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Department of Human Resources and Department of Health and Mental Hygiene. Affordable Care Act (ACA) Healthcare Reform Project Overview Maryland Medicaid Advisory Committee. March26, 2012. PMO. Agenda. Goals for Health Care Reform Project Implementation Progress at a snapshot

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march26 2012

Department of Human Resources


Department of Health and Mental Hygiene

Affordable Care Act (ACA) Healthcare Reform Project Overview

Maryland Medicaid Advisory Committee

March26, 2012



Goals for Health Care Reform Project Implementation

Progress at a snapshot

Health Care Reform Project Scope Overview

IT Vendor (Procurement) Update

Project Governance/Supporting Organizations

Role of DHR/DHMH

High-level Timeline

Detailed Timeline (including Milestones)

Transition Plan


goals for health care reform project implementation
Goals for Health Care Reform Project Implementation
  • Assist MD citizens in getting affordable healthcare by providing a “no wrong door” easy-to-use multiple channel gateways to MD health assistance programs.
  • To provide a technology platform, which facilitates the implementation of Affordable Care Act (ACA) requirements as defined by State of MD stakeholders (DHMH, DHR, Exchange) including:
    • Eligibility, Shopping Exchange(s), Enrollment, Plan Certification, Reporting
  • To protect the public trust by providing a technology platform that is:
    • Cost Effective, Scalable, Security-Enabled and Designed for Future Enhancements
  • To build a scalable platform that easily integrates health and social services programs.
progress at a snapshot
Progress at a snapshot

Following illustration represents progress of MD Healthcare Reform Project, which has primarily been led by the Program Management Office (PMO), instituted in May 2011.











PMO Team Starts


(Functional Requirement Document)


(Business Requirement Document)



  • Detail requirements from all stakeholders, including but not limited to: DHR, DHMH, DOIT, MIA, and various offices within
  • Detail process flows illustrating user and system interactions
  • Decomposition and inclusion requirements based on continuously published federal regulations from CCIIO
  • Federal ACA Reqs
  • MD ACA Reqs
  • As-is / To-be
  • Risks / Constraints
  • Scope In / Out
  • Regulations / Statutory Compliance



Progressively Elaborated Structured Approach


(Request for Proposal)


(Request for Information)

Draft Complete

  • 19 responses / 7 invitations / 6 demos
  • Market Research 2-hour sessions
  • Purpose not to down select
  • Findings based on functionality versus vendors


Stakeholders Review

Includes: DHR, DHMH, DOIT, Governor’s Office

Leadership / Board Approval


Publish RFP

Receive / Evaluate RFP



healthcare reform project scope overview
Healthcare Reform Project – Scope Overview
  • This is high-level representation of the end-to-end process steps, stakeholders and which step will be discussed during each JAD session for the Health Care Reform project.

XV. Notifications

I. Pre-Screen

II. Intake & Registration

(Customer ID Validation)

III. Verification of Customer Info

IV. Eligibility


V. Tax Credit / Subsidy Calculation

VI. Plan Presentment

& eCommerce HUB

VII. Plan Enrollment

VIII. Account / Case


IX. Premium Payment Tracking

X. Insurance Carrier Management

XI. SHOP (includes Small Business Owner Management)

XII. Agent / Navigator Management

XIII. Reporting

XIV. Outreach

JAD Session

Eligibility Enrollment

Change in Circumstances

ACA Functions for Insurance



Case Management







*Stakeholder’s include Executive Champion, Policy, End-User as well as Technology experts.

it vendor procurement update
IT Vendor (Procurement) Update
  • Vendor Select for the MD HIX is the Noridian Team
  • Offers the most complete and mature “out of the box” COTS solution:
    • 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),
    • Maryland specific data management and integration (CNSI)
  • Detailed project management plan and knowledgeable and experienced staff support achievement of aggressive implementation time lines
  • Solution and licenses are extensible to later implementation phases: SHOP (Phase 1B), Non-MAGI determinations (Phase 2), & other social services (Phase 3)
supporting organization s
Supporting Organization(s)

The following (primary and secondary) organizations are supported by this project:

Legal Counsel

Governor’s Office








role of maryland dhr dhmh
Role of Maryland DHR/DHMH
  • DHR, DHMH and HIX will be participating in a Business Process Reengineering (BPR) effort to answer key operational questions.
  • Decisions around the role of the Department of Human Resources and the Exchange as well as their operating models have not been solidified yet.
  • BPR will also address the role of the Local departments
      • how and when the Local department offices will be affected and to what extent;
      • will the Locals need to use multiple systems;
      • how to handle the influx and exchange information etc.
  • We realize no BPR process can succeed without input from the Local stakeholders and we will be requesting their active participation.
  • The BPR effort is expected to start in April 2012 and continue through August 2012.
high level timeline
High-Level Timeline
  • Following adjusted high-level timeline illustrates that based on our current delays we would be compressing Phase 1A already by two months. Maryland does not have the flexibility to extend the end date as it driven by ACA.










Phase 1A – Selected Exchange Functions and MAGI Medicaid Eligibility Determinations

(Mandatory Task Order)

Phase 1A – Selected Exchange Functions and MAGI Medicaid Eligibility Determinations

(Mandatory Task Order)

  • Establish a Technology Platform (or “HIX”) that allows for enrollment in Exchange plans and SHOP;
  • Conducts eligibility determinations and supports case management services for Advance Premium Tax Credits, cost-sharing reductions, Modified Adjusted Gross Income (MAGI)-related Medicaid categories, and MCHP.

Phase 1B – Operations, Hosting & Other Selected Services

(Optional Task Order)

Phase 1B – Maintenance Option

(Optional Task Order)

Phase 1B –

Maintenance Option

(Optional Task Order)

Phase 1B – Maintenance Option

(Optional Task Order)

  • Incorporate eligibility determinations and case management services for Non-MAGI Medicaid eligibility categories

Phase 2 – Integrating Non-MAGI Medicaid Determinations

  • Incorporate eligibility determinations and case management services for human services programs such as SNAP and TANF.

Phase 3 – Integrating Social Services Programs

detail timeline
Detail Timeline
  • Following detail timeline illustrates that based on current delays, we compress the Development & Test by almost a full quarter. Additionally, DDR & FDDR milestone

is also extended by the same.

Maryland does nothave the flexibility to change the date of Certification that is set by ACA to be January 1, 2013.

transition plan
Transition Plan
  • The purpose of the Transition-In Plan is to efficiently and effectively insert the Vendor into the Exchange environment in order to optimize utilization of resources and time. Additionally, the transition plan will ensure the Vendor and Exchange are in sync across the critical on-boarding tasks that are required for a project of this magnitude and aggressive timeline.
  • The following diagram articulates some of the key incoming transition activities the Vendor will need to accomplish in order to successfully integrate into the State environment. Details for each task follow in subsequent table slides.

61 - 90 Days

First 30 Days

31 – 60 Days

Kick Off & Project Administration

Detailed Design Documentation

Detailed Design Review

Validation of Work Products

Data Management Plan

Automated Code Review

Requirements to COTS Cross-walk

Technical Architecture

Physical & Logical Data Models

Facilities and Logistics

Testing Strategy

Data Conversion Plan

Review MD EA Repository

Data Use Agreements

System Integration Strategy

Project Management Documentation

Interface Control Documentation

Sprint Execution

Provide Application Licenses

Capacity Planning & Provisioning

On-Boarding & Training

Status Reporting

  • Discuss Role of a Navigator
    • Will support MAGI components only (Case Workers will continue with Medicaid and Non-MAGI)
    • Other Navigator functions to be determined and contracted out by the Exchange
    • Current – CARES is a COBOL-based case management system which keeps track of eligibility for Medical Assistance (MA) and other social services. CARES will remain the system of record for Non-MA services. MA Case Management system will have a bi-directional information exchange with CARES.
    • To-Be – CARES will remain the system of record for Non-MAGI and social services. Eligibility information for Non-MAGI and social services will flow back and forth from CARES to Exchange.