Medicaid Eligibility And Enrollment (EE) Implementation Advanced .
Rhode Island Unified Health Infrastructure Project (UHIP) Medicaid Eligibility and Enrollment(EE) Implementation Advanced Planning Document (IAPD)OMB Approval Number: 0938-1268Name of State: Rhode IslandName of State Medicaid Agency: Executive Office of Health and Human ServicesName of Contact(s) at State Medicaid Agency: Matt StarkE-Mail Address(es) of Contact(s) at State Medicaid Agency: Matt.Stark@ohhs.ri.govTelephone Number(s) of Contact(s) at State Medicaid Agency: (401) 871-5710Date of IAPD Submission to CMS: August 17, 2017Brief Description of Latest Version Additions/Changes/Deletions:This update includes a revised budget to Rhode Island’s FFY18 and FFY19 program of workpursuant to the previously submitted As Needed FFY17 IAPDU of May 2017. This updateprovides a revised budget and narrative to resource the state’s recovery efforts.1
Rhode Island Unified Health Infrastructure Project (UHIP) Medicaid Eligibility and Enrollment(EE) Implementation Advanced Planning Document (IAPD)OMB Approval Number: 0938-1268TABLE OF CONTENTS1.Executive Summary. 42.Results of Activities Included in the IAPD . 83.Statement of Needs and Objectives of the IAPD . 104.Requirements Analysis, Feasibility Study, and Alternative Considerations . 125.Cost Benefits Analysis . 126.Nature and Scope of Activities. 127.Project Management Planning and Procurement . 158.Personnel Resource Statement . 179.Proposed Activity Schedule . 1710. Proposed Budget. 2410.1.Design, Development and Implementation Costs. 2610.1.1.State Personnel – All Other / Medicaid Personnel . 2610.1.2.Contracted Services – Project Management Vendor . 2710.1.3.Contracted Services – Technology Implementation Vendor . 2710.1.4.Contracted Services – Technical Assistance Vendor . 2810.1.5.Contracted Services – IV&V Vendor . 2810.1.6.Contracted Services – InRhodes Conversion and Bridging . 2910.1.7.Contracted Services – Contact Center . 2910.1.8.Contracted Services – Other Contracted Services . 2910.1.9.Contracted Services – Data Management . 3210.1.10.State System Interfaces for Verification . 3210.1.11.Hardware and Software Costs. 3210.1.12.COTS Costs . 3310.2.Maintenance and Operations Costs . 3310.2.1.State Personnel – DHS Eligibility Support . 3310.2.2.State M&O – Other . 3410.2.3.Contracted Services – Reconciliation Services . 3410.2.4.Contracted Services – Data Management . 3510.2.5.Contracted Services – UHIP Security and Support . 352
Rhode Island Unified Health Infrastructure Project (UHIP) Medicaid Eligibility and Enrollment(EE) Implementation Advanced Planning Document (IAPD)OMB Approval Number: 0938-126810.2.6.Contracted Services – UHIP Technology Platform . 3610.2.7.Contracted Services – Contact Center . 3610.2.8.Contracted Services – Outreach and Enrollment Support Program . 3711. Cost Allocation Plan for Implementation and Maintenance Activities . 3712. Security, Interface, Disaster Recovery, and Business Continuity Planning . 4213. Conditions and Standards for Receipt of Enhanced FFP . 4214. IAPD Required Federal Assurances . 42Appendix A Medicaid Detailed Budget Table . 46Attachments. 49Attachment A: FFY Budgets by Funding Source. 49Attachment B: Rhode Island Timeline . 49Attachment C: Staffing . 49Attachment D: RI UHIP Project Runway . 493
Rhode Island Unified Health Infrastructure Project (UHIP) Medicaid Eligibility and Enrollment(EE) Implementation Advanced Planning Document (IAPD)OMB Approval Number: 0938-12681. EXECUTIVE SUMMARYTo comply with the Patient Protection and Affordable Care Act of 20101 (hereinafter the ACA)requirements regarding expansion of access to affordable health insurance, Rhode Island hastaken the following actions, the progression of which reflects Rhode Island’s evolving model toprovide seamless, consumer-friendly access to affordable health insurance and other humanservice programs:a) March 2011 - Submitted an application, which received federal approval, for Level OneEstablishment funding to provide planning support to design Rhode Island’s HealthBenefit Exchange.b) August 2011 - Submitted an IAPD, which received CMS approval for enhanced federalfinancial participation (FFP) to build and implement a new eligibility rules engine for MAGIMedicaid/SCHIP and the Exchange.c) September 2011 - Submitted an application, which received federal approval, for LevelTwo Establishment funding to complete the implementation of the Exchange through thedesign, development and implementation of a fully integrated, combined technologyinfrastructure supporting eligibility and other program management functions for boththe Exchange and MAGI Medicaid/SCHIP.d) January 2012 - Submitted a revised draft IAPD-U, consistent with our Establishment Twofunding request reflecting Medicaid’s share of the revised costs of design, development,and implementation of “HIX/IES”, a fully integrated, combined technology infrastructure,including the technology support for a fully functioning health insurance exchange andthe supporting eligibility determination system for both MAGI Medicaid/SCHIP and theExchange.e) April 2012 - Pursuant to RI’s approved Establishment II Grant as well as Federal Guidanceon January 23, 2012 encouraging states to build fully integrated eligibility systems,submitted a revised IAPD-U to reflect: 1Medicaid/SCHIP’s share of the revised costs of design, development, andimplementation of a fully integrated, combined technology infrastructure for afully functioning health insurance exchangeMedicaid’s costs of eligibility-related functions for the complex (Non-MAGI)Medicaid populations, including disabled adults and children, long term care,foster children, etc.Cost allocation (to the human service program) of functions related to specificmodifications or additional capacity needed for human service programs to bePublic Law 111-149, Patient Protection and Affordable Care Act, March 23, 2010, 124 Stat. 119.4
Rhode Island Unified Health Infrastructure Project (UHIP) Medicaid Eligibility and Enrollment(EE) Implementation Advanced Planning Document (IAPD)OMB Approval Number: 0938-1268added to the new Exchange/Medicaid/SCHIP eligibility system. These programsinclude Supplemental Nutrition Assistance Program (SNAP), Rhode Island Works(RI’s TANF Program), the Child Care Assistance Program (CC), General PublicAssistance (GPA), and State Supplemental Payment Program (SSP).f) January 2013 – Submitted a revised IAPD-U to reflect an updated budget based on thenegotiated contract with the winning bidder of RI’s competitive procurement to design,develop, and implement Rhode Island’s HIX/IES system, specifically as it relates to theMaintenance and Operations (M&O) costs of the project and the design, development,and Implementation (DDI) costs of Phase 2. Also included in the January 2013 IAPD-U areadditional costs for state personnel, interfaces with state data sources, and hardwareexpenditures.g) July 2013 – Submitted an “As-Needed” update to the UHIP project budget. This updaterevised the format from the previous version to provide additional clarity, transparency,and specificity to the project budget for our federal partners as well as improving RhodeIsland’s ability to monitor and report on the approved budget. This update also includednew project costs that had been identified as necessary. Following are a few projecthighlights and major impacts described in this submission: Contact Center Establishment and Operations – In order to comply with ACArequirements and establish its State Based Marketplace, Rhode Island has securedthe services of a vendor to implement and operate a contact center to providecustomer service to citizens seeking help with health insurance and insuranceaffordability programs.Mail Handling Capacity – As a result of analyses on expected new transactionalvolume as the result of the Exchange, Medicaid expansion, and the individualmandate, Rhode Island has identified additional equipment and personnel thatwill be required.Security, Privacy, and Support Staffing – Rhode Island will secure a UHIP SecurityOfficer and Privacy Officer to manage security and privacy over the entirety of theUHIP platform as well additional technology support personnel.Eligibility Operational Support – With unprecedented increases in the statewideMedicaid caseload, Rhode Island intends to add term-limited eligibility supportstaff to manage applications and eligibility determination. This represents anadditional 30 Department of Human Services (DHS) Eligibility Technicians that willbe located in both the local offices and collocating in the Contact Centerspecifically to manage the increased Medicaid volume as a result of the ACAincluding newly eligible individuals as a result of Medicaid expansion, previouslyunenrolled but potentially eligible individuals, and referrals to the Contact Centerfor ACA Insurance Program enrollments.5
Rhode Island Unified Health Infrastructure Project (UHIP) Medicaid Eligibility and Enrollment(EE) Implementation Advanced Planning Document (IAPD)OMB Approval Number: 0938-1268 Outreach and Enrollment Support Program – Rhode Island has secured theservices of a vendor to provide statewide Outreach and Enrollment SupportProgram services to comply with a key provision of the ACA.Increase in DDI Contract resulting from Change Orders – There has been a fewchanges to the original project scope to accommodate new federal guidance afterDDI Contract execution.h) April 2014 – A draft update introduced minor changes to a few of the cost categories toreflect project costs more accurately. Below is a summary of the main changes that arebeing proposed in this IAPD-U iteration: State Personnel – The category has been split to better reflect actual cost fordedicated Medicaid personnel.MMIS enhancements – Additional development work has been identified asnecessary to ensure proper communication between MMIS and UHIP solutions.Increase in Hardware cost related to the Electronic Document ManagementinitiativeIncrease in COTS Software cost – In order to support software integrationrequirements additional Master Client Index software is needed.Increase in DDI Contract resulting from Change Orders – There has been a fewadditional changes identified after system requirements have been specified.These are due to FSDH malfunction, changing Federal requirements, and otherupgrades.i) October 2014 – Revised and finalized update submitted to reflect adjustments toprojected shared technology costs made in the approval process for the February 2014Level 1 grant request. In addition, adjustment to the cost allocation methodology for theInRhodes Conversion and Bridging component is being requested based on actual projectwork to date and planned for the balance of the project.A detailed description of the revised project costs and cost allocation methodologies aredescribed in Section 4 of this IAPD-U.j) July 2015 – This as needed IAPD-U included a brief description of project goals andobjectives for next 12 to 18 months and the impacts to the IAPD-U to accomplish thoseobjectives: This plan is encapsulated in the project’s 2015/2016 road map and updatedproject schedule, which outlined the plan to implement enhanced functionality tothe Citizen Portal to address new federal guidance as well as improvements forease of use and processing efficiencies for both citizens and workers. This year’splan also included implementing the functionality to provide DHS, EOHHS and6
Rhode Island Unified Health Infrastructure Project (UHIP) Medicaid Eligibility and Enrollment(EE) Implementation Advanced Planning Document (IAPD)OMB Approval Number: 0938-1268 Contact Center workers with the capability to process and maintain applicationsfor MAGI Medicaid, complex Medicaid, QHP and all human service programs usingthe same “Worker Portal” that will improve processing efficiency, uniformity,error reduction, maintainability of the UHIP solution and reduce the overall costof system ownership. In addition, the integration of application processing andcase maintenance circumvents the potential for data quality and system errorscaused by the need for ongoing, real-time data synchronization of multipledatabases.The project’s road map includes the planned release dates for at least 4 majorfunctional upgrades of the Citizen Portal and implementation of the fullyintegrated Health Care and Human Services solution, RIBridges, in the summer of2016. Most importantly, the project team posts all project documents to the CMSCALT repository, which provides the details of all Phase 1 – Citizen Portal andPhase 2 RIBridges Worker Portal design, development and implementationdeliverables.The 2015/2016 road map envisions an integrated Citizen Portal (Phase 1) that willenable citizens to submit applications and changes via the internet for all healthcare and human services programs and state case workers and their agents toenter applications and maintain accounts/cases for all health care and humanservice programs using RIBridges (Phase 2).This IAPD-U also requested funding for upgrading the technical infrastructure tosupport a larger caseload, increased transaction volumes, and a more functionallyrich Citizen and Worker portal as well as improved system security for better useraccount management, compliance and risk management and advanced intrusiondetection and prevention.We are also requesting an adjustment to the cost allocation methodology formany of the cost items to include actual caseload counts and function points.k) July 2016 – This as needed IAPD-U provided updated costs for contracts that wererenewed/executed with vendors for updated FFY 2017 costs as well as new contracts thatwere not included in last years approved IAPD. In addition, it outlined Rhode Island’santicipated approach and roadmap for FFY 2017 in anticipation of a successful go livelaunch.l) May 2017 – This as needed IAPD-U provides a revised budget to support the state’sstabilization and recovery efforts. It includes updated costs for state staffing and vendorsupport for post go-live stabilization, rescoped design, development and implementationactivities to enable successful recovery, and other implementation activities that werepreviously approved.m) August 2017 – This IAPD update includes a reforcasted FFY 2017 budget, and updatedbudget forecast for FFY 2018. The changes in cost reflects the Project Runway developed7
Rhode Island Unified Health Infrastructure Project (UHIP) Medicaid Eligibility and Enrollment(EE) Implementation Advanced Planning Document (IAPD)OMB Approval Number: 0938-1268by the state to stabilize the system, and begin transitioning activities more towardmaintenance and operations starting in FFY 2019. Absent from the costs are a budget forthe system integration vendor for FFY 2018 and FFY 2019. The state is engaged innegotiation with the vendor and will formally submit an updated IAPD as negotiationsmove closer to contract amendment. Contract amendments will be submitted in advanceto CMS and FNS for approval prior to execution. Please note that the costs are notrepresented in the budget as zero, but are to be determined pending negotiations.2. RESULTS OF ACTIVITIES INCLUDED IN THE IAPDFor this IAPD Update, Rhode Island is asking for federal approval for FFY18 project budget thatprioritizes investments to accelerate stabilization and recovery and advances priority projectneeds that were identified in the last submission. A detailed description of the new costs andamounts is provided below.There have been no major changes to the cost categorization approach proposed since the July2013 IAPD-U, although some adjustments were made to ensure alignment of cost-allocation fornon-Medicaid programs. The cost allocation for certain categories benefitting from theintegrated worker portal have been updated based on Rhode Island’s integrated solutionapproach.Rhode Island has identified the need to reallocate resources and prioritize recovery andstabilization activities that advance the overall success of the UHIP/RIBridges project. The budgethas been updated to reflect actual expenditures to date (including a 27M credit from the state’ssystem integrator) and future approved expenditures have been adjusted to better reflect theexpected dates in which those costs will be incurred. Tables 1 and 2 below show the overallchange to the project budget for DD&I and M&O costs.8
Rhode Island Unified Health Infrastructure Project (UHIP) Medicaid Eligibility and Enrollment(EE) Implementation Advanced Planning Document (IAPD)OMB Approval Number: 0938-1268Table 1: May 2017 IAPDU As Needed SummaryIAPD-U May 2017 VersionFederal ShareState ShareTotal CostsDD&IPreviously Approved DD&I CostsUpdated Project DD&I CostVarianceM&OPreviously Approved M&O CostsUpdated Project M&O CostsVarianceUpdated Total Project 1,507,18167,745,596Approved Establishment Grant and IAPD34,217,742 Project Costs47,781,963 Represents net new 0Approved Establishment Grant and IAPD44,809,304 Project Costs39,722,695 Represents net new request(5,086,609)87,504,658Table 2: August 2017 IAPDU SummaryTotal CostsDD&IUpdated Project DD&I CostM&OUpdated Project M&O CostsUpdated Total Project CostsIAPD-U August 2017 VersionFederal ShareState Share298,510,765256,104,98342,405,782 Represents net new 46,921,896 Represents net new request89,327,678As shown in the table above, the overall project budget through FFY19 is estimated to be 444,513,110 of which 355,185,432 is the expected federal share and 89,327,678 is theexpected state share.The 30-Day Assessment, released February 15, 2017, enumerated challenges with the systemimplementation and defined areas of progress. The following lists out a high-level timeline andprojected progress as found in the report, and provides an update on progress.Timeline 3 months···Projected ProgressStop the growth in pendingapplications and begin toachieve week over weekreductions.Require Deloitte to execute itsIT turnaround plan, with a firstwave of improvements to thechild care, long term servicesand supports, and workerportals.Reach sufficient staffing forState and Deloitte to stabilizethe system.··9UpdateBacklog: In March of 2017, the backlog ofapplications was nearly 14,000. Total applicationspending today, including those pending clientaction, is below 4,000. This includes LTSS. WithoutLTSS, the total work in progress is 1,855applications. As of 8/16/2017, the overdueworkable SNAP backlog is 83, under the 100goal. The workable overdue MAGI backlog is 72,also under 100.Execute Turnaround Plan: During the period2/15/17 – 8/17/17, we have executed 5 CriticalProject Releases to add functionality acrossmultiple program and functional areas, including:LTSS, Self-Service Portal, Worker Portal, RIteShareChild Care and more. Please see Attachment D –Project Runway for a full listing. In addition, wehave executed 16 data and code fix releases withover 2,323 fixes. In addition, we are fixing 75-100individual accounts/cases per week.
Rhode Island Unified Health Infrastructure Project (UHIP) Medicaid Eligibility and Enrollment(EE) Implementation Advanced Planning Document (IAPD)OMB Approval Number: 0938-1268TimelineProjected Progress·3-6 months·····6-12 months····Improve the customer userexperience to produce, forexample, measurable selfservice enrollment for SNAPand other DHS benefits.Observe gains in workerproductivity through significantprocessing time reductions.Significantly improveapplication determinationtimes.See improvements in late orinaccurate provider payments.Correct most remaining dataconversion issues.·Reduce pending applications tosteady state levels.Ensure that the system is readyto handle open enrollment withsignificant increases in selfservice rates through thecustomer portal.Ensure that there are few to nolate or inaccurate paymentsthrough the system.Ensure that there are noremaining data conversionissues.····UpdateDHS has added 139 new positions to date and plansto add an additional 4 positions to reach the hiringsurge target of 143 positions. The State hasexecuted federally approved contracts andamendments to expand contract support andDeloitte has increased its staffing levels to 623FTEs.Processing has improved: The average time it takesto process applications is currently is 35:55, a 2minute drop from the previous month and nearly 5minutes faster than the 90-day average. Also,68.16% of the applications are currently processedwith an eligibility determination in one day. That isa 4% improvement from last month. The mediantime which is 20 minutes and in line with pre-golive numbers.The State continues to implement new processesto improve timeliness of applicationdeterminations. 74.9 % of expedited applicationsreceived in July were determined timely (278 out of371) and 84% of regular applications received inJune were determined timely (1,583 out of 1,884).62% of applicants through the customer portal doso in one sitting. In the last month, 20% ofapplications have been submitted through thecustomer portal across all programs. On averageover the last month, it takes 56 minutes to applyfor a new program online.Medicaid applications backlog numbers are nowbelow 100 and are consistent with DHS operationsprior to the implementation of the system.The release scheduled for 8/26 includesfunctionality for Open Enrollment; Medicare Buyin; Medicaid Notice Denial Reasons; RIteShare;Passive Renewal MAGI part 2 and complex parts 1and 2; Medicaid Reconciliation fixes; DCYFMedicaid fixes; and improvements to WorkerPortal and Customer Portal screens3. STATEMENT OF NEEDS AND OBJECTIVES OF THE IAPDOverall the goals of the UHIP project in Rhode Island have not changed. The state’s goal is anintegrated eligibility system supporting health and human service programs that will service bothACA program implementation as well as replace the state’s legacy health and human servicesystem.10
Rhode Island Unified Health Infrastructure Project (UHIP) Medicaid Eligibility and Enrollment(EE) Implementation Advanced Planning Document (IAPD)OMB Approval Number: 0938-1268The priority needs and objectives supported by this IAPDU, are described in the Assessment ofthe United Health Infrastructure Project, released by the state February 2017. IT goals aredescribed in the Project runway. Further details about objectives follow in the sections below.The focus for UHIP for at least the remainder of FFY17 will be on recovery efforts from the rolloutof Phase 2 of the system in September of 2016. This will continue into FFY 2018. This IAPDU hasbeen revised to support efforts to address challenges resulting from the September 2016 systemrelease and to get the UHIP project on track. The state has developed a Project Runway ofreleases to improve the system’s performance and ability to meet program needs. The IAPDU asrevised covers the state’s recovery plan for UHIP and will support improvements in projectgovernance, IT management and process, increase permanent and term-limited staff, andimprove training and change management; it will support system testing and release quality.While, ultimately, the objective is to completely stabilize the system and bring it into fullcompliance across programs served, there are several other priorities that demand the statesattention including; Clearing the remaining backlog items back to a more manageable levelAccurate Medicaid Termination and ReconciliationEligibility determination accuracy and timelinessOpen Enrollment (OE) ReadinessOverall, the State expects to meet the following high level milestones, which are laid out ingreater detail in Section 9:Anticipated SystemImprovement PhaseStabilizationStabilization ReducedMaintenance andOperations PlusMaintenance andOperationsDescriptionBacklogs are cleared out; Reconciliation is atmaintenance level; Notices, eligibility, payments andenrollments meet KPIsSystem is fully compliant across programs no laterthan June 2018. A roadmap for CY19 architecturalchanges will be developed ensuring that systemcomponents can be updated to support mobileoptimization, improved security, and rules flexibilityin the future.Specific objectives include: mobile-enabled userexperience; unified architecture; configurable rulesengine; improved user interfaceEnhancements are minor and/or to meet emergingfederal and state policy changes or regulatoryrequirements11TimingCurrent – 3/30/183/1/18 - 9/28/1810/1/18 – 6/28/197/1/19 – Ongoing
Rhode Island Unified Health Infrastructure Project (UHIP) Medicaid Eligibility and Enrollment(EE) Implementation Advanced Planning Document (IAPD)OMB Approval Number: 0938-12684. REQUIREMENTS ANALYSIS, FEASIBILITY STUDY, AND ALTERNATIVECONSIDERATIONSThis IAPDU is focused on stabilization of the existing system into Q2 of FFY 2018. As such ourfocus is on meeting existing requirements through the Project Runway and in further negotiationwith the systems integration vendor.5. COST BENEFITS ANALYSISThere are no changes to this section in this IAPD-U at this time. Re-assessment of cost benefitanalysis is dependent on completing stabilization efforts, bringing the system into full complianceand a re-baselining of system impact to caseload and long-term staffing required to supportprograms served by the system.6. NATURE AND SCOPE OF ACTIVITIESAlthough the State of Rhode Island’s primary goals and objectives for UHIP have not changed,the implementation approach has evolved in response to challenges with the systemimplementation in September 2016. State project leads have received feedback from citizens,the legislature, advocates, state functional and technical subject matter experts, and federalpartners and are incorporating lessons learned into the approach for recovery.This IAPD-U seeks new funds for stabilization and recovery efforts. The nature of the work sincethe UHIP recovery effort began in January 2017 and for the remainder of FFY 2018 will be focusedin IT delivery and quality, compliance, staffing and training, governance, operations andstakeholder engagement. Toward the end of FFY 2018, the state will begin transitioning activitiesmore toward maintenance and operations, as the project runway projects a more stable andcohesive system at the end of FFY 2018.Broadly, the vision for the enterprise supported by this IAPD is to achieve an integrated approachfor timely access to and delivery of health and human service benefits. Key goals in support ofthis vision are to deliver results in the following areas: Efficient and dignified service delivery for customers, clients, providers and stakeholdersCreate a user friendly and streamlined experience, including a “No Wrong Door” approachEmpowerment and support of management, staff and workersCompliance assurance through improved monitoring and control, and increased auditcomplianceTo measure progress, we have developed executive Key Performance Indicators (KPIs) that arereported weekly. These indicators were developed with two purposes in mind: t
Name of State Medicaid Agency: Executive Office of Health and Human Services Name of Contact(s) at State Medicaid Agency: Matt Stark E-Mail Address(es) of Contact(s) at State Medicaid Agency: Matt.Stark@ohhs.ri.gov Telephone Number(s) of Contact(s) at State Medicaid Agency: (401) 871-5710 Date of IAPD Submission to CMS: August 17, 2017
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