quality Reinsurance Exchange Organization and HR Exchange Organization Chart Exchange Accounting Procedures Exchange Finance and Accounting Technology Overview Change Management Plan Disaster Recovery Business Continuity Plan Business Rules Communications Matrix Data Conversion Plan Implementation Plan Interface Control Plan Performance Measurement Plan Testing Plan User Stories Database Design Document Data Management Plan Design Review (continued) System Design Document Project Schedule Quality Management Plan Risk Register Staffing Management Plan Training Plan Information Security Risk Assessment Privacy Impact Assessment System Security Plan Exchange Oversight Monitoring and Reporting Sprint 1 Test Script Testing Artifacts: Maryland Testing Strategy Test Plan Test Cases

13 Tier 2 Reuse: Code, Library, and Packages Framework for Technical Reuse Types of reusable technology: end-to-end systems, business services, standards-based interfaces, web services, source code, data models, data exchange formats, rule sets, product configurations Inventory of reusable technology including type, description, and appropriate usage Extensibility for new requirements Prerequisites and dependencies: specific COTS licenses and software, and underlying infrastructure requirements Mechanisms for Reuse? Memorandums of Understanding (MOU s) / Business Agreements / Contracts

14 Twelve Dimensions of Reuse System Architecture Functional Modules Enterprise Shared Services Informational Services Compliance High Availability and Scalability Presentation Layer Business Process Layer Business Service Layer Integration Layer Data Reporting Layer Quality of Service and Protection Layer

15 Questions?