100% found this document useful (2 votes)

251 views135 pages

Vermont IT Gap Analysis Report

Uploaded by

Rara Anjani

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

100% found this document useful (2 votes)

251 views135 pages

Vermont IT Gap Analysis Report

Uploaded by

Rara Anjani

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

You are on page 1/ 135

Style Definition: BH - Body - Univ 45 9/13 Style Definition: BH - Subhead1 - Univ 45 13/14: Space After: 10 pt Style Definition: BH - Subhead2

- Univ 45 B 9/13: Space After: 10 pt

State of Vermont/Wakely Consulting Health Insurance Exchange Assistance

IT Gap Analysis Report Julyne 302325, 2012

Table of Contents

Executive Summary ................................................................................................................... 4 Introduction ................................................................................................................................ 7 Methodology .............................................................................................................................10 Current State IT Systems Environment .....................................................................................11 Gap Analysis Summary.............................................................................................................15 Appendices ...............................................................................................................................30 Appendix A: IT Systems Current State Details ....................................................................31 Appendix B: Functional and Technical Components............................................................48 Appendix C: IT Assets Assessment Functional Component Worksheet (Detailed View) .....81 Appendix D: IT Assets Assessment Technical Component Worksheet (Detailed View).....118 Executive Summary ..................................................................................................................44 Introduction ...............................................................................................................................77 Methodology ...........................................................................................................................109 Current State IT Systems Environment .................................................................................1110 Gap Analysis Summary.........................................................................................................1413 Appendices ...........................................................................................................................2827 Appendix A: IT Systems Current State Details ................................................................2928 Appendix B: Functional and Technical Components........................................................3745 Appendix C: IT Assets Assessment Functional Component Worksheet (Detailed View) .3778 Appendix D: IT Assets Assessment Technical Component Worksheet (Detailed View). 37115

Formatted: No underline

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 1

List of Tables
Table 1: Gap Analysis Approach Steps .....................................................................................10 Table 2: IT Gap Analysis Initial Systems Review....................................................................12 Table 3: Vermont Systems Summary ........................................................................................14 Table 4: Current IT Assets ........................................................................................................15 Table 5: IT Assets Assessment Rating Scale ............................................................................16 Table 6: System Fit-Gap Rating Scale ......................................................................................19 Table 7: Functional Component Fit-Gap Rating ........................................................................20 Table 8: Technical Component Fit-Gap Rating..........................................................................24 Table 1: Gap Analysis Approach Steps ...................................................................................109 Table 2: IT Gap Analysis Initial Systems Review................................................................1211 Table 3: Vermont Systems Summary ....................................................................................1312 Table 4: Current IT Assets ....................................................................................................1413 Table 5: IT Assets Assessment Rating Scale ........................................................................1514 Table 6: System Fit-Gap Rating Scale ..................................................................................1716 Table 7: Functional Component Fit-Gap Rating ....................................................................1817 Table 8: Technical Component Fit-Gap Rating......................................................................2221

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)) Formatted: No underline, Font color: Auto

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 2

List of Figures
Figure 1: Gap Analysis Approach Summary..............................................................................10 Figure 2: IT Assets Assessment Functional Component Worksheet .........................................17 Figure 3: IT Assets Assessment Technical Component Worksheet...........................................17 Figure 4: Total Function Percentage by System (for Functional Components) ..........................21 Figure 5: Functional and Technical Capabilities Summary ........................................................29 Figure 1: Gap Analysis Approach Summary............................................................................109 Figure 2: IT Assets Assessment Functional Component Worksheet .....................................1615 Figure 3: IT Assets Assessment Technical Component Worksheet.......................................1615 Figure 4: Total Function Percentage by System (for Functional Components) ......................1918 Figure 5: Functional and Technical Capabilities Summary ....................................................2625

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)) Formatted: Font: Arial, No underline, Font color: Auto

Formatted: TOC 1, Tab stops: 6.49", Right,Leader:

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 3

Executive Summary

Formatted: No underline, Font color: White

The State of Vermont (the State, Vermont) engaged Wakely Consulting to conduct a limited Information Technology (IT) gap analysis to support the States planning for an integrated Health Insurance Benefits Exchange (HIXHBE) and modernized eligibility system. The gap analysis work should better help the State understand the IT implications of the business model options it is considering for Exchange and modernized eligibility system implementation. The objective of the analysis described in this report is to assess the functional and technical gaps between the IT systems requirements for the full Exchange and modernized eligibility system implementation and existing systems that are candidates for reuse. The IT systems requirements for an integrated Exchange and modernized eligibility reference model are defined by the Center for Medicare and Medicaid Services (CMS) Exchange Reference Architecture (ERA) and Medicaid Information Technology Architecture (MITA) 3.0, with extensions developed to address business areas not yet fully defined by CMS 1.

Formatted: No underline, Font color: Auto

Gap Analysis Process

The Wakely Consulting team worked with select State staff to gather the data required to perform the gap analysis between the States current physical system capabilities and future system requirements of the HIXHBE, using the requirements detailed in the integrated reference model. State stakeholders selected four legacy systems for full gap analysis based on their potential to meet some or all of the functional and technical requirements of the HIXHBE. The Wakely team analyzed these selected systems in further detail and entered the resultant data into our Gap Analysis Tool. We designed this Gap Analysis Tool to help identify which current physical systems show potential for reuse, including systems that may benefit from augmentation, either functional or technical, to be included in Vermonts HIXHBE. Functional requirements are the business requirements that the Exchange must meet, such as requirements around financial management, customer management, or eligibility and enrollment. Technical requirements are those requirements that the Exchange must satisfy with a technical component, for example, database management, security, workflow engine, or a business rules engine. Appendix B articulates all Exchange technical and functional requirements in detail.

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-03-28-12.pdf STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 4

Major Observations and Recommendations

General The four systems considered for their reuse potential were ACCESS, Vermonts custom-built human and health services eligibility and enrollment system; the Central Source for Measurements and Evaluation (CSME), a custom-built analytics tool; OnBase, a commercial records and document management system; and Event Replicator (EVR), a commercial add-on to ACCESS to enhance access to eligibility and enrollment data. Of these systems, ACCESS displayed limited ERA/MITA 3.0 functionality, and only the commercial product OnBase demonstrated good potential for reuse. In the observations below, we discuss the difference between the needs of an integrated Exchange and modernized eligibility system (i.e., its requirements) and those that existing State systems provide.

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: BH - Subhead2 - Univ 45 B 9/13 Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Left, Keep with next, Keep lines together

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Don't keep lines together

Key Observations
Observation One. Only ACCESS has any of the functional capability required by the ERA. The ACCESS system provides moderate support of less than 25% of the functions required by the Financial Management, Eligibility & Enrollment Operations, and Customer Service & Account Management components. Many of the functions required by these components are not supported, and those that are, are moderately supported by ACCESS. ACCESS technology is over three decades old and limits the prospects of enhancements to meet ERA/MITA requirements. We recommend that the State of Vermont not consider ACCESS for further reuse. There will more than likely need to be better exposure methods to ACCESS data and processes Recommendation One. Recommend further investigation into the reuse of data managed by ACCESS including, but not limited to, eligibility history, household member relations, Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), managed Care, Third Party Liability (TPL), and related transactional data. Observation Two. Overall technical quality of each system is low except for OnBase. We noted the following with respect to technical quality of the ACCESS, EVR CSME and ON Base systems: EVR is a supporting commercial product intended to provide ACCESS data mobility. EVR provides no ERA/MITA functionality and would only be useful if ACCESS is retained and if the EVR approach of exposing ACCESS data is determined to be appropriate.Some ACCESS technology is over 30 years old and as built limits the prospect of enhancements to meet ERA/MITA functional requirements.

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: No underline, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Keep with next Formatted: No underline, Font color: Black, Not Superscript/ Subscript Formatted: BH - Bullet - Univ 45 9/13, No bullets or numbering, Tab stops: Not at 0.72" Formatted: No underline, Font color: Black, Not Superscript/ Subscript Formatted: No underline, Not Superscript/ Subscript

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 5

interoperability point will be required for some time and may have to be enhanced through EVR or other. CSME is intended to be a data warehouse (DW) but has little DW capability and as built limits the prospect of improvements. The CSME system provides no ERA/MITA functionality and has poor technical functionality. CSME should not be considered for reuse. Agreed 100% Leveraging the BI side of this may be an option for reuse as it is a COT BI product suite (SAP Business Objects) that has some footing in SOV OnBase is however a modular commercial content management system, used by the State for records and document management. Its current functionality can be enhanced through purchasing additional modules to fill functional gaps found as a result of this IT Gap Analysis. Recommendation Two. Further investigate OnBase for potential reuse as the Records and Document Management component of the Information Management business support component. Agreed. The deployment and scale of the existing infrastructure that support the current onbase and lack of record schedule implications (full life cycle retention) will all need to be address and governed better.
Formatted: No underline, Font color: Black, Not Superscript/ Subscript Formatted: No underline, Not Superscript/ Subscript

Formatted: No underline, Font color: Black, Not Superscript/ Subscript

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Indent: Left: 0", First line: 0" Formatted: Font: Italic, No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Not Superscript/ Subscript

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 6

Introduction

Formatted: No underline, Font color: White, Not Superscript/ Subscript

Project Context
The Patient Protection and Affordable Care Act (PPACA) was signed into law in March 2010. The Stated aim of the health reform legislation is making health insurance more affordable and more accessible to small businesses and individuals. As defined by the legislation, States are required to make available a HIXHBE where individuals or small businesses will be able to compare and purchase health insurance by October 2013. The passing of this legislation has placed a significant burden on States to implement robust programmatic and technical infrastructure in a very limited time- frame. Most prominent among these requirements is the implementation of the HIXHBE. If the State is to take advantage of the opportunity to implement its own State-based Health Benefits Exchange that will be operated by the existing Department for Vermont Health Access (as opposed to allowing the Federal government to operate an Exchange on the States behalf, or establishing a new state agency) much work needs to be accomplished. The State needs to demonstrate substantial progress by January 1, 2013 so that the Federal government will allow the implementation of an operational Exchange by October 2013.

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Project Objective
The federal government has made available to States Federal Health Insurance ExchangeHealth Benefits Exchange Establishment Grants to set up a HIXHBE. These Establishment Grants are available in two types: a Level One grant, which provides one-year funding to complete planning efforts and to consider how to establish the Exchange; and a Level Two grant, which provides multiyear funding against a specific development plan to establish the Exchange and begin operations. Level One Establishment Grants require certain information and for the State to undertake specific tasks to qualify for federal funding. Among those tasks is the performance of an IT gap analysis, to determine which of the systems in place today (or under development) may be reusable for an State-Integrated Exchange and enhanced eligibility system. The State engaged us to provide assistance with conducting this gap analysis. Specifically, the State charged Wakely Consulting to: 1. Assess existing systems, including software, hardware, and systems interfaces to assess completeness in terms of efficiency and effectiveness in addressing the current needs of the State to support the integrated HIXHBE and modernized eligibility system. Note this task is the subject of this report. 2. Identify the potential gaps between the IT systems selected for the gap analysis and the desired level of Exchange operation as determined by the State of Vermont and the existing systems. Note this task is the subject of this report.
STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 7

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

3. Identify various implementation scenarios given the information for Exchange demand, provided specifically for this review by the State of Vermont. 4. Identify the desired operating levels of service and supporting systems. Organization of this Report This report addresses items one and two, the identification of potential gaps between the IT systems selected for the gap analysis and the target operating model selected by the State of Vermont. We worked closely with the State to help identify their needs for implementing and operating a State HIXHBE. This information highlighted the functional and technical requirements for their target operating model for the Exchange, leveraged to assess a number of systems identified by the State for potential reuse. This report includes a number of summary diagrams and observations depicting the ability of existing systems to meet the functional and technical needs identified by the State. Conversely, the gaps identified and illustrated are of functional and technical areas where the IT systems have minimal or no coverage of Exchange requirements as defined by CMS for the integrated ERA/MITA 3.0 model. The next sections provide information on the approach and analysis in detail. In particular: Description of the gap analysis methodology. Discussion on the current IT system environment, and provides descriptions of the State of Vermont systems assessed for potential reuse. Results from our gap analysis, with clearly identified observations and results. Following the report narrative are four appendices with additional detail about the gap analysis, including the following: Appendix A: IT Systems Current State Details Appendix B: Functional and Technical Components Appendix C: IT Assets Assessment Functional Component Worksheet (Detailed View) Appendix D: IT Assets Assessment Technical Component Worksheet (Detailed View)

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Black, Not Superscript/ Subscript Formatted: No underline, Font color: Black, Not Superscript/ Subscript Formatted: No underline, Font color: Black, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Black, Not Superscript/ Subscript Formatted: No underline, Font color: Black, Not Superscript/ Subscript Formatted: No underline, Font color: Black, Not Superscript/ Subscript Formatted: No underline, Font color: Black, Not Superscript/ Subscript

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 8

Important Notes about this Report The purpose of this report is to document observations that came to our attention during our work and to offer our observations and recommendations for the States consideration. Our procedures consisted of inquiry, observation, and analysis of provided information. Such work does not constitute an audit or attestation. Accordingly, we express no opinion on financial results, processes, other information, or internal controls. The State of Vermont is responsible for the decisions to implement any recommendations and for considering their impact. This report is meant solely for the use of the State management and is not to be reproduced or shared with any third party without Wakely Consultings written consent except as may be allowed by the terms of our Contract agreement.

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 9

Methodology

Formatted: No underline, Font color: White, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Left

The Vermont IT systems assessed in this report are in place, or are now being implemented, and support current health insurance and human service programs. The purpose of the gap analysis is to determine which, if any, of the IT systems have the potential for reuse to support the Vermont HIXHBE. The State will use the results of this analysis as support for the planning its HIXHBE. Our team followed a four-step approach to conduct the gap analysis, as illustrated in Figure 1Figure 1Figure 1.
Step 1 Review Technical & Functional Components

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: White, Not Superscript/ Subscript Formatted Table Formatted: No underline, Font color: White, Not Superscript/ Subscript

Step 2 Identify Relevant Current IT Assets

Step 3 Assess Current IT Assets

Step 4 Conduct Fit-Gap Analysis

Figure 1: Gap Analysis Approach Summary

Formatted: No underline, Font color: White, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Table 1Table 1Table 1 describes each of the steps in the gap analysis approach.
Step Step 1 Review Technical & Functional Components Step 2 Identify Relevant Current IT Assets Step 3 Assess Current IT Assets Objective Validate the technical and functional components to help ensure that each is applicable to Vermont Identify missing components Determine which current IT assets are potential candidates for automating one or more HIXHBE logical component(s) Document each assets ability to fulfill the technical and functional components identified in Step 1 Outputs List of technical and functional components required to support the target operating model

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

List of potential reusable IT assets

Completed assessment spreadsheet indicating if the functions within a component are performed, and the degree to which the functions are performed Matrix of system ratings against individual functional or technical components A rating of each system against overall functional or technical requirements A consolidated scoring of each system in terms of its reusability

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted Formatted Formatted Formatted Formatted ... ... ... ... ...

Step 4 Conduct Fit-Gap Analysis

Assess how well the IT assets identified fit the functional and technology requirements for the component

Table 1: Gap Analysis Approach Steps

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 10

Formatted Formatted Formatted Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Current State IT Systems Environment

Formatted Formatted Formatted Table Formatted Formatted

This section provides an inventory and brief description of the systems eligible for potential reuse in the Vermont HIXHBE. These systems were the subjects of our gap assessment described throughout this document. To qualify for use in a HIXHBE, the system must satisfy at least one functional software component identified as being integral to the logical design defined by the Exchange Reference Architecture. Appendix C shows the logical design. We worked with the State of Vermont to compile a list of nine IT systems for consideration for the gap assessment. The State stakeholders and our client service team compiled a list of systems to be considered. Table 2Table 2Table 2 contains a list of the systems considered as part of the IT Gap Analysis. From the full list, the team identified a subset of IT systems as likely candidates for reuse in the Vermont HIXHBE based on an initial high-level assessment, as well as discussions and interviews with State stakeholders. The IT systems used for the gap analysis included: ACCESS CSME ACCESS CSME
Information System ACCESS CSME OnBase EVR VISION IT Gap Review Yes Yes Yes Yes No ACCESS is not suitable for reuse. System does not provide ERA/MITA functionality. It should be replaced. Potential records and document management solution. EVR will not be required as ACCESS is not suitable for reuse. VISION was not reviewed or assessed for reuse as an Exchange software component. The Exchange will be a user of VISION like every other VT department. If suitable, new interfaces will be required between the premium billing collection components of the Exchange solution and VISION. The MMIS (Medicaid Management Information System) software contract is being renewed. A new interface may be required. System does not provide the functionality or technical capabilities to support the Exchange. System is being retained however a new interface may be required. System is being retained however a new interface may be required.

Formatted Formatted Formatted Formatted Formatted Formatted Table Formatted Formatted Formatted Formatted Formatted Table Formatted Formatted Formatted Formatted Formatted

OnBase EVR OnBase EVR

Leveragability

MMIS

Notices

JP Morgan PBM/SXC Health

No No

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 11

Formatted Formatted Formatted Formatted

Solutions Table 2: IT Gap Analysis Initial Systems Review

Vermont Health Enterprise Systems

Vermont is in the midst of many initiatives to modernize not only its technology (systems, hardware, software, etc.) but also its business processes. The single State Medicaid Agency, the Agency of Human Services (AHS) is currently involved in a modernization effort to integrate AHS s systems and make them more flexible, integrated, and better positioned to support AHS service integration and improved client outcomes. AHS is also seeking to improve and further develop local partnerships, so that the breadth of human services can be provided in a seamless fashion, addressing the full range of client and community needs leveraging shared services, common technology, and detailed information. CMSs MITA 3.0 guideline will help provide the framework to allow the State the ability to meet the goals of increasing electronic commerce and transitioning to a digital enterprise 2.

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Vermont Health Enterprise Implementation Advance Planning Document ( IAPD) , April 2012 STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 12

Table 3 describes tThe State of Vermonts current enterprise IT assets are described in Table 3.
Information System ACCESS

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted ... ...

Description ACCESS is Department of Children and Families (DCF)s eligibility application for all public assistance programs, including health care. ACCESS is also a major system for child support. Supports eligibility and enrollment, financial management, plan management, member management, child support enforcement and document generation. Supports Green Mountain Care (Healthcare), Reach Up (TANF), 3 Squares (SNAP), Low Income Home Energy Assistance Program (LIHEAP), Essential Person, General Assistance (GA), Emergency Assistance (EA), Crisis Fuel, Lifeline, and IV-D programs. CSME is a Microsoft SQL ( Structured Query Language) Server data warehouse that contains information for all departments within AHS supporting all programs.

Platform IBM mainframe

Operating System z/OS 1.11 Natural 4.2.3 Adabas 7.4.4

Formatted Formatted Table Formatted Formatted Formatted: Font: Not Bold, Font color: White Formatted Formatted: Font: Not Bold, Font color: White Formatted Formatted: Font: Not Bold, Font color: White Formatted Formatted: Table_text Formatted Formatted

... ...

...

... ... ... ... ... ... ... ...

CSME

Proliant BL25p G1 4GB RAM 2 AMD Opteron 280 processors Local storage: mirrored 72GB drives SAN storage: 400GB LUN, 800GB LUN, HP EVA 6000, disk group consists of 112 146GB 15K drives

Microsoft SQL Server 2005 9.00.4053.00 (Intel X86)

Formatted Formatted Formatted Formatted Formatted Formatted Formatted: Table_text Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

... ... ... ... ... ... ... ... ...

Information System OnBase

Description Hyland Software COTS (Commercial Off the Shelf) document management solution supporting Healthcare, TANF, SNAP, LIHEAP, GA ( General Assistance), EP (E- Prescribing), SSI (Supplemental Security Income/, Lifeline, and PSE ( Provider & Supplier Enrollment).

Platform Virtual machines, SAN file storage

Operating System SQL 2005 OnBase 11 SP1

Formatted: BH - Table Header, Left Formatted Formatted: BH - Table Header, Left Formatted Formatted Formatted Formatted: Table_text Formatted Formatted Formatted Formatted ... ... ... ... ... ... ... ...

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 13

EVR

EVR replicates real-time data from ACCESS to an SQL database. Supports Healthcare, TANF, SNAP, LIHEAP, GA, EP, SSI, Lifeline, Crisis Fuel, PSE, and IV-D.

IBM Z9 mainframe

z/OS 1.11 mainframe operating system Windows Server 2003 Enterprise (64 bit)

Formatted: Font: Bold, No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Table_text Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript

Table 3: Vermont Systems Summary

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 14

Gap Analysis Summary

Formatted: No underline, Font color: White, Not Superscript/ Subscript

Step 1 Review Technical & Functional Components

Step 2 Identify Relevant Current IT Assets

Step 3 Assess Current IT Assets

Step 4 Conduct Fit-Gap Analysis

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Step 1 Review Technical and Functional Components

The Wakely team reviewed the technical & functional components with Vermont. Given that the State of Vermont asked Wakely Consulting to plan for a fully functional Exchange, all of the functional and technical components are required in the target architecture for the States Exchange.

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript

Step 2 Identify Relevant Current IT Assets

The team assessed nine Vermont IT systems as part of the Gap Analysis. Based on the understanding gained from the review of the HIXHBE Logical Component Model, we worked with State stakeholders to help to comprise and refine a list of potential systems for further evaluation. Of the five systems the team identified, OnBase is the only system that appears to have significant potential for reuse in the Exchange.
Current IT Systems OnBase System Description Hyland Software commercial records and document management system supporting Healthcare, TANF, SNAP, LIHEAP, GA, EP, SSI/AABD, Lifeline, Crisis Fuel, PSE, IV-D. Custom-built Natural/Adabas application supporting Healthcare, TANF, SNAP, LIHEAP, GA, EP, SSI/AABD, Lifeline, Crisis Fuel, PSE, IV-D. Software AG software package designed to replicate data real-time from ACCESS to a SQL database. Supports Healthcare, TANF, SNAP, LIHEAP, GA, EP, SSI/AABD, Lifeline, Crisis Fuel, PSE, IV-D. This might be wrong or inadequate suite of products to expose ACCESS data and process in a SOA world. just a comment Microsoft SQL Server data warehouse that contains information for all departments within AHS supporting all programs.

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: BH - Body - Univ 45 9/13, Keep with next Formatted: No underline, Font color: White, Not Superscript/ Subscript Formatted Table Formatted: No underline, Font color: White, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

ACCESS

EVR

CSME

Table 4: Current IT Assets

The four identified systems address the Exchange functionality requirements to varying degrees. The Exchange components have been listed in Appendices B, C, D.

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 15

Being potential candidates for the future State Health Insurance ExchangeHealth Benefits Exchange, we then assessed each of these systems for their level of fit for performing the duties of the functional and technical components defined by the CMS ERA/MITA 3.0 guidelines.

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Step 3 Assess Current IT Assets

The Wakely Consulting team, along with Vermont staff, sought to gauge each systems capability in performing functions for the various functional and technical components defined by ERA/MITA 3.0 . We then assessed each system as to whether or not it performs the functions of each component and to what degree it performed the functions within the component. In seeking to assess whether or not the system performed the function, we assigned the subject system a value of yes, no, or unknown unknown indicating that further investigation was required prior to determining a yes or no value. If a system performed a function, we assessed the system as High, Medium, or Low to indicate the extent to which a system performs all of the functions within a component. We assessed the system N/A should it not perform the function and Unknown if the value of the systems ability to perform the function was not known. In order to use this assessment approach for calculating a systems potential support for a component, we employed the following schema (see Table 5Table 5Table 5) to score the ratings provided to each function of each component:
Value High Medium Low N/A Unknown Rating Implication The system provides 100% of the required functions for the component. The system provides 50% of the required functions for the component. The system provides 10% of the required functions for the component. The system does not provide the required functions for the component the rating assigned is 0%. Whether the system provides any of the functionality of the component was not determined the rating assigned is 0%.

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: White, Not Superscript/ Subscript Formatted: No underline, Font color: White, Not Superscript/ Subscript Formatted Table Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Centered Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Centered Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Centered Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Centered Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Centered Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript

Table 5: IT Assets Assessment Rating Scale

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 16

Figure 2Figure 2Figure 2 depicts an extract of the worksheet used to record this information during our system (functional) assessment efforts.
Functional Components Service capability indicator
Functional Component Plan Certification & Risk Management Plan Certification & Risk Management Plan Certification & Risk Management Plan Certification & Risk Management Plan Certification & Risk Management Plan Certification & Risk Management Plan Certification & Risk Management Plan Certification & Risk Management Plan Certification & Risk Management Service Performed by Component

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Space After: 5 pt

Service capability measure Explanatory comment

System 1 System 2 Performs Function Performs Function Comments Comments Function? Implementation Function? Implementation 0 Yes No Yes Yes Yes No No Yes Yes Med Med Low N/A N/A Hi Hi No No No No No No No N/A N/A N/A N/A N/A N/A N/A Current Physical Systems

Plan Certification Manage Plan Submission Process Certify / Recertify / Decertify Plan Form QHP Agreement with Issuer Manage Issuer and Plan Information Report Issuer and Plan Information Assign Plan Quality Rating Process Change in Plan Enrollment Availability

Figure 2: IT Assets Assessment Functional Component Worksheet

Appendix C: IT Assets Assessment Functional Component Worksheet (Detailed View) displays the detailed version of the IT Assets Assessment Functional Component WorksheetFigure 3 depicts an extract of the worksheet used to record information during our system (technical) assessment efforts.
Technical Components Service capability indicator
Current IT Systems Technical Component InRHODES Rite Share

Service capability measure Explanatory comment

Performs Function?
Information Management

Function Implementation

Comments Custom reporting through use of Natural programs. Internal identifier used among all programs

Performs Function?

Function Implementation

Comments

Yes Yes No No

Low Low N/A N/A

No No No No

N/A N/A N/A N/A

Master Person Index Knowledge Management Financial Transaction Procesing

Business Process Management

Yes

Med

Custom coding for alerts to worker. Xerox Elixir software for generation of documents through CSE portion of system.

N/A

Figure 3: IT Assets Assessment Technical Component Worksheet

Appendix C: IT Assets Assessment Functional Component Worksheet (Detailed View) displays the detailed version of the IT Assets Assessment Functional Component Worksheet. Appendix D: IT Assets Assessment Technical Component Worksheet (Detailed View) displays the detailed version of the IT Assets Assessment Technical Component Worksheet. Using this information, the next step in the process was to analyze how well each of the identified IT assets fits the needs of each of the functional and technical components defined by CMS for the Exchange.

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline Formatted: BH - Body KWN - Univ 45 9/13 Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 17

Step 4 Conduct Fit-Gap Analysis

We created a Gap Analysis Tool that used the input from Step 3 to calculate the reuse potential of the State assets evaluated. We translated the assessment data provided in Step 3 into scores, which were then used to rate each systems ability to perform the functions and to help determine the level of reuse to recommend. Those levels of reuse included reuse with no changes, reuse with system augmentation, or no reuse. We only assessed the systems against those components they were intended to support.

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 18

The Gap Analysis Tool provided three outputs to summarize the analysis. 1. A matrix of system ratings against individual functional or technical components The system-ratings matrix illustrates the scoring of each subject IT system against each functional component. Table 6Table 6Table 6 describes the colors used in the matrix.
Color Green Yellow Red Grey White Description The functions that this system supports for this component average a rating of High. The functions that this system supports for this component average a rating of Medium. The functions that this system supports for this component average a rating of Low. The functions that this system supports for this component average a rating of Unknown. The system was not designed to provide this functionality.

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Page break before Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: White, Not Superscript/ Subscript Formatted: No underline, Font color: White, Not Superscript/ Subscript Formatted Table Formatted: No underline, Not Superscript/ Subscript Formatted: Centered Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Centered Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Centered Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Centered Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Centered

Table 6: System Fit-Gap Rating Scale

The percentage within each cell indicates how much of the components required functionality the system provides. For example, a system component with a color of red and a percentage of 50% provides low functionality to one-half (50%) of its rated components. This same system could also receive a color of yellow for another component with a percentage of 50%, meaning that this component provides medium functionality to one-half of its rated components. 2. A rating of each system against overall functional or technical requirements A graph illustrating the score of the IT assets components against all reference functional and technical components. As an example, an IT asset that scores high in each of the components against which it is assessed would have a corresponding high rating on the graph. 3. A consolidated scoring of each system in terms of its reusability A bubble chart showing the functional and technical alignment of each IT asset as well as the degree to which the asset meets technical and functional requirements.

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 19

Functional Observations
Table 7Table 7Table 7 summarizes the ability of each system to meet the requirements for each of the functional components defined by ERA for an Exchange. As can be seen in Table 8, all of the systems assessed are capable of supporting only a small amount of component functionality.

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Current IT Systems Functional Component

IT Management Financial Accounting & Reporting Asset Management Human Resource Management Procurement Management Business Agreement Management Policy & Oversight Plan Management Financial Management Eligibility & Enrollment Operations Care Management Claims Management Broker/Navigator Rel'n Mgmt Marketing & Outreach Customer Service & Account Management
Table 7: Functional Component Fit-Gap Rating

ACCESS 0% 0% 0% 0% 0% 0% 0% 0% 23% 22% 0% 0% 0% 0% 22%

CSME 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

OnBase 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

EVR 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Space After: 5 pt

Figure 4Figure 4Figure 4 illustrates how much functionality each of the above systems provides relative to the requirements of the functional components covered by the system. It indicates a relative rating of how effective a system is at meeting the overall functional requirements.
Total Function Percentage Score for the System
Based on Functional Components

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: No underline, Not Superscript/ Subscript Formatted: Space After: 5 pt

60%

40%

20%

0% ACCESS CSME OnBase EVR

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 20

Figure 4: Total Function Percentage by System (for Functional Components)

Plan Management This component includes the processes to assess the actuarial value, benefit design, and quality of the plan to facilitate certification and quality rating of plans. In addition, this function includes management of the plan and carrier relationship. Observation: None of the systems assessed provide Plan Management functionality. Financial Management This component includes the processes to manage the risk adjustment processes as well as premium and tax credit processing. Observation: ACCESS provides limited financial management capabilities (e.g., premium AP/basic AR) covering less than 25% of the required functions, with moderate support of those supported functions. Eligibility and Enrollment Operations This component includes the processes to support insurance plan comparison-shopping, eligibility assessment, enrollment processing, and appeals management. Observation: Only ACCESS supports Eligibility and Enrollment Operations providing coverage to less than 25% of the required functions with moderate support of those supported functions. Broker/Navigator Relationship Management Broker/Navigator Relationship Management includes the processes necessary to manage the relationship between the Exchange and brokers and navigators through a portal, connect Navigators to consumers, measure Navigator performance, facilitate broker quoting of insurance plans, and provide broker incentive compensation capability. Observation: None of the systems have the necessary functionality required to meet the Broker/Navigator Relationship Management functional requirements for the Exchange. Marketing and Outreach Much of the marketing and outreach activities of an Exchange are not automated for the target population of the Exchange before a client is enrolled. Post enrollment, the Exchange solution should provide functionality to provide notifications and marketing communications to enrolled clients about open enrollment periods, new coverage options, etc. Observation: None of the systems provide the necessary functionality to satisfy the functional requirements for Marketing and Outreach.

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 21

Customer Service and Account Management This function includes member, provider, and contractor management processes, broker relationship management processes, and related support processes. Observation: Only ACCESS supports Customer Service and Account Management, providing coverage to less than 25% of the required functions with moderate support of those supported functions. IT Management This function includes application management, IT operations management, technical management, and service desk management. Observation: None of the systems reviewed provide the required functionality for the Information Technology Management component. Financial Accounting and Reporting The Financial Accounting & Reporting component enables generation of financial reports and publishes these reports to stakeholders. It supports accounting of all financial transactions and all assets and liabilities. Observation: None of the systems reviewed provide the required functionality for the Financial Accounting and Reporting Management component. Asset Management The Asset Management component enables and supports the tracking and maintenance of all valuable HHS agency resources. This may include things such as laptops, smart phones, servers, software, etc. Observation: None of the systems reviewed provide the required functionality for the Asset Management component. HR Management The component supports the management of the HHS agency human resources. The type of functionality within this component supports functional areas like payroll, employee relations, recruitment, training and development, employee benefits and performance appraisals. Observation: None of the systems reviewed provide the required functionality for the HR Management component. Procurement Management VISION is a PeopleSoft ERP system that supports Accounting & Reporting, Policy & Oversight, Procurement Management, Asset Management and HR Management. It is four versions behind the current product and the State is currently considering VISION for replacement, which is

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 22

independent of the Exchange implementation and eligibility modernization. VISION was not reviewed or assessed for reuse. Observation: VISION may be a candidate for business reuse. Financial Accounting and Reporting The Financial Accounting & Reporting component enables generation of financial reports and publishes these reports to stakeholders. It supports accounting of all State financial transactions and all assets and liabilities. Observation: VISION may be a candidate for limited business reuse. 3 Asset Management The Asset Management component enables and supports the tracking and maintenance of all valuable State assets. Observation: VISION may be a candidate for limited business reuse. 4 HR Management The HR Management component supports the management of the State human resources. The type of functionality within this component supports functional areas like payroll, employee relations, recruitment, training and development, employee benefits and performance appraisals. Observation: VISION may be a candidate for limited business reuse. 5 Procurement Management The Procurement Management components supports the management of State services and product procurement. Observation: VISION may be a candidate for limited business reuse. 6
Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Indent: Left: 0" Formatted: No underline, Font color: Auto

Formatted: Indent: Left: 0", Don't adjust space between Latin and Asian text Formatted: Indent: Left: 0"

Formatted: No underline, Font color: Auto Formatted: Indent: Left: 0", Don't adjust space between Latin and Asian text Formatted: Indent: Left: 0" Formatted: No underline, Font color: Auto

Formatted: Indent: Left: 0", Don't adjust space between Latin and Asian text Formatted: Indent: Left: 0" Formatted: No underline, Font color: Auto

Formatted: Indent: Left: 0", Don't adjust space between Latin and Asian text Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: BH - Subhead1 - Univ 45 13/14 Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Functional Observation Summary

The Wakley team recommends that none of the four IT systems assessed should be considered for significant reuse to support any of the fifteen functional components defined by ERA/MITA
3

VISION is the designated State Financial Management System, and the Exchange will use it in accordingly as do other State departments. VISION supports Financial Accounting & Reporting, Asset Management, HR Management and Procurement Management. While VISION has Accounts Payable and Accounts Receivable functionality, as the State Financial Management System it is unsuitable for use for the Exchange Billing and Collection function. In addition, VISION is currently out of date for configuration with the current Oracle stack planned for the Exchange. VISION is the States designated Financial Management System and the Exchange plans to use VISION accordingly as do other State departments. VISIONs capabilities currently support Financial Accounting & Reporting, Asset Management, HR Management and Procurement Management. While VISION does offer Accounts Payable and Accounts Receivable functionality, it is not suitable for use in support of the Exchanges anticipated Billing and Collection function. Furthermore, the current version of VISION is not configurable to the Oracle hardware suite planned for the Exchange. 4 ibid 5 ibid 6 ibid STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 23

Formatted: English (Canada) Formatted: English (Canada) Formatted: English (Canada) Formatted: English (Canada)

3.0 for the Vermont Health Insurance ExchangeHealth Benefits Exchange. In addition, the State should consider outsourcing, or using a different solution than VISION, such as PeopleSoft AP and AR, for the premium billing and collection functionality of the Exchange Financial Management component.

Technical Observations
Similar to the functional observations, we created a table to summarize the ability of each system to meet the technical requirements for each of the technical components for the Vermont HIXHBE. Table 8 shows tThis summary is shown in Table 8Table 8Table 8. The same scoring mechanism is used as the one described earlier; however, many of the technical components are considered to be building blocks for providing basic capabilities that other components access. The technical components were rated as either being provided or not provided and therefore we report no functional support for the specific component.

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Space After: 5 pt

Table 8: Technical Component Fit-Gap Rating

Information Management The Information Management component facilitates the collection of data pertaining to system performance and usage patterns and creates reports to improve system performance and service offerings.

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 24

OnBase provides a small degree of the Information Management functionality and implements it well. Both ACCESS and CSME provide limited Information Management functionality, but implement it poorly. Agreed. Observation: The OnBase low score is partially attributable to the CMS allocation of function between Information Management and Knowledge Management. The combined score suggests it may be a strong candidate for reuse, and further exploration is warranted. ACCESS and CSME do not provide the necessary functionality for this component. Agreed. Knowledge Management The Knowledge Management component supports the management of content on various electronic media and associated metadata to support content classification and retrieval (e.g., videos and presentations for marketing and training purposes). OnBase provides a large degree of the Knowledge Management functionality and implements it well. Both ACCESS and CSME provide limited Information Management functionality, but implement it poorly. Observation: The OnBase high score is partially attributable to the CMS allocation of function between Knowledge Management and Information Management. The combined score suggests it is a strong candidate for reuse, and further exploration is warranted. Workflow and Rules Management Workflow and Rules Management component supports the design, configuration, and execution of system workflows such as screening, intake, assessment, application processing, and eligibility determination, among other tasks. It also serves as a documented repository of business logic as well as being an executable part of the overall architecture in the application of those rules within the architecture. Both ACCESS and OnBase provide a limited amount of workflow and business rules management functionality. ACCESS incorporates business rules and workflow directly into its source code, making their access and reuse very difficult. OnBase is a modular commercial product that could be enhanced with the purchase of workflow and rules management modules, but is not designed to be an enterprise workflow or rules management system. Observation: None of the systems have the necessary capabilities to satisfy the requirements for the Workflow and Rules Management component. Master Person Registry The Master Person Registry component matches and identifies clients as well as providers across multiple systems and ties them together via a composite index. The component supports probabilistic matching of clients and providers and how it supports unique identification of persons who may be the AHHS agency clients and providers.

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Don't keep lines together Formatted: No underline, Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 25

ACCESS provides all of the Master Person Registry functionality, but is technically poor. It does not have self service functionality nor logic. I agree strongly the ACCESS 1 or 2 tables that makeup the 700k records depicting people may be used as a data source for MDM solution but that is it.

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: Font color: Auto

Observation: None of the systems have the necessary capabilities to satisfy the requirements for the Master Person Registry component. Agreed Financial Transaction Processing The Financial Accounting & Reporting component enables generation of financial reports (e.g., monthly summary reports, annual report) and publishes these reports to stakeholders. It supports accounting of all financial transactions and all assets and liabilities. ACCESS provides a small amount of financial transaction processing functionality, but is technically weak. Observation: None of the systems have the necessary capabilities to satisfy the requirements for the Financial Transaction Processing component. Identity and Access Management The Identity and Access Management component manages user identity and access privileges. All systems provide some form of identity and access management functionality. ACCESS uses a combination of RACF (Resource Access Control Facility) plus homegrown user authentication. CSME security is poor and users have access to database tables.I am not sure that is the case as tables should be abstracted through Business Object universes but I guess it is irrelevant as CSME needs to go away. OnBase provides strong identity and access management, but this is limited to OnBase access. Observation: None of the systems have the necessary capability to satisfy the requirements for the Identity and Access Management component. Intrusion Management The Intrusion Management component detects and prevents malicious code and viruses. Observation: None of the systems have the necessary capability to satisfy the requirements for the Intrusion Management component. Agreed, we have EA standard technology to introduce here. Confidentiality Management The Confidentiality Management component performs encryption and data anonymization.

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Font color: Auto Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 26

Confidentiality management varies from system to system. The State of Vermont believes ACCESS to be HIPAA compliant and is IRS ( Internal Revenue Services) safeguard compliant. Observation: None of the systems have the necessary capability to satisfy the requirements for the Confidentiality Management component. Data Management The Data Management component performs data indexing, storage, retrieval and transformation. Both CSME and EVR provide much of the required component functionality but implement it insufficiently. Hence they do not satisfy the requirements for Data Management. Observation: None of the systems surveyed provide the technical components needed to satisfy the Data Management (Indexing & Storage, Retrieval, and Transformation) component requirements of the Exchange. Unified Communications This component provides access to the HHS AHS agency programs and services via telecommunication services such as Interactive Voice Response, E-Mail, Fax, and Text Messaging. Observation: None of the systems surveyed provide the technical components needed to satisfy the Unified Communications component requirements of the Exchange. HHS Portal The HHS portal is a single point of access Web application user interface that allows all users to access the AHHS (Agency of Human Services) agency programs and services. It has multiple views available for Employer, Employee, Consumer, Carrier, Broker and Customer Service Rep Observation: None of the systems surveyed provide the technical components needed to satisfy the HHS (Health & Human Services) Portal component requirements of the Exchange. Integration Broker The Integration Broker component facilitates the information Exchange and interfaces with external systems including federal information sources such as the IRS, Social Services Administration (SSA), or vital records for verification and data purposes via an Enterprise Service Bus. Observation: None of the systems surveyed provide the technical components needed to satisfy the HHS Portal component requirements of the Exchange.

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 27

Technical Observation Summary

The Wakley team evaluated the four IT systems against the sixteen technical components defined by the ERA/MITA 3.0 guidelines and found only OnBase to be a suitable candidate for reuse. The team recommends further exploration of OnBases suitability.

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: BH - Subhead1 - Univ 45 13/14 Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: No underline, Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Font color: Auto, Not Highlight Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

Gap Analysis Summary

The degree of functional and technical capability of each system is summarized in the bubble chart (Figure 5Figure 5Figure 5). Systems in the top right quadrant (high functional and technical capability) are candidates for reuse. Systems in the bottom left quadrant (low functional and technical alignment) are not candidates for reuse by the HIXHBE and may be candidates for retirement in a legacy renewal initiative. Systems in the top left quadrant have strong functional alignment but poor technical alignment; to be reusable, some improvement of the technical platform would be required. Systems in the bottom right quadrant have strong technical alignment but poor functional alignment. The technical elements of these systems might be reusable as a base from which to build out more aligned functionality.

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript Formatted: Space After: 5 pt

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 28

Figure 5: Functional and Technical Capabilities Summary

OnBase appears in the lower right quadrant, indicating that it is a good technical reuse candidate in a Vermont Exchange. It can be considered for reuse for the records and document management component of Information Management. The State may however need to purchase additional modules to fill the current functional gaps and . Ssome redesign and redeployment may also be required.Modules, redesign/deployment will more than likely be required. Agreed it is the best suited product that exists of all reviewed for reuse/expansion. ACCESS appears in the upper left quadrant indicating that it provides moderate Exchange/MITA functionality but is technically unsuitable. ACCESS data should be considered for reuse. I would assume that ACCESS data and service exposure is more important and required than leveraging it for application solution. EVR system is a commercial add-on to ACCESS and it appears in the lower right quadrant indicating that it provides no ERA/MITA functionality and is only useful if ACCESS is retained and the EVR approach of exposing ACCESS data is determined to be appropriate. Access will be around but unclear the exact requirements other than for data consolidation, MDM and other. EVR is still possibly the wrong approach to exposing this data. The CSME system appears in the bottom left quadrant indicating that no ERA/MITA functionality and has poor technical functionality. CSME should not be considered for reuse.

Formatted: No underline, Font color: Auto, Not Superscript/ Subscript

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 29

Appendices

Formatted: No underline, Font color: White, Not Superscript/ Subscript

List of Appendix Sections

Appendix A: IT Systems Current State Details Appendix B: Functional and Technical Components Appendix C: IT Assets Assessment Functional Component Worksheet (Detailed View) Appendix D: IT Assets Assessment Technical Component Worksheet (Detailed View)

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)), Not Superscript/ Subscript Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 30

Appendix A: IT Systems Current State Details

Formatted: No underline, Font color: White

Understanding Appendix A
Appendix A contains the IT System Asset Sheets for some VT IT systems collected to inform the teams gap analysis work. The team collected these responses directly from the system owners or their designees. We did not modify the information provided prior to incorporating it into this report. The key terms described below were used in the IT System Asset Sheets artifact. A systems Create, Read, Update, and Delete (CRUD) operations show those functions that perform some combination of four distinct operations on the systems data. The letters components have the following meaning:
Abbreviation C Name Create Description The system functions produce information within the specified subject area (i.e., the business process needs to have the ability to create/store such information in a repository). The system functions require use of the information from the specified subject area. Common usage for information being read is for display and analytical purposes. The system function revises information within the specified subject area (i.e., updates an existing record). The business process erases information within the specified subject area. Information about entities in the indicated subject area is permanently removed from the repository.

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)) Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: White Formatted: No underline, Font color: White Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: Auto Formatted Table Formatted: No underline, Font color: Auto Formatted: Left Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: Left Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto

Read

Update

Formatted: No underline, Font color: Auto Formatted: Left

Delete

Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: Left

ACCESS
System Acronym System Description ACCESS ACCESS is DCFs eligibility application for all public assistance programs, including healthcare. ACCESS also is a major system for child support. Eligibility and enrollment, financial management, plan management, member management, child support enforcement, and document generation Green Mountain Care (healthcare), Reach Up (TANF), 3 Squares (SNAP), Supplemental Fuel (LIHEAP), Essential Person, General Assistance, Emergency Assistance, Crisis Fuel, and Lifeline, IV-D

Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Custom Color(RGB(0,51,141)) Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: Auto Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: Auto Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto

Business Process/Function Programs Supported

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 31

Formatted Formatted Table Formatted Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Development Platform Hardware Software IBM mainframe z/OS 1.11, Natural 4.2.3, Adabas 7.4.4 Currently going through hardware and Software refresh Production Platform Hardware Software Single-Tier, Two-Tier, Multi-Tier, Hybrid Same as development Same as development Single-tier; database and Natural code reside on the same mainframe. Natural code includes both the user interface and application. There are mirrored environments utilizing async mirroring. DR

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Table Formatted Formatted

Message-Oriented Middleware Web Services SOA Open Architecture VPN Web Access FTP ETL API (Application Programming Interface) Adapters Other data Exchange

EntireX 8.1.1

Formatted Formatted

None None None None None z/OS FTP; utilizes FTPS but not SFTP Event Replicator 3.2.1, TRelational None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

None Connect: Direct, TIBCO MFT

Formatted Formatted Formatted Formatted Formatted

User Access and Authentication Services User Interaction Services (i.e., 3270, 3270 emulation, Web front-end) Data Access (i.e., database adapters) Enterprise Information Management (i.e., data warehouse, data Exchange, integration with enterprise tools)

RACF plus homegrown user authentication 3270 emulation

Formatted Formatted Table Formatted Formatted

Natural and Adabas are integrated Data shipped via Event Replicator 3.2.1 to DCF IV-A data repository and PEAKS IV-D data repository; data shipped via TRelational to CSME

Formatted Table Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 32

Formatted Formatted Formatted Formatted Table Formatted

Management Services (i.e., vendor, State agency)

Department for Children and Families (DCF)

Formatted Formatted Formatted

Interfaces and Inputs Type (point-to-point, Web services, etc.) Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Source/Destination Inputs Numident 4 SDX (State Data Exchange) BENDEX (Beneficiary Data Exchange) SVES IRS OCS Federal Registry TOPS CSNET Newhire NCIC ACF MMA COB LIS MMIS Maximus eFunds Credit bureaus DMV VSARA Courts Dept. of Labor Dept. of Tax Dept. of Financial Reg. Lottery

Format (XML, flat file, etc.) Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 33

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Table Formatted Formatted Formatted

Interfaces and Inputs Type (point-to-point, Web services, etc.) Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Message-oriented middleware Point-to-point Message-oriented middleware Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point Point-to-point

Formatted Formatted

Source/Destination Outputs Numident SDX BENDEX SVES IRS OCS Federal Registry TOPS CSNET Newhire NCIC ACF MMA COB IV-A Notices IV-D Notices Vision MMIS PBM TD Bank Maximus eFunds Credit bureaus Dept. of Motor Vehicles Archives and Records (VSARA) Courts Dept. of Labor Dept. of Tax Dept. of Financial Regulation Lottery SSMIS Bright Futures Dept. of Education

Format (XML, flat file, etc.) Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Message/flat file Message Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file Flat file

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 34

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Table Formatted Formatted Formatted

Core Business Functions Function Eligibility and enrollment Financial management Description Performs eligibility and enrollment for all supported programs. Payment system for all IV-D and nonhealthcare IV-A programs. Sends payment data to MMIS for healthcare programs. Collection system for IV-D and healthcare. Billing system for healthcare. Master plan index for subsidized Catamount plans. Case management solution for all IV-A and IV-D programs. Member management solution for all members of IV-A and IV-D cases. Enforcement management system for all IV-D cases. Generates notice content for IV-A (Notices) and IV-D (VRU) notice systems.

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Plan management Member management

Child support enforcement Document generation

Core Technology Components Offered Portal Client Relationship Management (CRM) Case Management Records/Document Management Business Workflow Management Business Rules Management Financial Management Business Intelligence Integration Management Reporting Master Person Indexing Calculators No No Supporting Technology

Formatted Table Formatted Formatted Formatted Formatted Formatted

Yes Yes

None. Integrated in code Limited management of notices in conjunction with Notices VB application.

Formatted Formatted Formatted Formatted Formatted

Yes

None. Integrated in code

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Yes No No Yes Yes Yes

None. Integrated in code

None. Integrated in code None. Integrated in code None. Integrated in code

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 35

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Maintenance and Upgrades Current/In-Progress Future Plans Will be replaced by VIEWS. Supported programs will be removed in phases.

Scalability

Poor. The mainframe can be upgraded as necessary to accommodate work. However, additional work often results in the breakdown of Event Replicator, which cant keep up. Breakdowns of Event Replicator result in extended high-load ACCESS batch processes that counter any performance advantages realized by mainframe upgrades. Very poor. Numerous kludges and spaghetti code solutions often result in breaking one process to fix another process. Very poor. System was originally designed on a business model developed 30 years ago. Subsequent changes to that model were accommodated with kludges and spaghetti code. Recent attempts to radically change the business model have been severely restricted by the extensibility limitations of ACCESS. Fair. The mainframe lies off the main network, which allows ACCESS to remain online when network issues take other systems offline. ACCESS requires downtime of a few hours per night and several hours per weekend for routine batch jobs and system maintenance.

Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: Auto Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto

Serviceability

Extensibility

Reliability

Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto

Formatted: Space After: 5 pt

Standards (met and how met) Security (i.e., HIPAA, FIPS, Role-based, data in motion, and at-rest, etc.) Role-based security model. HIPAA (Health Insurance Portability and Accountability Act) compliant to the best of our knowledge. IRS Safeguards compliant. N/A

Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto Formatted: Space After: 5 pt

Other (i.e., Section 508, NIEM, HL7, etc.)

Central Source for Measurements and Evaluation

System Acronym System Description Business Process/Function Programs Supported CSME Central Source for Measurements and Evaluation An attempt at an enterprise data warehouse.

Formatted: No underline, Font color: Custom Color(RGB(0,51,141)) Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: Auto Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto

All Agency Departments.

Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto Formatted: Space After: 5 pt

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 36

Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Development Platform Hardware Software Nonexistent (lost in flood). To be reinStated. Nonexistent (lost in flood). To be reinStated. Production Platform Hardware Proliant BL25p G1 4GB RAM 2 AMD Opteron 280 processors Purchased 10-26-2006 Local storage: mirrored 72GB drives SAN storage: 400GB LUN, 800GB LUN, HP EVA 6000, disk group consists of 112 146GB 15K drives Microsoft SQL Server 2005 9.00.4053.00 (Intel X86) May 26, 2009 14:24:20 Copyright (c) 1988-2005 Microsoft Corporation Enterprise Edition on Windows NT 5.2 (Build 3790: Service Pack 2) Business Objects Data Integrator 11.7 Single-Tier Not correct as the business object deployment is multi tier

Formatted Table Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Software

Single-Tier, Two-Tier, Multi-Tier, Hybrid

Message-Oriented Middleware Web Services SOA Open Architecture VPN Web Access FTP ETL

N/A

Formatted Formatted Formatted Table

N/A N/A N/A N/A N/A Receiver (only) of ETL files 1. 2. N/A N/A SQL Server Integration Services Business Objects Data Integrator

API Adapters

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 37

Formatted Formatted Formatted Formatted Table Formatted

User Access and Authentication Services

Most users have direct access to databases and their tables (not through security groups, not through database views as preferred). N/A

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

User Interaction Services (i.e., 3270, 3270 emulation, Web front-end) Data Access (i.e., database adapters)

SSMS .NET Data warehouse

Enterprise Information Management (i.e., data warehouse, data Exchange, integration with enterprise tools) Management Services (i.e., vendor, State agency)

State Agency of Human Services

Formatted Table Formatted Formatted Table Formatted Formatted

Interfaces and Inputs Type (point-to-point, Web services, etc.) Point-to-point T-Relational FTP point-to-point Point-to-point FTP point-to-point N/A

Source/Destination Inputs SPHINX_MH (source) ACCESS (source) Medicaid (source) SSMIS (source) VOCREHAB (source) Outputs Various ad hoc queries and reports.

Format (XML, flat file, etc.) SSIS (SQL to SQL) Flat files Flat files SSIS (SQL to SQL) Flat files Varies

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Core Business Functions Function N/A Description

Formatted Formatted Formatted Formatted Formatted Formatted

Core Technology Components Offered Portal Client Relationship Management (CRM) Case Management No No Supporting Technology

Formatted Formatted Formatted Formatted Formatted Formatted Table

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 38

Formatted Table Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Table Formatted Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Core Technology Components Offered Records/Document Management Business Workflow Management Business Rules Management Financial Management Business Intelligence No Supporting Technology

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted

No Yes SSRS Business Objects SSIS Business Objects Data Integrator SSRS Business Objects

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Integration Management

Yes

Reporting

Yes

Master Person Indexing Calculators

No No

Maintenance and Upgrades Current/In-Progress Planning to virtualize the production server. Remove ACCESS data set (replaced with EVR system). Dismantle the structure (replace with scalable, stable solutions). THROW IT AWAY

Formatted Formatted Formatted Formatted Table

Future Plans

Formatted Formatted Formatted

Scalability Serviceability Extensibility Reliability

Poorly designed does not scale Highly volatile requires much DBA baby-sitting Poorly designed not extensible Poorly designed not reliable both technically and with regard to data, e.g., person/organization matching algorithm not tuned well (lack of requirements).

Formatted Formatted Formatted Table Formatted Formatted Formatted Formatted Formatted

Standards (met and how met) Security (i.e., HIPAA, FIPS, Role-based, data in motion and at-rest, etc.) Other (i.e., Section 508, NIEM, HL7, etc.) Security is extremely loose within CSME. Permissions are overStated and users are allowed direct table access.

Formatted Formatted Formatted Formatted Formatted Table Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 39

Formatted

Formatted Formatted Table Formatted Formatted Formatted

Other Information

Formatted Table Formatted Formatted Formatted Table

OnBase
System Acronym System Description Business Process/Function Programs Supported OnBase Document management system Document management and workflow

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Table Formatted Formatted

DCF business office, OCS, ESD

Development Platform Hardware Software Virtual machines, SAN file storage SQL 2005, OnBase 11 SP1 Production Platform Hardware Software Single-Tier, Two-Tier, Multi-Tier, Hybrid Virtual machines, Blade servers for SQL, SAN file storage SQL 2005, OnBase 9.0 Hybrid

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Message-Oriented Middleware Web Services SOA Open Architecture VPN Web Access FTP ETL API Adapters

Formatted Table Formatted

Yes

Formatted Table Formatted Formatted

No No Yes No No Yes

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 40

Formatted Formatted Formatted

Formatted Formatted Formatted Table Formatted Formatted Table Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

AD integration Web front-end, thick client

Formatted Formatted Formatted Formatted Formatted Table

Integrations available

Formatted Formatted Formatted

AHS

Formatted Table Formatted Formatted Table

Interfaces and Inputs Type (point-to-point, Web services, etc.) OnBase client COLD imports DIP imports API API

Formatted Formatted

Source/Destination Inputs Scanners/OnBase Mainframe/OnBase SecurShred/OnBase Web Application/OnBase .NET Application/OnBase Outputs

Format (XML, flat file, etc.) Tiff TEXT Tiff XML PDF

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Core Business Functions Function Document management Description ESD, OCS, and DCF business office store and retrieve at least a portion of their files from OnBase. OnBase workflow is used to load balance and route ESD 202 applications (and other ESD applications for assistance) and supporting documents for processing.

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Table Formatted Formatted Formatted Formatted Table Formatted Formatted Formatted Formatted

202 Application (and other applications for assistance) processing

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 41

Formatted Formatted Table Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted

Yes

Workflow module

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Maintenance and Upgrades Current/In-Progress Future Plans Upgrade to OnBase 11 in progress Expanding to other departments

Formatted Formatted Formatted Formatted Table Formatted Formatted Formatted Formatted Formatted Formatted

Scalability Serviceability Extensibility Reliability

As needed Good

Good

Formatted Table Formatted Formatted Formatted Formatted Formatted Formatted Table Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 42

Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Standards (met and how met) Security (i.e., HIPAA, FIPS, Role-based, data in motion and at-rest, etc.) Other (i.e., Section 508, NIEM, HL7, etc.) Other Information OnBase has many modules that allow integrations with almost any line of business application. Group based

Formatted Formatted Table Formatted Formatted Formatted Formatted Formatted Table Formatted Formatted Formatted

Event Replicator
System Acronym System Description EVR EVR replicates data from our master Adabas transactional database on the mainframe, turns it into data that can fit into a relational model, and sends it to an MS SQL server database in our server environment. Makes mainframe ACCESS data accessible, in real time, to the SQL environment.

Formatted Formatted Table Formatted Formatted Formatted Formatted Formatted Formatted Formatted Table Formatted Formatted

Business Process/Function Programs Supported

IVR, call center, Web application portal, (maybe more)

Development Platform Hardware Software IBM Z9 mainframe sends data to Windows Server (Server hardware specs unknown) z/OS 1.11 mainframe operating system, Windows Server 2003 Enterprise (64 bit) Server operating system Production Platform Hardware Software Single-Tier, Two-Tier, Multi-Tier, Hybrid Same as Dev Same as Dev Unknown Further explanation needed

Formatted Formatted Table Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Message-Oriented Middleware

EntireX is the messaging system used primarily to transmit replicated data (and replication utility messaging) from the mainframe source to the server target. It also handles data persistence and processes target application messages back to source. Web services that utilize the replicated data (I believe) run on various application servers. Not the best architecture for fitting into a SOA This is correct and I have highlighted this may not be the best fit solution wise to expose data realtime short or longterm. This is a unidirectional solution and would do nothing if HIX process is required to interact with ACCESS as a provider and not consumer of data. I might have this wrong

Formatted Formatted Formatted Table Formatted Formatted

Web Services

SOA

Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 43

Open Architecture VPN Web Access FTP ETL API Adapters No I dont really know what you mean, but Tthere are adapters to convert and load the data into different relational database management systems. Currently we are only configured to use MS SQL servers adapter. No Yes No

Formatted: No underline, Font color: White Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto Formatted Table Formatted: No underline, Font color: White Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: Auto, Highlight Formatted: Space After: 5 pt

User Access and Authentication Services

Access to the data replicated is handled at the server level, and provided to a combination of end users and program administrators. Access to administrative tools for the system itself is limited to AHS DBA staff. The replicated data is accessed by users via a combination of Web applications, and generated reports (again at the server level). Developers and administrators generally have direct (read-only) access to the SQL tables themselves. Access to the replicated data in the SQL server environment is strictly read only for all users, with the sole exception being the Event Replicator Target Adapter (commonly referred to as ART), which receives the replicated data from EntireX (middleware), and applies it to the SQL Server database. The process begins by loading up the SQL Server database with data records, read directly from the source Adabas database, then all transactions occurring on the source database are replicated, converted to equivalent SQL Statements, and applied to the target database. Thus keeping the data in the target SQL Server database in sync with the source Adabas database. This approach adds much more processing and storage capacity and system overhead as compared to leveraging the data at rest through a different mechanism. I remember when AHS moved forward with this in an attempt to reduce MIPS on the mainframe and it did just the opposite. The process itself can be considered a data warehousing solution, but really it is an extension of the existing production system designed to provide data mobility.

User Interaction Services (i.e., 3270, 3270 emulation, Web front-end)

Data Access (i.e., database adapters)

Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto

Enterprise Information Management (i.e., data warehouse, data Exchange, integration with enterprise tools) Management Services (i.e., vendor, State agency)

Design, management, and support for this system are handled solely by AHS DBA staff.

Formatted: Space After: 5 pt Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: White

Interfaces and Inputs Type (point-to-point, Web services, etc.) Point-to-point

Formatted: No underline, Font color: White Formatted: No underline, Font color: White

Source/Destination Inputs Source Adabas Database

Format (XML, flat file, etc.) Adabas records, before and after images of record(s) for a

Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 44

Interfaces and Inputs Type (point-to-point, Web services, etc.)

Formatted: No underline, Font color: White Formatted Table

Source/Destination

Format (XML, flat file, etc.) transaction

Formatted: No underline, Font color: White Formatted: No underline, Font color: White Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto

Outputs

Single EntireX Broker

Point-to-point

XML units of work

Core Business Functions Function N/A Core business functions of determining eligibility and issuing benefits all handled on the mainframe, independent of EVR Description

Formatted: No underline, Font color: Auto Formatted: Space After: 5 pt Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: White Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto Formatted: Space After: 5 pt

Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: White Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto

N/A N/A

N/A

Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto

N/A N/A Many components of the EVR architecture can be managed from a server, which the DBAs set up for this purpose, called SAGADMIN. SAGADMIN hosts a suite of tools for use in administrative tasks of many SAG products across multiple platforms we commonly refer to this suite of tools as SMH (for system management hub). Specific tools that are included on SAGADMIN, which are integral to integration and management of EVR, include: the Data Mapping Tool, Adabas Manager, Event Replicator Manager, and EntireX Broker Administration. These tools connect to the mainframe environment via a thick client application called Entire Net-Work. The end result of Replication provides a means for reporting; however,

Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto

Reporting

Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 45

Core Technology Components Offered Supporting Technology EVR itself is not used for reporting. Master Person Indexing Calculators N/A N/A

Maintenance and Upgrades Current/In-Progress Our current version of the EVR server is 3.2.1. We are currently in the process of upgrading ART from version 2.6.1 to 2.7 EVR server has an approximate projected upgrade date of third quarter 2013.

Formatted: Space After: 5 pt Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: White

Future Plans

Formatted: No underline, Font color: Auto Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto

Scalability

The scalability of EVR is limited by the resources that can be made available to it. Right now we replicate about half of all mainframe transactions in ACCESS, but are approximately at the capacity that we can handle with our current configuration. Replication of the transactions incurred during our month end processing consumes almost 100% of the mainframe CPU for about 12 hours any more and wed be unable to prevent this from running into the work day and impeding ACCESS users. Serviceability of the EVR server is relatively limited. Partially because the functionality makes use of so many different Software AG products, in debugging replication you often get passed from support team to support team and they often have a great deal of difficulty in identifying root cause. Additionally, EVR is a relatively new product (5 plus years old) and although it is based on Adabas functional architecture, there are few vendor support personnel with even as much experience with it as our in house DBA staff. However, once root causes can be narrowed down to either the source Adabas database, or the EntireX messaging system, serviceability becomes extremely good as the vendor has support personnel with decades of experience. EVRs extensibility is primarily dictated by its installation and use rather than its architecture. As mentioned above, we are just about at capacity for our current configuration but that is simply a result of the summation of the volumes of transactions that were required to be replicated by the various projects that have been implemented. In other words, we have more or less exhausted our extensibility by fulfilling the needs of various projects on a first- come, first- served basis, rather than on a controlled growth plan.

Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: Auto

Serviceability

Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto Formatted: No underline, Font color: Auto

Extensibility

Formatted: No underline, Font color: White Formatted: No underline, Font color: Auto

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 46

Reliability

Overall, replication is very reliable. Once a set of subscriptions has been implemented and the systems are left alone, things are very stable. Properly set up replication subscriptions virtually never get out of sync, and the persistence in the messaging system insures that no messages are ever missed. However, the system isnt without its pitfalls. One major source of problems is the fact that replication depends on so many different pieces all working in unison , (WAIT UNTIL THE TRUE SOA MODEL IS ESTABLISHED )100% of the time. Any network or server maintenance can disrupt the flow of replicated data and unless the DBAs catch the problem it can cause backups of replicated data on the mainframe that cause EntireX to use so much memory it causes huge problems. Also since the current version of ART needs to be run as an application (not a service), someone always needs to maintain a connection to the server running ART; so, even getting a session ended by someone trying to log on to a server can result in huge problems. The best way to ensure stability is by good communication. With no human interference, the reliability would be excellent. But in the real world Id say that replication is disrupted about once every month or two.

Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: Auto

Formatted: Space After: 5 pt

Standards (met and how met) Security (i.e., HIPAA, FIPS, Role-based, data in motion and at-rest, etc.) Other (i.e., Section 508, NIEM, HL7, etc.)

Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: White Formatted: No underline, Font color: White Formatted: Space After: 5 pt

Other Information

Formatted: No underline, Font color: White Formatted Table

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 47

Formatted Formatted Formatted Formatted Table

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Appendix B: Functional and Technical Components

Formatted Formatted Formatted Formatted Formatted

Functional Component Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management IT Management IT Management IT Management IT Management IT Management IT Management Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Service desk management Technical management IT operations management Application management Deployment management

Service Performed

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Assess agency initiatives and plans Assess external factors affecting program Examine current budget revenue stream, trends, and expenditures Model budget scenarios Define new budget Apply encryption algorithms for security Define report attributes Define State and federal budget service categories Extract financial info Send alert to target destination

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 48

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Table Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Functional Component Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Asset Management Asset Management Asset Management Asset Management Asset Management Human Resource Management Human Resource Management Human Resource Management Human Resource Management Manage recruitment Manage compensation Manage job evaluations Manage deployment

Service Performed Transform information for target destination Modify budget Prepare budget modification request Review budget Review long-term goals and objective plans Review policies and procedures for budget Draw and report FFP (Federal Financial Participation) Create and manage claims, payments, and recoveries rules Prepare, generate, and review reports Review and modify FMAP ( Federal Medical Assistance Percentage) activity Bookkeeping & Budgeting Forecasting Trend analysis

Manage system specifications Monitor assets Manage vendor contracts

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 49

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Table Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Functional Component Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Human Resource Management Human Resource Management Human Resource Management Human Resource Management Human Resource Management Human Resource Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Manage performance Manage time and attendance

Service Performed

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Benefits, pension, and leave administration Salary administration Return to work administration Manage professional development

Determine awarded contractor Evaluate proposal Define/complete contract Notify award results Post award information Receive protests and disposition protests Receive, validate and verify proposal Request proposal Report requirements for contract termination Manage/monitor closure activities Notify contractor of termination of contract Receive request for contract termination Request validation to terminate contract Implement contract Modify/update contract

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 50

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Table Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Functional Component Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Business Agreement Management Business Agreement Management Business Agreement Management Business Agreement Management Business Agreement Management Business Agreement Management Business Agreement Management Business Agreement Management Business Agreement Management Business Agreement Management Monitor terms of the contract

Service Performed

Formatted Formatted Formatted

Notify/alert contractor of modifications Define/receive contract information Advertise solicitation Develop solicitation for services Gather requirements Approval management for State and Federal solicitation Manage purchase orders Manage inventory Perform cost analysis Determine data Exchange communication protocols Establish business partner agreement Notify business partner of agreement Receive and confirm business partner information Modify partner agreement Notify business partner of agreement update Receive agreement modification request Receive termination of agreement request Terminate partner agreement Validate terminate agreement request

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 51

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Table Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Functional Component Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight

Service Performed

Formatted Formatted Formatted

Assign and authorize incident manager View medical records and validate credentials. Determine and perform appropriate action Document evidence as required Establish adverse accident insurance case Gather historical information/reports Manage correspondence Report case disposition Initiate adverse accident insurance Send alerts to members, providers, and contractors Assign incident manager Establish incidence case Collect case information Perform audit and performance reviews Identify/report target groups not incompliance with rules Determine/report disposition of incident Journal activities Modify incident information Refer incident to appropriate manager/agency Identify member selection

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 52

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Table Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Functional Component Business Management Policy & Oversight

Service Performed Notify member with Recipient Explanation of Medicaid Benefits (REOMB) information Prepare REOMB Generate/Review selection information Scheduled REOMB generation Develop/publish consensus Statement Report/receive goals and objectives Report/review existing goals, objectives, and priorities Manage/review policy changes Revise policy Develop implementation plan for policy Develop training plan for new policy Disseminate policy Formulate and publish policy Receive request to add, delete or change policy Revise policy Monitor business results against established performance measures Manage performance measures Report/Review existing performance measures Revise, delete or add to performance measures

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management

Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 53

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Table Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Service Performed

Review Medicaid State Plan modifications. Publish Medicaid State Plan amendment Modify Medicaid State Plan Review documentation Create/modify health plan benefit packages Send health plan benefit services to HIX for certification Add/update/verify codes or rates Add/update/verify drug formulary information. Add/update/verify member benefits Add/update program for available services Review addition/modification to reference information Send alert for reference code addition/modification to provider and contractor Assign Plan quality rating Certify/Recertify/Decertify Plan Consumer Rating Form QHP (Qualified Health Plan) agreement with issuer Manage Issuer and Plan information Manage Plan submission process

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 54

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Table Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Functional Component Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Plan Management Plan Management Plan Management Plan Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Manage Rates and Benefits Monitor Plan Compliance

Service Performed

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Process Change in Plan Enrollment Availability Report Issuer and Plan Information

Generate remittance advice transaction Manipulate information Receive claims info from Process Claim Send alert to provider Prepare 1099 Correct errors and validate 1099 Send 1099 to appropriate providers and contractors Calculate payment amounts Disperse funds Generate electronic and paper-based reimbursement instruments Assign account codes to State Medicaid Enterprise transactions Disburse federal admin costs Load AP information Manage cancelled, voided or State dated warrants Manage payroll Reconcile State Medicaid Enterprise and the accounting system(s) Process payment invoices

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 55

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Table Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Service Performed Perform/Respond to accounting inquiries Alert to provide/MCO capitation payments Manage/Resolve invoice discrepancies Generate alert to dependent business process Validate invoice details for reimbursement Analyze policy alternatives Forecast utilization and expenditures for a program Research and evaluate health care activities Check eligibility for incentive payment Select Invoices for payments based on policy Disseminate Federal or State policy regarding incentive program Receive payment requests Receive application for incentive Check/modify eligibility information Determine cost effectiveness and produce report Receive insurance information for Health Insurance Premium Payment (HIPP) Receive SDX, Enrollment Data Base (EDB) file, and/or the SSA Beneficiary Data Exchange (BENDEX) eligibility files Generate buy-in file for Medicare Part A & B members Match invoice and member data store Post buy-in modifications to the member data store Process CMS responses

Core Business Core Business Core Business Core Business

Financial Management Financial Management Financial Management Financial Management

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 56

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Table Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Functional Component Core Business Core Business Core Business Core Business Core Business Financial Management Financial Management Financial Management Financial Management Financial Management Produce buy-in reports

Service Performed

Formatted Formatted Formatted

Send alert to dependent business process Send/receive buy-in file to CMS Calculate payment amounts Generate/send payment report to submit HCBS (Home and Community-Based Payment )info to member Receive alert from HCBS Payment claims Perform edits/audit on reports Receive alert from capitation payment Apply payments to AR ( Accounts Receivable) Create payment receipt notice Record payment information Send notifications Assign account codes to State Medicaid Enterprise transactions Manage cash receipt process Manage payment-offset Reconcile State Medicaid Enterprise and accounting systems Process accounts receivable invoice Inquire/Respond to accounts receivable inquiries Calculate final annual cost settlement Establish cost settlements or compliance reviews basis Notify provider of cost settlement

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business

Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 57

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Table Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Functional Component Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management

Service Performed Receive audited Medicare Cost Report Review provider costs Calculate total rebate per manufacturer Prepare drug rebate invoices Receive drug rebate information from CMS Send invoice information to the drug manufacturer Conduct case follow-up Determine the value of the e-State lien File estate claim of lien File petition for a lien Open a formal estate recovery case Monitor payments for overpayment Notify provider of recoupment request Create coordination of benefits file Create post payment recovery file Identify/report recoverable claims Notify Third-Party Liability (TPL) of recover request Receive TPL information Format and output information Retrieve member premium information Provide Plan data Receive and process enrollee data

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 58

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Table Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Functional Component Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management

Service Performed Receive and process Plan data Consumer Rating Bookkeeping/Accounting for the reinsurance entity Calculate reinsurance payment Manage reinsurance contributions Process reinsurance payment request Verify reinsurance contribution amount Verify reinsurance payments Book keeping/Accounting for risk adjustment Calculate actuarial risk Calculate risk adjustment payments and charges Automated invoice generation Automated invoice printing Automated premium reconciliation Calculate individual premium Calculate SHOP premium Capture payment information Identification of delinquent accounts Report advanced premium tax credits/cost sharing reductions to CMS Termination of delinquent accounts Create reinsurance annual financial report Provide enrollment and premium data

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 59

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Table Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Functional Component Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Financial Management Financial Management Financial Management Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Conduct eligibility appeal

Service Performed Provide individual and SHOP enrollee data Receive and process claims/encounter data Generate/Send invoice prepared alerts

Conduct SHOP eligibility appeal Halt appeals processing Implement adjusted eligibility determination resulting from appeal Conduct contractor eligibility appeal Conduct provider eligibility appeal Communicate individual eligibility determination Communicate to employees regarding availability of insurance through SHOP Exchange Communicate to issuer [including Medicaid for BHP] regarding enrollment in Qualified Health Plan Report enrollment in QHP Report on individual exemption status Communicate training results Communicate certification results Communicate compliance results Create notification Update notification content Delete notification

Core Business

Eligibility & Enrollment Operations

Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business

Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 60

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Table Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Functional Component Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Send notification Manage notification rules Manage business rules Manage workflow rules

Service Performed

Determine Plan availability and calculate Plan cost Select SHOP Employee QHP QHP side-by-side comparison tool Calculate Federal poverty level Determine category for cost-sharing reductions Determine eligibility Determine eligibility for advance premium tax credit Process individual exemption renewal request Process SHOP employee renewal request Qualify individual for an enrollment period Refer potentially eligible individuals to Medicaid and Children's Health Insurance Program (CHIP) for additional Screening Verify employee roster Verify household Income Verify incarceration status Verify individual eligibility for employer-sponsored minimum essential coverage Verify individual eligibility of public minimum essential coverage Verify individual residency status

Core Business Core Business Core Business Core Business Core Business Core Business

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 61

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Table Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Functional Component Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations

Service Performed Verify information required for exemption Verify lawful presence Verify SHOP employee application Verify SHOP employer identity Verify whether individual is a native American Accept individual eligibility application Accept individual eligibility application update Accept individual exemption application Accept individual exemption application update Accept SHOP employee application Accept SHOP employee application update Accept SHOP employer application Accept SHOP employer application update Assess current QHP enrollment status Determine SHOP employer contribution Un-enroll from QHP Enhanced Medicaid Enroll in MAGI Medicaid Process employer participation renewal Process individual eligibility & enrollment renewal request Review and adjudicate alternative documentation Select individual QHP

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 62

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Table Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Service Performed Terminate employer participation Validate application submission Enroll in SNAP, TANF, Childcare Assistance Store supporting document image Interface to billing system

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Assign tracking number and prioritize referral authorization request Confirm referral authorization request completeness Notify member, referring provider, referred-to provider of authorization Notify referral authorization requestor of result/request Validate referral request Assign tracking number and prioritize service authorization request Confirm service authorization request completeness Notify member and requesting provider of service authorization Notify service authorization requestor of results Validate service authorization request Assign tracking number and prioritize treatment plan authorization request Confirm treatment plan authorization request completeness Notify member, care manager, provider of treatment plan authorization Notify treatment plan authorization requestor of result Validate service authorization request Assess members needs

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 63

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Table Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Service Performed

Identify/select target members for specific programs Notify member of care management case Prepare information for communication Select program Audit case information Manage State criteria and rules Notify provider and member of case update Update case information Prepare registry updates Receive/input inquiry for health outcome information Receive members health outcome information Respond to inquiries Modify members treatment plan Notify treatment plan modifications to related parties Manage services and treatment plans Receive/define federal and State criteria and rules for providers/contractors evaluation Receive members health information Send modified treatment plan to Health Information Exchange (HIE)

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Core Business Core Business

Care Management Care Management

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 64

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Table Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Functional Component Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Core Business Care Management Care Management Care Management Care Management Care Management Care Management Care Management Care Management Claims Management Claims Management Claims Management Claims Management Claims Management Claims Management Claims Management

Service Performed Assess members health for risk factors Assign care manager Associate with application service needs Establish risk categories and hierarchy, severity, and need level Establish severity scores and diagnoses Notify member of applicable services Update risk categories Verify information from external sources

Identify incorrect payments by SMA ( State Medicaid Agency) Receive retroactive modifications Determine spend-down obligation amount Process/alert to manage member information Receive health plan info from enroll member Apply DRG/APC (Diagnosis-Related Group/ Ambulatory Payment Classifications) Apply NCCI ( National Correct Coding Initiative ) Calculate paid amount Receive/audit claims Suspend claims Perform encounter edits/audits Receive encounter

Core Business Core Business Core Business Core Business Core Business Core Business

Claims Management Claims Management Claims Management Claims Management Claims Management Claims Management

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 65

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Functional Component Core Business Core Business Core Business Core Business Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Broker/Navigator Relationship Management Broker/Navigator Relationship Management Broker/Navigator Relationship Management Broker/Navigator Relationship Management Broker/Navigator Relationship Management Broker/Navigator Relationship Management Broker/Navigator Relationship Management Broker/Navigator Relationship Management Broker/Navigator Relationship Management Broker/Navigator Relationship Management Broker/Navigator Relationship Management Broker/Navigator Relationship Management Broker/Navigator Relationship Management Broker/Navigator Relationship Management Marketing & Outreach Marketing & Outreach Marketing & Outreach Claims Management Claims Management Claims Management Claims Management Suspend encounters

Service Performed

Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: White

Reject, suspend, or purge attachment information Receive attachment information Validate attachment and application
Formatted Table Formatted: No underline, Font color: Background 1 Formatted: Font color: Background 1

Self-service broker/navigator Portal Online training Record/modify training Record/modify certification Record/modify compliance Manage broker/navigator monthly targets Manage compensation Testing of incentive returns Broker/Navigator evaluation Produce monthly paper/e-statements Manage broker inquiries File dispute Manage dispute

Determine mode of communication Generate communication

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 66

Functional Component Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach

Service Performed Prepare communication content Receive request for information, appointments, and assistance Review and approve communication Validate information Create new health plan/benefit offering Identify target groups Manage enrollment campaigns Modify existing health plan/benefit offering Notify new/modified health plan/benefit offering to stakeholders. Perform enrollment campaigns Receive population information and statistics from SMA Create/Update/Delete standard notification Generate communication Identify target population Prepare content for the communication Review and Approve communication Approve, deny, or modify decisions to develop outreach communications Determine content and method of communication and performance measures Generate communication Analyzing information, performance measures, feedback from community, and policy directives Log communication message

Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: White

Service Delivery

Marketing & Outreach

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 67

Functional Component Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Marketing & Outreach Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management

Service Performed Review and approve communication

Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: White

Assign unique account identifier Prepare verification request response Receive contract verification request Send contract verification response Generate claim status response Inquire payment status info Provide/send claim status response via HCISN (Hospital Cultural Interpreter Services Network)

Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery

Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management

Receive and log claim status request Validate requester authorization Prepare/provide provider information Receive request for provider information Send inquiry response Determine provider/member eligibility status Notify provider/member of eligibility status Validate request for provider/member eligibility Notify modification in insurance affordability program to HIX Receive request to modify contractor information Request modification in contractor information

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 68

Functional Component Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Update contractor information Validate request

Service Performed

Formatted: No underline, Font color: White Formatted Table Formatted: No underline, Font color: White

Create/inquire/delete/modify provider information Create/inquire/delete/modify provider/member information Validate provider/member information Validate the authorization by requestor to acquire provider/member information Conduct investigations and communicate Remove provider/contractor from Medicaid Program Review determination of noncompliance and investigation materials Send alert of provider termination to HIX and business partners. Rescind termination Record inquiry information Manage call transfer business rules Administer employer liability Manage FAQs Manage performance measures/measurements Receive complaint Resolve complaint Close complaint

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 69

Technical Component Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Mandatory report templates Additional report templates Mandatory reports Additional reports Review reports Manage report schedule

Service Performed

Formatted Table Formatted: No underline, Font color: Background 1 Formatted: Font color: Background 1

Manage report delivery mechanism Manage analytic templates Perform analytics Portal integration of analytics Web analytics Ad hoc reporting Manage data feeds Audit collected data Manage surveys Manage survey templates Review survey (includes survey estimate) Manage survey schedule Manage survey delivery mechanism Publish survey

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 70

Technical Component Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Knowledge Management Knowledge Management Knowledge Management Knowledge Management Knowledge Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Create notification Update notification content Delete notification Send notification Manage notification rules Manage workflow rules Manage taxonomy Store content Tag content

Service Performed

Formatted Table

Retrieve content (search features)

Manage business rules (Create/Edit/Delete) Maintains a rules catalog Automated interfaces through a set of Application Programming Interfaces (APIs) Allow the reuse of the rule-repository and rules-driven technology Modification of business rules via a Graphical User Interface (GUI) Ability to attach business rules to workflow activities Manage business rules

Business Support Business Support Business Support Business Support

Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 71

Technical Component Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Master Person Registry Master Person Registry Master Person Registry Master Person Registry Master Person Registry Master Person Registry Master Person Registry Master Person Registry Financial Transaction Processing Financial Transaction Processing Financial Transaction Processing Financial Transaction Processing Financial Transaction Processing Financial Transaction Processing Financial Transaction Processing Manual settlements Batch settlements Automated payments Electronic funds transfer Payment reconciliation

Service Performed

Formatted Table

Manage master person data sources Resolve matching issues Determine match probability Manage probabilistic matching Manage deterministic matching Resolve matching issues Manage master person index

HIPAA adopted transaction standards (e.g., ASC X12N 834, ASC X12N 270, ASC X12N 271) for interfaces Generate receipts Electronic distribution of receipts

Business Support Business Support Business Support Business Support Business Support Business Support

Financial Transaction Processing Financial Transaction Processing System Integration Management System Integration Management System Integration Management System Integration Management

Verify lawful presence Review documentation to verify lawful presence Verify household income

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 72

Technical Component Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management

Service Performed Receive notice of enrollment and payment Receive notice of disenrollment from QHP Receive monthly enrollment report Report individual exemption status to IRS Receive notice of termination of employers participation in SHOP Exchange Calculate maximum APTC (Advance Premium Tax Credits) Receive notice of SHOP Exchange employer participation Receive notice of Exchange appeal decision Receive notice of enrollee changes and renewals Receive monthly enrollment APTC/CSR (Corporate Social Responsibility ) report for reconciliation Receive notice of enrollment and payment Notify Exchange of disenrollment from QHP Receive notice of disenrollment from QHP Receive notice of enrollee changes and renewals Verify whether individual has already been determined for Medicaid, CHIP, or BHP (Basic Health Program) Receive enrollment transaction for individual determined eligible for Medicaid, CHIP or BHP Determine individual eligibility for Medicaid or CHIP based on factors other than MAGI Verify employer identification number Retrieve current income data Validate address existence

Formatted Table

Business Support Business Support Business Support Business Support Business Support

System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management

Business Support

System Integration Management

Business Support

System Integration Management

Business Support Business Support Business Support

System Integration Management System Integration Management System Integration Management

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 73

Technical Component Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management

Service Performed Verify individual eligibility for employer-sponsored Minimum Essential Coverage Verify individual unemployment Insurance Verify individual eligibility for other public minimum essential coverage Verify whether Individual is an Indian Verify individual incarceration status Verify individual residency status Publish issuer and Plan information Provide plan quality rating methodology Receive issuer and Plan information Receive Plan non-renewal, decertification, and change in availability notices Receive rate and benefit data Provide response to solicitation Provide QHP agreement materials Provide required issuer and Plan information Provide Plan non-renewal and change in availability notices Provide issuer and Plan information Receive issuer and Plan information Receive Plan non-renewal, decertification, and change in availability notices Provide rate information Provide work participation rates to ACF Provide SNAP information Provide eligibility information to WIC

Formatted Table

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 74

Formatted Table Formatted Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Technical Component Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management

Service Performed Notify eligibility specialists of nursing home eligibility Pay premium on behalf of SD clients Provide mailing address information Provide client information to TEFRA (Tax Equity and Fiscal Responsibility Act) Provide Medicaid information to MMIS Provide premium and spend-down information Provide private insurance information Provide health insurance payment program information Provide 1099 information Acquire social security, SSI, and Medicare information Retrieve claims overpayment information Provide spend-down population information Pay temp assistance and food stamps to electronic benefit cards Provide new recipient information to EBT (Electronic Benefit Transfer) Provide insurance premiums information Submit federal report Provide federal pharmacy discount card information Provide drug program eligibility information ITSD (Information Technology Services Department ) payments system Identify children eligible for school lunch program Share common client numbering Death match

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 75

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Table Formatted Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Technical Component Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management

Service Performed EPSDT (Early Periodic Screening, Diagnosis, and Treatment) PACE (Program of All Inclusive Care for the Elderly) Quarterly wage match UC (Utilization Control) Match IMES Provide Medicaid Information to DMH (Department of Mental Health) Match DSS (Data Set Service ) Spend-down Lock-in ASAP (Aging Services Access Points) DOR online transactions available For DSS Receive file from motor vehicles Online interface with motor vehicles Obtain provider information Submit Medicaid 1099 to IRS Verify EPSDT Participation CCA (Catastrophic Coverage Act) to SSA for SSN Verification DSS and SSA Matching Transform canonical to/from State hub Transform canonical to/from issuer

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 76

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Table Formatted Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Technical Component Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Unified Communications Unified Communications Unified Communications Unified Communications Unified Communications Unified Communications HHS Portal HHS Portal HHS Portal HHS Portal Interactive voice response Fax Text messaging

Service Performed

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Email interface synchronizing calendar & scheduling data Transmit report/notification

Web-browser-based primary interface Support the use of mobile devices Multiple views available: Employer, Employee, Consumer, Carrier, Broker, Customer Service Rep, Administrative

Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components

Integration Broker Integration Broker Integration Broker Integration Broker Integration Broker Integration Broker Integration Broker Integration Broker SFTP (Secure File Transfer Protocol) EDI ( Electronic Data Interchange) Web services ESB (Enterprise Service Bus) Service registry and repository Service manager Non-repudiation

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 77

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Table Formatted Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Technical Component Privacy and Security Privacy and Security Privacy and Security Privacy and Security Privacy and Security Privacy and Security Identity and Access Management Identity and Access Management Identity and Access Management Identity and Access Management Identity and Access Management Manage user Identity

Service Performed

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Enforce standards for password rules Compliance management LDAP (Lightweight Directory Access Protocol service(s) for user authentication

) compliant authentication

Formatted Formatted Formatted Formatted Formatted Formatted

Privacy and Security Privacy and Security

Identity and Access Management Identity and Access Management

Prevent concurrent logins for the same User ID unless specifically authorized Automatically log and disable access to any user accounts following a specified administrator-configurable number of unsuccessful log-on attempts Manage resources Manage ACCESS Privileges Field level security in accordance with RBAC Maintain a history of security profile assignments for a User. Real-time validation of user access Digital certificates using X.509 standard (or most recent version)

Privacy and Security Privacy and Security Privacy and Security Privacy and Security Privacy and Security Privacy and Security Privacy and Security Privacy and Security Privacy and Security Privacy and Security Privacy and Security Privacy and Security

Identity and Access Management Identity and Access Management Identity and Access Management Identity and Access Management Identity and Access Management Identity and Access Management Intrusion Management Intrusion Management Intrusion Management Intrusion Management Intrusion Management Intrusion Management

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Host-based Intrusion Detection Software (IDS) Detect malicious code Detect viruses Host-based Intrusion Prevention Software (IPS) Prevent malicious code

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 78

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Table Formatted Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Technical Component Privacy and Security Privacy and Security Privacy and Security Privacy and Security Privacy and Security Privacy and Security Privacy and Security Intrusion Management Intrusion Management Intrusion Management Intrusion Management Intrusion Management Confidentiality Management Confidentiality Management Configure quarantine policies

Service Performed

Formatted Formatted Formatted

Authorized personnel to view all security audit logs Log user/system activity Log user access violations Analyze user/system activity

Formatted Formatted Formatted Formatted Formatted Formatted

Utilize encryption algorithms and implementations, in compliance with National Institute of Standards and Technology Special Publications 800-52, 800-77, or 800-113. (http://csrc.nist.gov/publications/PubsSPs.html) Data encryption (e.g., passwords) Perform data anonymization Manage data anonymization Format

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Privacy and Security Privacy and Security Privacy and Security Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management

Confidentiality Management Confidentiality Management Confidentiality Management

Business Rules Engine Business Rules Engine Business Rules Engine Workflow Engine Workflow Engine Workflow Engine Workflow Engine Workflow Engine Process scripting (Business Process Execution Language (BPEL) Current status verification user Authority validation Script execution Inference engine Event processing engine

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Table Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 79

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Technical Component Data Management Data Management Data Management Data Management Data Management Data Indexing & Storage Data Indexing & Storage Data Indexing & Storage Data Indexing & Storage RDBMS

Service Performed

Formatted Table Formatted: Font: Not Italic, No underline, Font color: Background 1 Formatted: Font color: Background 1 Formatted Formatted Formatted Formatted Formatted Formatted: Don't keep with next Formatted ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Referential integrity enforcement Support data dictionaries with the usage, associated business rule and semantic information on its data elements

Data Management Data Management Data Management Data Management Data Management

Data Transformation Data Transformation Data Transformation Data Retrieval Data Retrieval Master data management functions, including data standardization and deduplication. Manage data stores/data marts Manage ETL scripts Manage ETL schedules

Data Management

Data Retrieval

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 80

Formatted Formatted Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Appendix C: IT Assets Assessment Functional Component Worksheet (Detailed View)

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Management Business Management Business Management Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Assess agency initiatives and plans Assess external factors affecting program Examine current budget revenue stream, trends, and expenditures Model budget scenarios Define new budget Apply encryption algorithms for security Define report attributes Define State and federal budget service categories Extract financial info No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Business Management Business Management Business Management Business Management Business Management Business Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 81

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Financial Accounting & Reporting Send alert to target destination Transform info for target destination Modify budget No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Prepare budget modification request Review budget

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Review long-term goals and objective plans Review policies and procedures for budget. Draw and report FFP Create and manage claims, payments, and recoveries rules Prepare, generate, and review reports Review and modify FMAP activity Bookkeeping & Budgeting

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Table Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Business Management Business Management Business Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 82

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Trend Analysis

N/A

None

N/A

None

N/A

None

N/A

None

Manage Deployment Manage System Specifications Monitor Assets Manage Vendor Contracts

No No No No No No No No No No

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

None None None None None None None None None None

No No No No No No No No No No

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

None None None None None None None None None None

No No No No No No No No No No

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

None None None None None None None None None None

No No No No No No No No No No

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

None None None None None None None None None None

Human Resource Manage Management Recruitment Human Resource Manage Management Compensation Human Resource Manage Job Management Evaluations Human Resource Manage Management Performance Human Resource Manage Time and Management Attendance Human Resource Benefits, Pension, Management and Leave Administration Human Resource Salary Management Administration Human Resource Return to Work Management Administration Human Resource Manage Management Professional Development

No No No

Formatted Formatted Formatted Formatted Formatted Formatted

No No No No No

N/A N/A N/A N/A N/A

None None None None None

No No No No No

N/A N/A N/A N/A N/A

None None None None None

No No No No No

N/A N/A N/A N/A N/A

None None None None None

No No No No No

N/A N/A N/A N/A N/A

None None None None None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted Formatted Formatted

Business Management Business Management Business Management Business Management Business Management

Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 84

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Management Business Management Business Management Business Management Business Management Business Management Business Management Business Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Procurement Management Modify/update contract Monitor terms of the contract Notify/Alert contractor of modifications Define/receive contract information Advertise solicitation Develop solicitation for services Gather requirements Approval management for State and federal solicitation Manage Purchase Orders Manage Inventory Perform Cost Analysis Determine data Exchange communication protocols Establish business partner agreement Notify business partner of agreement No No No ACCESS Function Implementation N/A N/A N/A Performs Function? No No No CSME Function Implementation N/A N/A N/A Performs Function? No No No OnBase Function Implementation N/A N/A N/A Performs Function? No No No EVR Function Implementation N/A N/A N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None None None

Formatted Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted Formatted Formatted

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted Formatted Formatted

Business Management Business Management Business Management Business Management

Procurement Management Procurement Management Procurement Management Business Agreement Management Business Agreement Management Business Agreement Management

No No No No

N/A N/A N/A N/A

None None None None

No No No No

N/A N/A N/A N/A

None None None None

No No No No

N/A N/A N/A N/A

None None None None

No No No No

N/A N/A N/A N/A

None None None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Business Management Business Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 85

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Management Business Agreement Management Business Agreement Management Business Agreement Management Business Agreement Management Business Agreement Management Business Agreement Management Business Agreement Management Policy & Oversight Policy & Oversight Receive and confirm business partner information Modify partner agreement Notify business partner of agreement update Receive agreement modification request Receive termination of agreement request Terminate partner agreement Validate terminate agreement request Assign and authorize incident manager View medical records and validate credentials Determine and perform appropriate action Document evidence as required Establish adverse accident insurance case No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Business Management Business Management Business Management

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Business Management

N/A

None

N/A

None

N/A

None

N/A

None

Business Management Business Management Business Management Business Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Business Management Business Management Business Management

Policy & Oversight Policy & Oversight Policy & Oversight

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 86

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Management Business Management Business Management Business Management Business Management Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Gather historical information/ reports Manage correspondence Report case disposition Initiate adverse accident insurance Send alerts to members, providers and contractors Assign incident manager Establish incidence case Collect case information Perform audit and performance reviews Identify/report target groups not incompliance with rules Determine/report disposition of incident Journal activities Modify incident information Refer incident to appropriate manager/agency No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted Formatted

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Business Management Business Management Business Management Business Management Business Management

Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight

No No No No

N/A N/A N/A N/A

None None None None

No No No No

N/A N/A N/A N/A

None None None None

No No No No

N/A N/A N/A N/A

None None None None

No No No No

N/A N/A N/A N/A

None None None None

Formatted Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Business Management Business Management Business Management Business Management

Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 87

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Management Business Management Business Management Policy & Oversight Policy & Oversight Policy & Oversight Identify member selection Notify member with REOMB information Prepare REOMB (Recipient explanation of Medicaid Benefits) Generate/ Review selection information Scheduled REOMB generation Develop/publish consensus Statement Report/receive goals and objectives Report/review existing goals, objectives and priorities Manage/review policy changes Revise policy Develop implementation plan for policy Develop training plan for new policy Disseminate policy No No ACCESS Function Implementation N/A N/A Performs Function? No No CSME Function Implementation N/A N/A Performs Function? No No OnBase Function Implementation N/A N/A Performs Function? No No EVR Function Implementation N/A N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Business Management Business Management Business Management Business Management Business Management

Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Business Management Business Management Business Management Business Management Business Management

Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 88

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Management Business Management Business Management Business Management Policy & Oversight Policy & Oversight Policy & Oversight Policy & Oversight Formulate and publish policy Receive request to add, delete or change policy Revise policy Monitor business results against established performance measures Manage performance measures. Report/Review existing performance measures Revise, delete or add to performance measures Analyze change impact Modify Medicaid State Plan Review Medicaid State Plan modifications Publish Medicaid State Plan Amendment Modify Medicaid State Plan Review documentation No No ACCESS Function Implementation N/A N/A Performs Function? No No CSME Function Implementation N/A N/A Performs Function? No No OnBase Function Implementation N/A N/A Performs Function? No No EVR Function Implementation N/A N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None None

Formatted Formatted Formatted Formatted Formatted Formatted

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted Formatted Formatted Formatted

Business Management Business Management

Policy & Oversight Policy & Oversight

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Business Management

Policy & Oversight

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Core Business Core Business Core Business

Plan Management Plan Management Plan Management Plan Management Plan Management Plan Management

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business Core Business

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 89

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Plan Management Plan Management Create/modify health plan benefit packages Send health plan benefit services to Health Insurance Exchange (HIX) for certification Add/update/ verify codes or rates Add/update/ verify drug formulary information Add/update/ verify member benefits Add/update program for available services Review addition/modificati on to reference information Send alert for reference code addition/modificati on to provider and contractor Assign Plan Quality Rating Certify/Recertify/ Decertify Plan Consumer Rating Form QHP Agreement with Issuer No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

Plan Management Plan Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Core Business

Plan Management Plan Management Plan Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

Plan Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Plan Management Plan Management Plan Management Plan Management Plan Management Plan Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Manage Issuer and Plan Information Manage Plan Submission Process Manage Rates and Benefits Monitor Plan Compliance Process Change in Plan Enrollment Availability Report Issuer and Plan Information Generate remittance advice transaction Manipulate info Receive claims info from Process Claim Send alert to provider Prepare 1099 correct errors and validate 1099 Send 1099 to appropriate providers and contractors. Calculate payment amounts Disperse funds No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business Core Business Core Business

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Core Business Core Business

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted

Core Business Core Business

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

Yes Yes

Hi Hi

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 91

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Financial Management Generate electronic and paper-based reimbursement instruments Assign account codes to State Medicaid Enterprise transactions Disburse federal admin costs Load AP information Manage cancelled, voided or State dated warrants Manage payroll Reconcile State Medicaid Enterprise and the accounting system(s) Process payment invoices Perform/ Respond accounting inquiries Alert to provide/MCO capitation payments Manage/Resolve invoice discrepancies Yes ACCESS Function Implementation Hi Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

Financial Management

N/A

None

N/A

None

N/A

None

N/A

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted Formatted Formatted

Core Business Core Business

Financial Management Financial Management

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted Formatted Formatted Formatted

Core Business

Financial Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

Financial Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 92

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Financial Management Financial Management Financial Management Financial Management Generate alert to dependent business process Validate invoice details for reimbursement Analyze policy alternatives Forecast utilization and expenditures for a program Research and evaluate health care activities Check eligibility for incentive payment Select Invoices for payments based on policy Disseminate federal or State policy regarding incentive program Receive payment requests Receive application for incentive Check/modify eligibility information Determine cost effectiveness and produce report Receive insurance information for HIPP No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business Core Business

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

Financial Management Financial Management Financial Management Financial Management

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business Core Business

Financial Management Financial Management Financial Management Financial Management Financial Management

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

Yes

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 93

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Financial Management Receive SDX, EDB file, and/or the SSA Beneficiary Data Exchange (BENDEX) eligibility files Generate buy-in file for Medicare Part A & B members Match Invoice and member data store Post buy-in modifications to the member data store Process CMS responses Produce buy-in reports Send alert to dependent business process Send/receive buy-in file to CMS Calculate payment amounts Generate/send payment report to submit HCBS payment info to member Receive alert from HCBS Payment claims Perform edits/audit on reports Yes ACCESS Function Implementation Med Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Core Business

Financial Management

Yes

Med Low N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 94

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Receive alert from capitation payment Apply payments to AR Create payment receipt notice Record payment information Send notifications Assign account codes to State Medicaid Enterprise transactions Manage cash receipt process Manage payment-offset. Reconcile State Medicaid Enterprise and accounting systems Process accounts receivable invoice Inquire/Respond to accounts receivable inquiries Calculate final annual cost settlement Establish cost settlements or compliance reviews basis No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted Formatted

Core Business Core Business Core Business Core Business Core Business

Yes No Yes Yes Yes

Low Low

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

Financial Management Financial Management

Low

None

N/A

None

N/A

None

N/A

None

Core Business

Low

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 95

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Core Business Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Notify provider of cost settlement Receive audited Medicare Cost Report Review provider costs Calculate total rebate per manufacturer Prepare drug rebate invoices Receive drug rebate information from CMS Send invoice information to the drug manufacturer Conduct case follow-up Determine the value of the estate lien File eSstate claim of lien File petition for a lien Open a formal eSstate recovery case Monitor payments for overpayment Notify provider of recoupment request No No ACCESS Function Implementation Low Low Performs Function? No No CSME Function Implementation N/A N/A Performs Function? No No OnBase Function Implementation N/A N/A Performs Function? No No EVR Function Implementation N/A N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None None

Formatted Formatted Formatted Formatted Formatted Formatted

Core Business Core Business

No No

Low Low

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted

Core Business Core Business

No No

Low Low

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted Formatted Formatted

Core Business

Low

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business Core Business

No No

Low Low

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

No No

Low Low

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 96

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Create coordination of benefits file Create postpayment recovery file Identify/report recoverables claims Notify TPL of recover request Receive TPL information Format and output information Retrieve member premium information Provide Plan Data Receive and process Enrollee Data Receive and Process Plan Data Consumer Rating Bookkeeping/ Accounting for the Reinsurance Entity Calculate Reinsurance Payment Manage Reinsurance Contributions No ACCESS Function Implementation Low Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Core Business

Low

None

N/A

None

N/A

None

N/A

None

Core Business

Low

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business Core Business Core Business Core Business

No Yes Yes Yes

Low Hi Low Med

None None None None

No No No No

N/A N/A N/A N/A

None None None None

No No No No

N/A N/A N/A N/A

None None None None

No No No No

N/A N/A N/A N/A

None None None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Core Business Core Business

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 97

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

None

Core Business Core Business

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Core Business

Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management Financial Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

Core Business Core Business

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Core Business

N/A

None

N/A

None

N/A

None

N/A

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Financial Management Report advanced premium tax credits/cost sharing reductions to CMS Termination of Delinquent Accounts Create Reinsurance Annual Financial Report Provide Enrollment and Premium Data Provide Individual and SHOP Enrollee Data Receive and Process Claims/Encounter Data Generate/Send invoice prepared alerts Conduct Eligibility Appeal Conduct SHOP Eligibility Appeal Halt Appeals Processing Implement Adjusted Eligibility Determination Resulting from Appeal No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

Financial Management Financial Management

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Core Business

Financial Management Financial Management Financial Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Core Business

Financial Management Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 99

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Conduct Contractor Eligibility Appeal Conduct Provider Eligibility Appeal Communicate Individual Eligibility Determination Communicate to Employees Regarding Availability of Insurance Through SHOP Exchange Communicate to Issuer [including Medicaid for BHP] Regarding Enrollment in Qualified Health Plan Report Enrollment in Qualified Health Plan Report on Individual Exemption Status Communicate Training Results Communicate Certification Results Communicate Compliance Results No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

Core Business

Eligibility & Enrollment Operations

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 100

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Core Business

Update Notification Content Delete Notification

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

Send Notification

Yes

Low

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Core Business

Manage Notification Rules Manage Business Rules Manage Workflow Rules Determine Plan Availability and Calculate Plan Cost Select SHOP Employee Qualified Health Plan QHP side-by-side comparison tool Calculate Federal Poverty Level Determine Category for Cost-Sharing Reductions

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Core Business

Yes

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 101

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Determine Eligibility Determine Eligibility for Advance Premium Tax Credit Process Individual Exemption Renewal Request Process SHOP Employee Renewal Request Qualify Individual for an Enrollment Period Refer Potentially Eligible Individuals to Medicaid and CHIP for additional Screening Verify Employee Roster Verify Household Income Verify Incarceration Status Verify Individual Eligibility for EmployerSponsored Minimum Essential Coverage Yes ACCESS Function Implementation Med Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

Yes

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

Core Business

Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

Yes

Low

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 102

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Eligibility & Enrollment Operations Verify Individual Eligibility of Public Minimum Essential Coverage Verify Individual Residency Status Verify Information Required for Exemption Verify Lawful Presence Verify SHOP Employee Application Verify SHOP Employer Identity Verify Whether Individual is a Native American Accept Individual Eligibility Application Accept Individual Eligibility Application Update Accept Individual Exemption Application Accept Individual Exemption Application Update Accept SHOP Employee Application No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

Yes

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

Yes

Low

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Core Business

Yes

None

N/A

None

N/A

None

N/A

None

Core Business

Yes

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 103

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Accept SHOP Employee Application Update Accept SHOP Employer Application Accept SHOP Employer Application Update Assess Current Qualified Health Plan Enrollment Status Determine SHOP Employer Contribution Disenroll from Qualified Health Plan Enhanced Medicaid Enroll in MAGI Medicaid Process Employer Participation Renewal Process Individual Eligibility & Enrollment Renewal Request Review and Adjudicate Alternative Documentation No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

Core Business

Yes

None

N/A

None

N/A

None

N/A

None

Core Business

Yes

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 104

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Eligibility & Enrollment Operations Care Management Select Individual Qualified Health Plan Terminate Employer Participation Validate Application Submission Enroll in SNAP, TANF, Childcare Assistance Store supporting document image Interface to Billing System Assign tracking number and prioritize referral authorization request Confirm referral authorization request completeness Notify member, referring provider, referred-to provider of authorization Notify referral authorization requestor of result/request Validate referral request No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

Yes

Low

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

Yes

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

Care Management

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

Care Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

Care Management

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

Care Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 105

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Care Management Assign tracking number and prioritize service authorization request Confirm service authorization request completeness Notify member and requesting provider of service authorization Notify service authorization requestor of results Validate service authorization request Assign tracking number and prioritize treatment plan authorization request Confirm treatment plan authorization request completeness Notify member, care manager, provider of treatment plan authorization. Notify treatment plan authorization requestor of result Validate service authorization request No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

Care Management

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

Care Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

Care Management

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

Care Management Care Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Core Business

Care Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Core Business

Care Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Core Business

Care Management Care Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 106

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Core Business Core Business Core Business Core Business Care Management Care Management Care Management Care Management Care Management Assess members needs Assign care manager Establish treatment plan Identify and confirm provider Identify/select target members for specific programs Notify member of care management case Prepare information for communication Select program Audit case information Manage State criteria and rules Notify provider and member of case update Update case information Prepare registry updates Receive/input inquiry for health outcome information No No No No No ACCESS Function Implementation N/A N/A N/A N/A N/A Performs Function? No No No No No CSME Function Implementation N/A N/A N/A N/A N/A Performs Function? No No No No No OnBase Function Implementation N/A N/A N/A N/A N/A Performs Function? No No No No No EVR Function Implementation N/A N/A N/A N/A N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None None None None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

Care Management Care Management Care Management Care Management Care Management Care Management Care Management Care Management Care Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business Core Business Core Business Core Business

No No No No

N/A N/A N/A N/A

None None None None

No No No No

N/A N/A N/A N/A

None None None None

No No No No

N/A N/A N/A N/A

None None None None

No No No No

N/A N/A N/A N/A

None None None None

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Care Management Receive members health outcome information Respond inquiries Modify members treatment plan Notify treatment plan modifications to related parties Manage services and treatment plans Receive/define federal and State criteria and rules for providers/ contractors evaluation Receive members health information Send modified treatment plan to Health Information Exchange (HIE) Assess members health for risk factors Assign care manager Associate with application service needs Establish risk categories and hierarchy, severity, and need level No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Core Business Core Business Core Business

Care Management Care Management Care Management Care Management Care Management

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

Formatted Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Core Business Core Business

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 108

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Core Business Care Management Care Management Care Management Care Management Claims Management Claims Management Claims Management Claims Management Claims Management Claims Management Claims Management Claims Management Claims Management Claims Management Establish severity scores and diagnoses Notify member of applicable services Update risk categories Verify information from external sources Identify incorrect payments by SMA Receive retroactive modifications Determine spend-down obligation amount Process/Alert to Manage Member Info Receive health plan info from Enroll Member Apply DRG/APC Apply NCCI Calculate paid amount Receive/audit claims Suspend claims No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business Core Business

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Core Business Core Business

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Core Business Core Business Core Business Core Business Core Business

No No No No No

N/A N/A N/A N/A N/A

None None None None None

No No No No No

N/A N/A N/A N/A N/A

None None None None None

No No No No No

N/A N/A N/A N/A N/A

None None None None None

No No No No No

N/A N/A N/A N/A N/A

None None None None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 109

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Core Business

N/A

None

N/A

None

N/A

None

N/A

None

Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery

Broker/Navigator Self-service Reln Mgmt Broker/Navigator Portal Broker/Navigator Online Training Reln Mgmt Broker/Navigator Record/Modify Reln Mgmt Training Broker/Navigator Record/Modify Reln Mgmt Certification Broker/Navigator Record/Modify Reln Mgmt Compliance Broker/Navigator Manage Broker/ Reln Mgmt Navigator Monthly Targets Broker/Navigator Manage Reln Mgmt Compensation Broker/Navigator Testing of Reln Mgmt Incentive Returns Broker/Navigator Broker/ Reln Mgmt Navigator Evaluation

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

No No No No No

N/A N/A N/A N/A N/A

None None None None None

No No No No No

N/A N/A N/A N/A N/A

None None None None None

No No No No No

N/A N/A N/A N/A N/A

None None None None None

No No No No No

N/A N/A N/A N/A N/A

None None None None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 110

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Broker/Navigator Produce Monthly Reln Mgmt Paper/ E-Statements Broker/Navigator Manage Broker Reln Mgmt Inquiries Broker/Navigator File Dispute Reln Mgmt Broker/Navigator Manage Dispute Reln Mgmt Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Determine mode of communication Generate communication Prepare communication content Receive request for information, appointments and assistance Review and Approve communication Validate information Create new health plan/benefit offering Identify target groups Manage enrollment campaigns Modify existing health plan/benefit offering No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted Formatted

No No No No

N/A N/A N/A N/A

None None None None

No No No No

N/A N/A N/A N/A

None None None None

No No No No

N/A N/A N/A N/A

None None None None

No No No No

N/A N/A N/A N/A

None None None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery

Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 111

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Service Delivery Marketing & Outreach Notify new/modified health plan/benefit offering to stakeholders. Perform enrollment campaigns Receive population information and statistics from State Medicaid Agency (SMA) Create/Update/ Delete standard notification Generate communication Identify target population Prepare content for the communication Review and Approve communication Approve, deny, or modify decisions to develop outreach communications Determine content and method of communication and performance measures Generate communication No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted Formatted

Service Delivery Service Delivery

Marketing & Outreach Marketing & Outreach

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery Service Delivery

Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach Marketing & Outreach

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

Service Delivery

Marketing & Outreach

N/A

None

N/A

None

N/A

None

N/A

None

Service Delivery

Marketing & Outreach

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 112

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Service Delivery Marketing & Outreach Analyzing information, performance measures, feedback from community, and policy directives Log communication message Review and approve communication Assign Unique Account Identifier No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Service Delivery Service Delivery Service Delivery

Marketing & Outreach Marketing & Outreach Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

Yes

None

N/A

None

N/A

None

N/A

None

Service Delivery

Prepare verification request response Receive contract verification request Send contract verification response Generate claim status response

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Service Delivery

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Service Delivery

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Service Delivery

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

Service Delivery

Inquire payment status info

N/A

None

N/A

None

N/A

None

N/A

None

Service Delivery

Provide/send claim status response via HCISN

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 113

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Service Delivery Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Receive and log claim status request Validate requester authorization No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted Formatted

Service Delivery

N/A

None

N/A

None

N/A

None

N/A

None

Service Delivery

Prepare/provide provider information. Receive request for provider information. Send inquiry response

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Service Delivery

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Service Delivery

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Service Delivery

Determine provider/member eligibility status Notify provider/member of eligibility status Validate request for provider/ member eligibility Notify modification in insurance affordability program to Health Insurance Exchange (HIX). Receive request to modify contractor information

Yes

Med

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

Service Delivery

Yes

Med

None

N/A

None

N/A

None

N/A

None

Service Delivery

Yes

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Service Delivery

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Service Delivery

Customer Service & Account Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 114

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Service Delivery Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Customer Service & Account Management Request modification in contractor info Update contractor information No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted Formatted

Service Delivery

N/A

None

N/A

None

N/A

None

N/A

None

Service Delivery

Validate request

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Service Delivery

Create/inquire/ delete/modify provider information Create/inquire/ delete/modify provider/member information Validate Provider/ Member information Validate the authorization by requestor to acquire provider/member information Conduct investigations and communicate Remove provider/ contractor from Medicaid Program

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Service Delivery

Yes

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Service Delivery

Yes

Med

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

Service Delivery

Yes

Low

None

N/A

None

N/A

None

N/A

None

Service Delivery

Customer Service & Account Management Customer Service & Account Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Service Delivery

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 115

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Service Delivery Customer Service & Account Management Customer Service & Account Management Review determination of noncompliance and investigation materials Send alert of Provider termination to Health Insurance Exchange (HIX) and business partners. Rescind termination No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Service Delivery

N/A

None

N/A

None

N/A

None

N/A

None

Service Delivery

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Service Delivery

Record Inquiry Information

Yes

Med

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Service Delivery

Manage Call Transfer Business Rules Administer Employer Liability

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

Service Delivery

N/A

None

N/A

None

N/A

None

N/A

None

Service Delivery

Manage FAQs

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

Service Delivery

Manage Performance Measures/ Measurements Receive complaint

N/A

None

N/A

None

N/A

None

N/A

None

Service Delivery

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 116

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Service Delivery Customer Service & Account Management Customer Service & Account Management Resolve complaint No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Service Delivery

Close complaint

N/A

None

N/A

None

N/A

None

N/A

None

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 117

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Appendix D: IT Assets Assessment Technical Component Worksheet (Detailed View)

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Mandatory Report Templates Additional Report Templates Mandatory Reports Additional Reports Review Reports Manage Report Schedule Manage Report Delivery Mechanism Manage Analytic Templates Perform Analytics Portal Integration of Analytics Web analytics Ad Hoc Reporting No No Yes Yes Yes Yes Yes ACCESS Function Implementation N/A N/A Med Med Low Hi Low Performs Function? Yes No Yes No No No No CSME Function Implementation Med N/A Med N/A N/A N/A N/A Performs Function? Yes No Yes No No No No OnBase Function Implementation Hi N/A Hi N/A N/A N/A N/A Performs Function? No No No No No No No EVR Function Implementation N/A N/A N/A N/A N/A N/A N/A

Formatted Formatted Formatted

Comments None None None None None None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

No No No No Yes

N/A N/A N/A N/A Hi

None None None None None

Yes Yes No No Yes

Med Hi N/A N/A Med

None None None None None

No No No No No

N/A N/A N/A N/A N/A

None None None None None

No No No No No

N/A N/A N/A N/A N/A

None None None None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 118

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Information Management Information Management Information Management Information Management Information Management Information Management Information Management Information Management Knowledge Management Knowledge Management Knowledge Management Knowledge Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Manage Data Feeds Audit Collected Data Manage Surveys Manage Survey Templates Review Survey (includes survey estimate) Manage Survey Schedule Manage Survey Delivery Mechanism Publish Survey Manage Taxonomy Store Content Tag Content Retrieve Content (Search Features) Create Notification Yes Yes No No No ACCESS Function Implementation Low Low N/A N/A N/A Performs Function? No No No No No CSME Function Implementation N/A N/A N/A N/A N/A Performs Function? No Yes No No No OnBase Function Implementation N/A Med N/A N/A N/A Performs Function? No No No No No EVR Function Implementation N/A N/A N/A N/A N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None None None None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Formatted Formatted

No No No No No Yes

N/A N/A N/A N/A N/A Low

None None None None None None

No No No No No No

N/A N/A N/A N/A N/A N/A

None None None None None None

No Yes Yes No Yes Yes

N/A Med Hi N/A Hi Low

None None None None None None

No No No No No No

N/A N/A N/A N/A N/A N/A

None None None None None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Update Notification Content Delete Notification

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 119

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Support Business Support Business Support Business Support Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Send Notification Yes ACCESS Function Implementation Low Performs Function? No CSME Function Implementation N/A Performs Function? Yes OnBase Function Implementation Low Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Manage Notification Rules Manage Workflow Rules Manage Business Rules (Create/Edit/ Delete) Maintains a Rules Catalog Automated interfaces through a set of APIs (Application Programming Interfaces) Allow the reuse of the rule-repository and rules-driven technology Modification of business rules via a GUI (Graphical User Interface) Ability to attach business rules to workflow activities Manage Business Rules Manage Master Person Data Sources

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Business Support Business Support

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

Business Support

Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Master Person Registry

N/A

None

N/A

None

N/A

None

N/A

None

Business Support

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Business Support Business Support Business Support

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Yes

Med

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 120

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Master Person Registry Master Person Registry Master Person Registry Master Person Registry Master Person Registry Master Person Registry Financial Transaction Processing Financial Transaction Processing Financial Transaction Processing Financial Transaction Processing Financial Transaction Processing Financial Transaction Processing Resolve Matching Issues Determine Match Probability Manage Probabilistic Matching Manage Deterministic Matching Resolve Matching Issues Manage Master Person Index Manual Settlements Batch Settlements Yes Yes Yes ACCESS Function Implementation Med Low Low Performs Function? No No No CSME Function Implementation N/A N/A N/A Performs Function? No No No OnBase Function Implementation N/A N/A N/A Performs Function? No No No EVR Function Implementation N/A N/A N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None None None

Formatted Formatted Formatted Formatted Formatted Formatted

Yes

Low

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Yes Yes No

Low Med N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Automated Payments Electronic Funds Transfer Payment Reconciliation Health Insurance Portability and Accountability Act (HIPAA) adopted transaction standards (e.g., ASC X12N 834, ASC X12N 270, ASC X12N 271) for interfaces

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 121

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Support Business Support Business Support Business Support Financial Transaction Processing Financial Transaction Processing System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management Generate Receipts Electronic Distribution of Receipts Verify Lawful Presence Review Documentation to Verify Lawful Presence Verify Household Income Receive Notice of Enrollment and Payment Receive Notice of Disenrollment from QHP Receive Monthly Enrollment Report Report Individual Exemption Status to IRS Receive Notice of Termination of Employers Participation in SHOP Exchange Calculate Maximum APTC Receive Notice of SHOP Exchange Employer Participation Yes ACCESS Function Implementation Med Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Yes

Med

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Business Support Business Support Business Support Business Support Business Support Business Support

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Business Support Business Support

System Integration Management System Integration Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 122

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Support Business Support Business Support System Integration Management System Integration Management System Integration Management Receive Notice of Exchange Appeal Decision Receive Notice of Enrollee Changes and Renewals Receive Monthly Enrollment APTC/CSR Report for Reconciliation Receive Notice of Enrollment and Payment Notify Exchange of Disenrollment from QHP Receive Notice of Disenrollment from QHP Receive Notice of Enrollee Changes and Renewals Verify Whether Individual has already been Determined for Medicaid, CHIP, or BHP Receive Enrollment Transaction for Individual Determined Eligible for Medicaid, CHIP or BHP No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Business Support Business Support Business Support Business Support Business Support

System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Business Support

System Integration Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 123

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Support System Integration Management Determine Individual Eligibility for Medicaid or CHIP Based on Factors Other than MAGI Verify Employer Identification Number Retrieve Current Income Data Validate Address Existence Verify Individual Eligibility for Employer-Sponso red Minimum Essential Coverage Verify Individual Unemployment Insurance Verify Individual Eligibility for Other Public Minimum Essential Coverage Verify Whether Individual is an Indian Verify Individual Incarceration Status Verify Individual Residency Status No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Business Support Business Support Business Support Business Support

System Integration Management System Integration Management System Integration Management System Integration Management

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 124

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Support Business Support Business Support Business Support System Integration Management System Integration Management System Integration Management System Integration Management Publish Issuer and Plan Information Provide Plan Quality Rating Methodology Receive Issuer and Plan Information Receive Plan Non-Renewal, Decertification, and Change in Availability Notices Receive Rate and Benefit Data Provide Response to Solicitation Provide QHP Agreement Materials Provide Required Issuer and Plan Information Provide Plan Non-Renewal and Change in Availability Notices Provide Issuer and Plan Information Receive Issuer and Plan Information No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Business Support Business Support Business Support Business Support Business Support

System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

Business Support Business Support

System Integration Management System Integration Management

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 125

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Support System Integration Management Receive Plan Non-Renewal, Decertification, and Change in Availability Notices Provide Rate Information Provide Family Medicaid Cases Information to MACSS Provide Work Participation Rates to ACF Provide SNAP Information Provide Eligibility Information to WIC Notify Eligibility Specialists of Nursing Home Eligibility Pay premium on behalf of SD clients. Provide Mailing Address Information Provide Client Information to TEFRA Provide Medicaid Information to MMIS No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Business Support Business Support

System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Business Support Business Support Business Support Business Support

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Business Support Business Support Business Support Business Support

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Yes

Med

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 126

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Support Business Support Business Support System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management Provide Premium and Spend-down Information Provide Private Insurance Information Provide Health Insurance Payment Program Information Provide 1099 Information Acquire Social Security, SSI and Medicare Information Retrieve Claims Overpayment Information Provide Spend-down Population Information Pay Temp Assistance and Food Stamps to Electronic Benefit Cards Provide New Recipient Information to EBT Provide Insurance Premiums Information Submit Federal Report No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Business Support Business Support

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

Yes

Med

None

N/A

None

N/A

None

N/A

None

Business Support Business Support

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Business Support

Yes

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Business Support

System Integration Management System Integration Management System Integration Management

Yes

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Business Support Business Support

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 127

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Support System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management Provide Federal Pharmacy Discount Card Information Provide Drug Program Eligibility Information ITSD Payments System Identify Children Eligible for School Lunch Program Share Common Client Numbering (DCN) Death Match No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Yes

Low

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

EPSDT

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

PACE

N/A

None

N/A

None

N/A

None

N/A

None

Quarterly Wage Match UC Match

Yes

Low

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Yes

Med

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

IMES

N/A

None

N/A

None

N/A

None

N/A

None

Provide Medicaid Info to DMH

Yes

Low

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 128

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support Business Support System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management System Integration Management Match DSS Spend-down Lock-in No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

ASAP

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

DOR online Transactions Available For DSS Receive File from Motor Vehicles Online Interface with Motor Vehicles Obtain Provider Information Submit Medicaid 1099 to IRS Verify EPSDT Participation CCA to SSA for SSN Verification DSS and SSA Matching Transform Canonical to/from State Hub Transform Canonical to/from Issuer

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 129

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Unified Interactive Voice Communications Response Unified Fax Communications Unified Text Messaging Communications Unified Email interface Communications synchronizing calendar & scheduling data Unified Transmit Communications Report/Notification HHS Portal Web-browserbased primary interface Support the use of mobile devices Multiple views available: Employer, Employee, Consumer, Carrier, Broker, Customer Service Rep, Administrative SFTP No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

HHS Portal

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

HHS Portal

N/A

None

N/A

None

N/A

None

N/A

None

Channel Interface Components Channel Interface Components Channel Interface Components

Integration Broker Integration Broker Integration Broker

N/A

None

N/A

None

N/A

None

N/A

None

EDI

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Web Services

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 130

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Channel Interface Components Channel Interface Components Channel Interface Components Channel Interface Components Privacy and Security Privacy and Security Privacy and Security Privacy and Security Integration Broker Integration Broker Integration Broker Integration Broker Identity and Access Management Identity and Access Management Identity and Access Management Identity and Access Management Identity and Access Management ESB No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Service Registry and Repository Service Manager

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Non-Repudiation

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Manage User Identity Enforce standards for password rules Compliance management LDAP compliant authentication service(s) for user authentication Prevent concurrent logins for the same User ID unless specifically authorized Automatically log, and disable access to any user accounts following a specified, administrator configurable number of unsuccessful log-on attempts

Yes

Med

None

Yes

Low

None

Yes

None

N/A

None

Yes

Low

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Yes

Low

None

N/A

None

Yes

Med

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Privacy and Security

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted

Privacy and Security

Identity and Access Management

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 131

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Privacy and Security Privacy and Security Privacy and Security Privacy and Security Identity and Access Management Identity and Access Management Identity and Access Management Identity and Access Management Identity and Access Management Identity and Access Management Intrusion Management Manage Resources Manage access Privileges Field level security in accordance with RBAC Maintain a history of security profile assignments for a User Real-time validation of user access Digital Certificates using X.509 standard (or most recent version) Host-based Intrusion Detection software (IDS) Detect malicious code Detect viruses Host-based IPS Prevent malicious code Configure Quarantine Policies Authorized personnel to view all security audit logs No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? Yes OnBase Function Implementation Hi Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

Yes

Med

None

Yes

Low

None

Yes

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Privacy and Security Privacy and Security

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Privacy and Security

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted

Privacy and Security Privacy and Security Privacy and Security Privacy and Security Privacy and Security Privacy and Security

Intrusion Management Intrusion Management Intrusion Management Intrusion Management Intrusion Management Intrusion Management

No No No No No

N/A N/A N/A N/A N/A

None None None None None

No No No No No

N/A N/A N/A N/A N/A

None None None None None

No No No No No

N/A N/A N/A N/A N/A

None None None None None

No No No No No

N/A N/A N/A N/A N/A

None None None None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 132

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Privacy and Security Privacy and Security Privacy and Security Privacy and Security Intrusion Management Intrusion Management Intrusion Management Confidentiality Management Log User/System Activity Log User access Violations Analyze User/System Activity Utilize encryption algorithms and implementations, in compliance with National Institute of Standards and Technology Special Publications 800-52, 800-77, or 800-113. (http://csrc.nist.go v/publications/ PubsSPs.html) Data Encryption (e.g., passwords) Perform Data Anonymization Manage Data Anonymization Format Inference Engine No No No ACCESS Function Implementation N/A N/A N/A Performs Function? No No No CSME Function Implementation N/A N/A N/A Performs Function? No No No OnBase Function Implementation N/A N/A N/A Performs Function? No No No EVR Function Implementation N/A N/A N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None None None

Formatted Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Privacy and Security Privacy and Security Privacy and Security Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management

Confidentiality Management Confidentiality Management Confidentiality Management Business Rules Engine Business Rules Engine

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

No No No

N/A N/A N/A

None None None

Formatted Formatted Formatted Formatted Formatted

N/A

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 133

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Formatted Formatted Formatted Formatted

Current Physical Systems Functional Component Service Performed Performs Function? Workflow and Rules Management Workflow and Rules Management Workflow and Rules Management Data Management Data Management Data Management Workflow Engine Current Status Verification User Workflow Engine Authority Validation Workflow Engine Script Execution No ACCESS Function Implementation N/A Performs Function? No CSME Function Implementation N/A Performs Function? No OnBase Function Implementation N/A Performs Function? No EVR Function Implementation N/A

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Formatted Formatted Formatted

Comments None

Formatted Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

N/A

None

Formatted Formatted

Data Indexing & Storage Data Indexing & Storage Data Indexing & Storage

RDBMS Referential integrity enforcement Support data dictionaries with the usage, associated business rule and semantic information on its data elements Manage ETL scripts Manage ETL schedules Master Data Management functions, including data standardization and deduplication Manage Data Stores/Data Marts

No No

N/A N/A

None None

No No

N/A N/A

None None

No No

N/A N/A

None None

Yes Yes

Hi Hi

None None

Formatted Formatted Formatted Formatted

N/A

None

N/A

None

N/A

None

Med Med Med

None None None

Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted Formatted

Data Management

Data Retrieval

N/A

None

N/A

None

N/A

None

N/A

None

STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP ANALYSIS REPORT 134

Formatted Formatted Formatted Formatted Formatted Formatted Formatted

PQSCADA Sapphire User Manual 2024 Version 1.0.7.x - ELSPEC PQS
No ratings yet
PQSCADA Sapphire User Manual 2024 Version 1.0.7.x - ELSPEC PQS
214 pages
IT Project Intake and Evaluation Process Overview
100% (2)
IT Project Intake and Evaluation Process Overview
40 pages
Evolution of Data Models
100% (8)
Evolution of Data Models
13 pages
Managing Enterprise Projects: Using Project Online and Microsoft Project Server 2019
From Everand
Managing Enterprise Projects: Using Project Online and Microsoft Project Server 2019
Dale Howard
No ratings yet
SQL in The Wild (Slides)
No ratings yet
SQL in The Wild (Slides)
11 pages
Idp Project Batch - 6
No ratings yet
Idp Project Batch - 6
44 pages
Requirement Analysis
100% (2)
Requirement Analysis
45 pages
Recency System Manual
No ratings yet
Recency System Manual
32 pages
CSE202 Database Management Systems: Lecture #1
No ratings yet
CSE202 Database Management Systems: Lecture #1
122 pages
White Paper - The Business Case For Business Intelligence
67% (3)
White Paper - The Business Case For Business Intelligence
12 pages
Discovery - Starter Stories
No ratings yet
Discovery - Starter Stories
29 pages
IT Governance Analysis & Design - Group 2 - TKMTI - PDAM TIRTA RAHARJA
No ratings yet
IT Governance Analysis & Design - Group 2 - TKMTI - PDAM TIRTA RAHARJA
65 pages
Continuum Alarm Event Archiver User Guide Rev 2.6
No ratings yet
Continuum Alarm Event Archiver User Guide Rev 2.6
50 pages
FYP Final Report (Template)
No ratings yet
FYP Final Report (Template)
51 pages
FK Group Spa: FKAD Software
100% (1)
FK Group Spa: FKAD Software
2 pages
Unsw Mechanical Engineering Thesis Database
100% (3)
Unsw Mechanical Engineering Thesis Database
5 pages
Peoplesoft Uat Test Case Template1
100% (1)
Peoplesoft Uat Test Case Template1
14 pages
EMC NetWorker Foundations
100% (1)
EMC NetWorker Foundations
60 pages
User Manual: CSD - Completion String Design
No ratings yet
User Manual: CSD - Completion String Design
220 pages
RFP-2023-011-DCTP - On-Premises and Azure Infrastructure Analysis and New Design Proposal
No ratings yet
RFP-2023-011-DCTP - On-Premises and Azure Infrastructure Analysis and New Design Proposal
13 pages
DBA Lecture
No ratings yet
DBA Lecture
39 pages
Hostel Management Srs Phase
100% (1)
Hostel Management Srs Phase
33 pages
(ERP) Enterprise Resource Planning - Questionaire
100% (1)
(ERP) Enterprise Resource Planning - Questionaire
5 pages
8 Grade Career Project: Step-by-Step Description
No ratings yet
8 Grade Career Project: Step-by-Step Description
6 pages
IT Benchmark Report 2003
No ratings yet
IT Benchmark Report 2003
44 pages
KM UAT Plan - Sample
100% (1)
KM UAT Plan - Sample
10 pages
Integrigy - WebLogic Vulnerabilities Oracle E-Business Suite Impact CVE-2020-14882CVE-2020-14750
No ratings yet
Integrigy - WebLogic Vulnerabilities Oracle E-Business Suite Impact CVE-2020-14882CVE-2020-14750
19 pages
QlikView in The Big Enterprise - Center of Excellence - 1.3
No ratings yet
QlikView in The Big Enterprise - Center of Excellence - 1.3
67 pages
Procurement Technology Modernization: Kick-Off Oct 7, 2019
No ratings yet
Procurement Technology Modernization: Kick-Off Oct 7, 2019
25 pages
St. Ann'S School: Computer Science
No ratings yet
St. Ann'S School: Computer Science
25 pages
Software Requirements Specification
100% (1)
Software Requirements Specification
26 pages
BI171 Requirements SAMPLE
No ratings yet
BI171 Requirements SAMPLE
69 pages
De Guzman Data Mapping Template
No ratings yet
De Guzman Data Mapping Template
17 pages
Test Case Template
No ratings yet
Test Case Template
21 pages
Ontology Reasoning With Deep Neural Networks
No ratings yet
Ontology Reasoning With Deep Neural Networks
38 pages
Pid Example Northumbria Datawarehouse
100% (1)
Pid Example Northumbria Datawarehouse
28 pages
Data Integration
No ratings yet
Data Integration
26 pages
Feature Requirement Priority Timeline Vendor Response OOB CUS
No ratings yet
Feature Requirement Priority Timeline Vendor Response OOB CUS
10 pages
TOGAF 9 Template - Requirements Catalog
No ratings yet
TOGAF 9 Template - Requirements Catalog
5 pages
Microsoft Dynamics CRM 2011: Dashboards Cookbook
From Everand
Microsoft Dynamics CRM 2011: Dashboards Cookbook
Mark AuCoin
No ratings yet
Issue and Escalation Process (4004)
No ratings yet
Issue and Escalation Process (4004)
18 pages
Framework - Post Implementation Review Template
No ratings yet
Framework - Post Implementation Review Template
11 pages
A Transaction Log Grows Unexpectedly or Becomes Full On A Computer That Is Running SQL Server
100% (1)
A Transaction Log Grows Unexpectedly or Becomes Full On A Computer That Is Running SQL Server
21 pages
Remedy 7 Data Model User Guide - v1.1
No ratings yet
Remedy 7 Data Model User Guide - v1.1
32 pages
ITT Evaluation Matrix
No ratings yet
ITT Evaluation Matrix
18 pages
SPRING MEADOWS PUBLIC SCHOOL (AutoRecovered)
No ratings yet
SPRING MEADOWS PUBLIC SCHOOL (AutoRecovered)
19 pages
1) What Is SDLC?
No ratings yet
1) What Is SDLC?
19 pages
Presented By-Devendra Singh-19014 Amit Singh-19064 Kumar Vikas-19078 Shashank Bhosle-19094 Tuhin Subra Choudhary-19102 Jay Shankar Bajpai-19108
No ratings yet
Presented By-Devendra Singh-19014 Amit Singh-19064 Kumar Vikas-19078 Shashank Bhosle-19094 Tuhin Subra Choudhary-19102 Jay Shankar Bajpai-19108
32 pages
Requirements 101 - User Stories vs. Use Cases - Building Better Software PDF
No ratings yet
Requirements 101 - User Stories vs. Use Cases - Building Better Software PDF
12 pages
Business Requirements Document Template 09
No ratings yet
Business Requirements Document Template 09
14 pages
Spark SQL
No ratings yet
Spark SQL
12 pages
Project Inititation Document Template PDF
No ratings yet
Project Inititation Document Template PDF
8 pages
Deepak Cs Project
No ratings yet
Deepak Cs Project
25 pages
Change Management Guiding Principles: User Focused Minimize Impact On Productivity Build Credibility & Trust
No ratings yet
Change Management Guiding Principles: User Focused Minimize Impact On Productivity Build Credibility & Trust
9 pages
CRM Presentation
No ratings yet
CRM Presentation
20 pages
Decision Log
No ratings yet
Decision Log
7 pages
01 - Risk Register - Template
No ratings yet
01 - Risk Register - Template
19 pages
Business Requirements For : Revision History
No ratings yet
Business Requirements For : Revision History
16 pages
0000 BA Template Business Requirements v116
No ratings yet
0000 BA Template Business Requirements v116
43 pages
Cds Deploymnet Steps
No ratings yet
Cds Deploymnet Steps
18 pages
Edw Uat: Adding & Executing Uat Scenario - Process
No ratings yet
Edw Uat: Adding & Executing Uat Scenario - Process
8 pages
Case / Cardiosoft: Ge Healthcare
No ratings yet
Case / Cardiosoft: Ge Healthcare
24 pages
User Acceptance Testing
No ratings yet
User Acceptance Testing
2 pages
Business Requirement Document
No ratings yet
Business Requirement Document
7 pages
NetDocuments Whitepaper DMS Best Practices
No ratings yet
NetDocuments Whitepaper DMS Best Practices
18 pages
Solutions For Homework Assignment 2
No ratings yet
Solutions For Homework Assignment 2
9 pages
Introduction To The Issue Log Template: (Insert Project Name)
No ratings yet
Introduction To The Issue Log Template: (Insert Project Name)
5 pages
Requirements Gathering
No ratings yet
Requirements Gathering
13 pages
Template Business Process-View Mapping
No ratings yet
Template Business Process-View Mapping
2 pages
Prince 2 Highlight Report 2013
No ratings yet
Prince 2 Highlight Report 2013
5 pages
DQT Project Charter - Final
No ratings yet
DQT Project Charter - Final
13 pages
CSE (M Tech) Syllabus: 1 - Year
No ratings yet
CSE (M Tech) Syllabus: 1 - Year
26 pages
Final Web Experience Statement of Work
No ratings yet
Final Web Experience Statement of Work
13 pages
Bi Project Implementation Life Cycle
No ratings yet
Bi Project Implementation Life Cycle
5 pages
QlikView Sviluppo Progettuale en
No ratings yet
QlikView Sviluppo Progettuale en
5 pages
BI Requirements Gathering - Facilitation Tips
No ratings yet
BI Requirements Gathering - Facilitation Tips
3 pages
User Story Template
No ratings yet
User Story Template
1 page
Project Status Update Template
No ratings yet
Project Status Update Template
3 pages
Testing and BA
No ratings yet
Testing and BA
4 pages
Use Case Realization Document
No ratings yet
Use Case Realization Document
5 pages
Proposal School Management System
100% (1)
Proposal School Management System
12 pages
2011 - Zachman Framework For Enterprise Architecture 3.0
No ratings yet
2011 - Zachman Framework For Enterprise Architecture 3.0
1 page
Valerie Arraj, Managing Director, Compliance Process Partners, LLC
No ratings yet
Valerie Arraj, Managing Director, Compliance Process Partners, LLC
5 pages
Deep Dive For Project Management
No ratings yet
Deep Dive For Project Management
4 pages
FAQ in IDMS
No ratings yet
FAQ in IDMS
5 pages
Resume: Rakesh Kumar Prasad Mobile:-09560910462 Objective
No ratings yet
Resume: Rakesh Kumar Prasad Mobile:-09560910462 Objective
6 pages
Cloud computing architecture A Clear and Concise Reference
From Everand
Cloud computing architecture A Clear and Concise Reference
Gerardus Blokdyk
No ratings yet
Enterprise Metadata Management Standard Requirements
From Everand
Enterprise Metadata Management Standard Requirements
Gerardus Blokdyk
No ratings yet
Disaster Recovery Business Continuity Complete Self-Assessment Guide
From Everand
Disaster Recovery Business Continuity Complete Self-Assessment Guide
Gerardus Blokdyk
No ratings yet
Continuity of Operations The Ultimate Step-By-Step Guide
From Everand
Continuity of Operations The Ultimate Step-By-Step Guide
Gerardus Blokdyk
No ratings yet