March26, 2012 D EPARTMENT OF H UMAN R ESOURCES AND D EPARTMENT OF H EALTH AND M ENTAL H YGIENE Affordable Care Act (ACA) Healthcare Reform Project Overview Maryland Medicaid Advisory Committee PMO

- 1 - Agenda 1.Goals for Health Care Reform Project Implementation 2.Progress at a snapshot 3.Health Care Reform Project Scope Overview 4.IT Vendor (Procurement) Update 5.Project Governance/Supporting Organizations 6.Role of DHR/DHMH 7.High-level Timeline 8.Detailed Timeline (including Milestones) 9.Transition Plan 10. Discussion

- 2 - Goals for Health Care Reform Project Implementation 1.Assist MD citizens in getting affordable healthcare by providing a “no wrong door” easy-to-use multiple channel gateways to MD health assistance programs. 2.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 3.To protect the public trust by providing a technology platform that is: Cost Effective, Scalable, Security-Enabled and Designed for Future Enhancements 4.To build a scalable platform that easily integrates health and social services programs.

- 3 - 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 PMO Team Starts OctJunJulAug Sep May Strategy Delivery Methodologies Documentation Strategy Methodologies Documentation Delivery Progressively Elaborated Structured Approach 5/16 BRD (Business Requirement Document)  Federal ACA Reqs  MD ACA Reqs  As-is / To-be  Risks / Constraints  Scope In / Out  Regulations / Statutory Compliance RFI (Request for Information)  19 responses / 7 invitations / 6 demos  Market Research 2- hour sessions  Purpose not to down select  Findings based on functionality versus vendors FRD (Functional 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 RFP (Request for Proposal) Draft Complete Stakeholders Review Leadership / Board Approval Publish RFP Receive / Evaluate RFP Includes: DHR, DHMH, DOIT, Governor’s Office Nov Dec Jan

- 4 - 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. I. Pre-Screen II. Intake & Registration (Customer ID Validation) III. Verification of Customer Info IV. Eligibility Determination VI. Plan Presentment & eCommerce HUB VII. Plan Enrollment IX. Premium Payment Tracking X. Insurance Carrier Management XI. SHOP (includes Small Business Owner Management) XII. Agent / Navigator Management XIV. Outreach VIII. Account / Case Management V. Tax Credit / Subsidy Calculation XIII. Reporting ExchangeDHMHDHR Legend: Stakeholders* JAD Session Eligibility EnrollmentChange in Circumstances Case Management ACA Functions for InsuranceAll *Stakeholder’s include Executive Champion, Policy, End-User as well as Technology experts. XV. Notifications MIA

- 5 - 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)

- 6 - Supporting Organization(s) The following (primary and secondary) organizations are supported by this project: Exchange DHR DHMH Governor’s Office DOIT MIA Legal Counsel Carriers TPA’s

- 7 - 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.

- 8 - Phase 1A – Selected Exchange Functions and MAGI Medicaid Eligibility Determinations (Mandatory Task Order) 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 2 – Integrating Non-MAGI Medicaid Determinations Phase 3 – Integrating Social Services Programs 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) 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. Incorporate eligibility determinations and case management services for Non-MAGI Medicaid eligibility categories Incorporate eligibility determinations and case management services for human services programs such as SNAP and TANF.

- 9 - 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 not have the flexibility to change the date of Certification that is set by ACA to be January 1, 2013.

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. 31 – 60 Days Days First 30 Days Status Reporting Kick Off & Project Administration Validation of Work Products Requirements to COTS Cross-walk Facilities and Logistics Review MD EA Repository Project Management Documentation Provide Application Licenses Detailed Design Documentation Data Management Plan Technical Architecture Testing Strategy Data Use Agreements Interface Control Documentation Capacity Planning & Provisioning Detailed Design Review Automated Code Review Physical & Logical Data Models Data Conversion Plan System Integration Strategy On-Boarding & Training Sprint Execution

Discussion 1.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 2.CARES 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.