Transmittal Letter (rfp 1)

Phase 2: Remediation Strategies (RFP 3.2.3)

Overview

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  Commitment to NPI implementation
  
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  Funding for NPI implementation
  
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  Personnel resource management
  

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  IME will have created an enterprise structure for the Impact project.
  
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  Program use for provider identifiers will have been identified
  
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  The systems involved will have been inventoried
  
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  The applications for NPI assessment will have been identified
  

1. 
   The number of systems impacted by the use of provider identifiers
   
2. 
   The number of code lines impacted by provider identifiers
   
3. 
   The number of processes impacted by provider identifiers
   
4. 
   The scheduled maintenance/updating/elimination of the major systems involved
   
5. 
   The availability of IT maintenance staff employed by the client entity
   
6. 
   The IME response and remediation to manage HIPAA compliance for Transactions and Code Sets (e.g. system remediation, translator, other)
   
7. 
   Anticipation of additional remediation efforts related to National Plan ID, ICD-10, Medicare Part D, MITA, etc.
   
8. 
   Resources, both human and financial, for remediation
   
9. 
   Risks involved with ineffective or inefficient remediation actions.
   

Key Activity: Recommend Remediation Strategies for Impact Medicaid Policies (RFP 3.2.3.1)

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  Upon completion of policy analysis recommend to the Department any remediation strategies needed to be considered to meet NPI compliance
  
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  Prepare a cost benefit analysis, comparing the recommended strategies and any other feasible strategies so the Department can compare costs
  
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  Present recommended strategies to the Department as part of a walk through so the Department has a clear understanding of all possible remediation strategies
  

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  A report giving all remediation recommendations for Medicaid policies
  
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  A cost benefit analysis on each remediation strategy of impacted Medicaid policies
  
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  A scheduled meeting to walk through recommended remediation strategies
  

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  Report is due no later than noon on May 1, 2006
  
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  Cost benefit analysis is due no later than noon on May 1, 2006
  
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  Walk through must be scheduled within 5 days of final report and cost benefit analysis submitted
  

Key Activities

Contractor Responsibilities

Deliverables

Performance Measures

Key Activity: Recommend Remediation Strategies for Impacted Medicaid Systems (RFP 3.2.3.2)

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  Upon completion of system, interface and coding analysis, recommend to the Department any remediation strategies needed to be considered to meet NPI compliance
  
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  Prepare a cost benefit analysis comparing the recommended strategies and any other feasible strategies so the Department can compare costs
  
• 
  Present recommended strategies to the Department as part of a walk through so the Department has a clear understanding of all possible remediation strategies
  

• 
  A report giving all remediation recommendations for Medicaid systems
  
• 
  A cost benefit analysis on each remediation strategy of impacted Medicaid systems
  
• 
  A scheduled meeting to walk through recommended system remediation strategies
  

• 
  Report is due no later than noon on May 1, 2006
  
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  Cost benefit analysis is due no later than noon on May 1, 2006
  
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  Walk through must be scheduled within 5 days of final report and cost benefit analysis submitted
  

Key Activities

Contractor Responsibilities

Deliverables

Key Activity: Recommend Remediation Strategies for Medicaid Business Processes (RFP 3.2.3.3)

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  Upon completion of business process analysis, recommend to the Department any remediation strategies needed to be considered to meet NPI compliance
  
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  Prepare a cost benefit analysis comparing the recommended strategies and any other feasible strategies so the Department can compare costs
  
• 
  Present recommended strategies to the Department as part of a walk through so the Department has a clear understanding of all possible remediation strategies
  

• 
  A report giving all remediation recommendations for Medicaid business processes
  
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  A cost benefit analysis on each remediation strategy of impacted Medicaid business processes
  
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  A scheduled meeting to walk through recommended business process remediation strategies
  

• 
  Report is due no later than noon on May 1, 2006
  
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  Cost benefit analysis is due no later than noon on May 1, 2006
  
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  Walk through must be scheduled within 5 days of final report and cost benefit analysis submitted
  

Key Activity

Contractor Responsibilities

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  Provider enrollment/reenrollment
  
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  Provider outreach
  
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  Billing requirements
  
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  Maintaining patient services
  
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  Equitable payment to providers
  
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  Prompt provider payments
  
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  Maintaining good provider relationships
  
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  Accurate data collection
  
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  Fraud and abuse detection
  
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  Data comparability over time (current vs. historical)
  
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  Secure integrity of data exchange
  
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  Minimizing project costs
  
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  Minimizing business project disruptions
  

Deliverable

Performance Measures

Phase 3: Implementation Tasks (RFP 3.2.4)

Key Activity: Implementation Work Plan for Medicaid Systems (RFP 3.2.4.1)

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  Based on the decisions of the Department for systems remediation, create a work plan for each impacted system and its related interfaces.
  
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  Include in the work plan key tasks and timelines
  
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  Obtain Department approval for each of the final work plans
  

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  A work plan for each NPI impacted Medicaid or Medicaid-related system and related interfaces
  
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  A scheduled meeting to walk through to review and obtain approval for all work plans
  

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  Work plans are due 21 calendar days from election of the Department’s remediation strategy
  
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  Walk through must be scheduled within 5 days of submission of work plans
  

Key Activities

Contractor Responsibilities

Some of the WBS tasks in the following table may be completed concurrently.

The following strategy presumes that a wrapper/translator strategy is chosen, but such technology must be purchased and installed prior to the actual remediation process.

Deliverables

Performance Measures

Key Activity: Implementation Work Plan for Medicaid Policies (RFP 3.2.4.2)

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  Based on the decisions of the Department for Medicaid policy remediation, create a work plan for impacted policies that are to be changed.
  
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  Include in the work plan key tasks and timelines
  
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  Obtain Department approval for the final work plan
  

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  A work plan for approved Medicaid policy remediation
  
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  A scheduled meeting to walk through on work plan for Medicaid policy remediation
  

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  Work plans are due 21 calendar days from election of the Department’s remediation strategy
  
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  Walk through must be scheduled within 5 days of final report and cost benefit analysis submitted
  

Key Activities

Contractor Responsibilities

Deliverables

Performance Measures

Key Activity: Implementation Work Plan for Medicaid Business Processes (RFP 3.2.4.3)

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  Based on the decisions of the Department for remediation to IME business processes, create a work plan for changes to business processes.
  
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  Structure the work plan in such a way as to create individual work plans by IME units.
  
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  Include in the work plan key tasks and timelines and identifying IME units impacted.
  
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  Obtain Department approval for the final work plan.
  

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  A work plan to include each operational business process impacted by IME laid out by IME unit
  
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  A scheduled meeting to walk through work plan for business process remediation.
  

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  Work plans are due 21 calendar days from election of the Department’s remediation strategy
  
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  Walk through must be scheduled within 5 days of final report.
  

Key Activities

Contractor Responsibilities

Deliverables

Performance Measures

Key Activity: Create APD (RFP 3.2.4.4)

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  Identify all activities from the Department’s remediation plans that would receive enhanced federal funding.
  
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  Create an APD according to requirements of CMS for Department approval to obtain enhanced funding for these activities.
  
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  Obtain Department approval on the final document to be sent to CMS.
  

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  A report of all activities identified as qualifying for enhanced federal funding
  
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  An APD to be submitted to CMS requesting ninety percent funding for remediation of Iowa Medicaid systems and processes
  

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  Submit report of all activities no later than noon on May 15, 2006
  
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  Submit final APD to Department for submission to CMS no later than noon on May 22, 2006
  
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  APD created must meet all CMS criteria. Questions on APD from CMS should not be the result of any technical or mechanical failure by the Contractor.
  

Key Activities

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  The nature of the project and the program needs or the requirements that the proposed solution is intended to meet
  
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  The functions to be automated and the level of automation being used
  
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  How the project fits into the State’s long-term automation plans and, if appropriate, how it fits into the overall direction of its automation plans i.e., telecommunication plan, central automated data processing (ADP) center, Enterprise Information Systems (EIS) strategy
  
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  The involvement of the State’s top management in the project to ensure success and the proposed project management organization and responsibilities
  
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  The State’s plans concerning transfer including the source of any transfer under consideration
  
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  The schedule for developing and implementing the system, showing major milestones including a statement concerning the State’s judgment about its ability to meet this preliminary schedule
  

Contractor Responsibilities

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  Definition of the needs and objectives
  
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  Requirements Analysis,
  
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  Feasibility Study,
  
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  Alternative Analysis including cost analysis
  
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  Cost/Benefit Analysis
  
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  Cost Allocation Alternatives
  

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  Project Organization and Personnel Resources
  
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  State and Contractor Resource Needs
  
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  Assurances
  
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  Project Management Plan
  

Development of Draft Sections of the APD

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  Statement of Needs and Objectives – a summary of the current environment and the new system needs, objectives, and anticipated benefits. A basic description of the modification or system utilized in order to make the MMIS NPI-compliant will be included.
  

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  Problems or deficiencies in existing system – a description of why the current IME MMIS is unable to process the new or changed requirements required by NPI.
  
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  New or changed program requirements – an explanation of any differences between the current MMIS and NPI requirements.
  

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  Summary of Requirements Analysis and Alternatives Analysis – summarizing the results of any previously conducted requirements analysis, feasibility study, and alternatives analysis including:
  

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  General Requirements – a general requirements analysis for NPI compliance efforts, describing both the functional and technical needs and include all analysis completed up to the point of submission of the APD.
  
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  Alternatives Analysis – a summary of which alternatives to the selected remediation effort were selected for evaluation of costs and benefits, and provide the rationale for selection of the chosen alternative.
  

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  Cost/Benefit Analysis – a summary of the results of the cost benefit analysis including program performance improvements, projected costs, and anticipated benefits the NPI-compliant system is expected to deliver. The narrative will address the basis, assumptions, calculations and measurement plan related to performance, cost and benefit goals. This section will indicate, through a check box, whether the following items are included with this analysis:
  

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  Cost/Benefit Profile – A brief cost-benefit profile of the chosen method for NPI compliance must be included;
  
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  Systems Life Benefits – A spreadsheet detailing the systems life of the chosen method of compliance.
  

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  Project Management Plan – this summarizes the project activities, deliverables and products; project organization; State and Contractor Resource needs and anticipated system life. Any differences in from the Project Management Plan from previously submitted APDs must be explained.
  

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  Proposed Project Budget – the proposed budget which considers all costs for Implementation Phase activities. This might include, but is not limited to, costs associated with system software and data conversion, software development, computer capacity planning, contractor costs, supplies, training, maintenance and operations. Miscellaneous automated data processing costs (ADP) may also be included.
  

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  Assurances – statements related to the procurement of automated data processing equipment for mechanical claims processing, and whether it was procured under the appropriate requirements outlined in the Code of Federal Requirements listed, the appropriate sections of the State Medicaid Manual and a State Medicaid Letter (dated December 4, 1995). This section also refers to access to records, licensing, ownership of software and the safeguarding of information contained within the system.
  

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  Cost Allocation – this section describes the prospective cost allocation model including procedures to identify, record, allocate, and report direct and indirect costs, partially and fully attributable to the system project.
  

Submittal of Draft APD to the State for Review and Approval

Submittal of the Final APD to Department and CMS

Deliverables

Performance Measures