List of Figures Figure 1. Agency of Human Services Health and Human Services Enterprise Overview 16 Figure 2. HSE/AHS Program Scope 17 Figure 3. AHS Vision Statement 36 Figure 4. Health and Human Services Enterprise Overview 36 Figure 5. HSE Governance Structure 37 Figure 6. Conceptual View of the AHS Health and Human Services Enterprise Platform 40 Figure 7. Example of Iterative QA/IV&V Strategy 50 Figure 8. Proposed QA/IV&V Staffing Model 76 Remainder of this page intentionally left blank List of Tables
Reporting and Analytics Quality Assurance Medication Therapy Management Financial Management Management of State and CMS Drug Rebate Programs Support of Multistate Supplemental Rebate Consortium 340B Program Management Additional Services: GMC 2017 Considerations Project Objectives and Goals The State has identified several business drivers for the procurement of QA/IV&V services to support the Medicaid Projects. These drivers include: Implement QA/IV&V within a coordinated QA/IV&V approach established to assure the HSE Program objectives are achieved. Ensure QA/IV&V activities for the Medicaid projects procurements complement the HSE Program approach which assesses quality at both the Program level and within the respective Projects to assure program objectives are achieved. Coordinate with other entities providing QA/IV&V to limit duplication of effort and share critical information. Maintain/Secure funding from the CMS through adherence to Federal regulations. Demonstrate compliance with CMS requirements by proactively assessing the Medicaid Projects and its deliverables against the criteria specified within the Medicaid Enterprise Certification Toolkit (MECT) checklists, the Seven Conditions and Standards and MITA 3.0 framework during execution of the DDI effort as opposed to upon completion. This assures early identification of non-compliance allowing the State to take corrective actions as needed to maintain/secure federal funding. CMS provides funding to support the development and operation of the State’s MMIS at 75-percent to 90-percent when specific criteria are met. Provide independent, objective guidance and expertise to assure Medicaid Projects success and decrease implementation risks. Gain perspective and recommendations on the health of the Medicaid Projects and associated deliverables from an experienced, neutral third party to assure the development of the solution is managed in accordance with practices that reduce risk and support achievement of the stated project objectives. Leverage assessments and deliverable reviews to ensure end users’ practice needs drive the system NOT technology.
Deliverable 4 – Requirements Analysis, System Design and Development Strategy X Deliverable 5 – System Implementation Strategy X Deliverable 6 – Master Testing Strategy X Deliverable 7 – Requirements Traceability Plan X Task 2 – Requirements Analysis and System Design Deliverable 8 – Functional Specification and System Design Document X X Deliverable 9 – Data Integration and Interface Design Document X X Deliverable 10 –System Architecture X X Deliverable 11 – Technical Design Document X X Task 3 – System Configuration and Development Deliverable 12 – System Implementation Plan X X Deliverable 13 – Data Integration and Synchronization Plan, including multiple test files (MMIS/claims, PBM, eligibility, VCCI legacy, etc.) X X Deliverable 14 – System Maintenance Support Plan X X Task 4 – Testing Deliverable 15 – Test Plan X X Deliverable 16 – Test Scenarios, Test Cases and Test Scripts, using VCCI legacy and live data with VT staff X X
QA/IV&V Project Manager The QA/IV&V Project Manager: Acts as the single point of contact for the State for all aspects of the QA/IV&V project Is responsible for all scheduling and operational correspondence between the State and the Vendor Develops, delivers and supports all reports sent to the State and Federal partners, including all status reporting Ensures alignment of all project QA/IV&V standards with Program, State and Federal expectations Provides the leadership, creating standards and processes required for the successful execution of the QA/IV&V project Manages the QA/IV&V project (i.e., scope, schedule and budget and resources) and reports on these Is accountable for execution of all tasks and deliverables specified within this RFP Ensures all QA/IV&V deliverables meet state and/or federal defined quality standards Delivers briefings to the State project team leadership with support from the Vendor team as needed Is responsible for all IV & V subcontractor relationships Must have a minimum of five (5) years’ direct project oversight and authority over large-scale government health and human services system implementation projects in excess of 10 million dollars and at least five (5) years’ experience in QA/IV&V for a total of ten (10) years’ experience overall Must have a minimum of five (5) years’ experience creating QA/IV&V processes and plans directly related to Medicaid implementation projects, of similar size and complexity to the Medicaid Projects described within this RFP, to include industry-standard and best practices regarding quality, quality assurance and quality control principles and techniques Must have a Bachelor’s degree or equivalent experience preferably in Information Technology, Engineering or a business or related field. Should possess Project Management Professional (PMP) or equivalent certification Must have excellent verbal and written communication skills Must be able to communicate effectively with clients and technical staff in English Special consideration will be given to those who have previously managed Medicaid project implementations and who have experience working with HIPAA privacy and security rules
Functional Lead The Functional Lead: Provides input on the QA/IV&V Plan and Work Plan to ensure appropriate review of project processes and artifacts Is primarily responsible for development of functional aspects of QA/IV&V assessments Leads review of non-technical deliverables and provides recommendations to accept or reject with supporting rationale and recommendations for remediation Conducts reviews of requirements validation efforts, User Acceptance Testing, deployment planning and training and other business linked components of the DII vendor’s SDLC efforts Participates in review of technical deliverables Proactively identifies project and Program risks and issues and proposes recommended courses of action as necessary Engages and coordinates functional subject matter experts to execute QA/IV&V tasks as needed Provides input on the status reports Supports other tasks as identified by the QA/IV&V Project Manager Must have a minimum of five (5) years direct experience with Medicaid health and human services business operations and related concepts including requirements development and validation, system configuration to meet business needs, and User Acceptance Testing (e.g., role of Business Analyst) Must have a Bachelor’s degree preferably in Information Technology, Engineering or a business or related field. Relevant experience with Medicaid project implementations may be considered in lieu of degree Must demonstrate an understanding of Federal requirements for business, systems and Federal funding for all systems and programs in scope. Must demonstrate experience using the MITA 3.0 framework, the Seven Conditions and Standards and all recent changes from the Accountable Care Act and other Federal and State laws, mandates and guidance Must demonstrate experience with CMS MMIS Certification processes Should have significant experience with industry-standards and best practices regarding quality, quality assurance and quality control principles and techniques
Technical Lead The Technical Lead: Provides input on the QA/IV&V Plan and Work Plan Is primarily responsible for development of non-functional (e.g. technical, implementation, technical operations, usability, performance, etc.) aspects of QA/IV&V assessments Leads review of technical deliverables and provides recommendations to accept or reject with supporting rationale Conducts reviews of non-functional requirements validation efforts, Security assessments, SDLC Testing, Systems integration with HSE Platform, deployment planning and other technical linked components of the DII vendor’s SDLC efforts Participates in review of functional deliverables Proactively identifies project and Program risks and issues and proposes recommended courses of action as necessary Engages and coordinates subject matter experts to execute QA/IV&V tasks as needed Provides input on the status reports Supports other tasks as identified by the QA/IV&V Project Manager Must have a minimum of five (5) years direct experience in the oversight of the technical aspects of large-scale government health and human services system implementation projects (e.g., role of architect, development lead) Must have a Bachelor’s degree preferably in Information Technology, Engineering or a business or related field. Relevant Medicaid project implementation experience may be considered in lieu of degree Must have significant experience with the specified architectural/design concepts (e.g. service-oriented architecture) and technologies in use on this project and Program Must demonstrate experience using the MITA 3.0 framework, the Seven Conditions and Standards and all recent changes from the Accountable Care Act and other Federal and State laws, mandates and guidance Must demonstrate experience with CMS MMIS Certification processes Should demonstrate significant experience with industry-standards and best practices regarding quality, quality assurance and quality control principles and techniques across the relevant technical domains (e.g., security, privacy, etc.)