REQUEST FOR INFORMATION -- MEDICARE MANAGED CARE SYSTEM REDESIGN The Health Care Financing Administration (HCFA) seeks contractor support to develop and implement a new Medicare Managed Care System (MMCS) that meets the MMCS business requirements for beneficiary enrollment and beneficiary payment functions. This is referred to as Stage 1. The purpose of this Request for Information is to obtain industry feedback about potential contract types that are appropriate for this effort and innovative approaches that may be used to accomplish Stage 1. This RFI solicits industry comment to help HCFA develop an acquisition strategy. HCFA will review the information and will incorporate beneficial suggestions into an RFP for this effort. (NOTE: HCFA intends to develop Stage 1 only at this time. Stages 2 and 3 are not the focus of this acquisition effort.) This project is the first stage of an incremental approach for replacing the current group of Medicare Managed Care systems that currently utilize COBOL and Model 204 programming languages to process transactions on IBM OS390 hardware. One of the major operational functions associated with the Medicare managed care program is enrollment and beneficiary payment calculation currently supported by the Group Health Plan (GHP) system. The GHP system, a batch model process of approximately 240K SLOC, is the crucial component of the legacy MMCS for processing beneficiary transactions: enrollments and disenrollments, changes in beneficiary status, and calculation of the capitated amount to be paid to MCOs for each enrolled beneficiary, as well as any retroactive payment adjustments resulting from beneficiary status changes. The GHP system also disseminates reports to the plan providers, notices to the beneficiaries, and interacts with other systems. HCFA has selected an approach that is comprised of three major stages:  Stage 1: Redesign of the current beneficiary enrollment and beneficiary payment calculation modules -- this is the functionality provided by the current GHP system. This system will need to interface with the Automated Plan Payment System (APPS) and with other systems (to include the Beneficiary Database and Health Plan Management System (formerly the Plan Information Control System)) that are to be implemented prior to Stage 1. Stage 1 is expected to begin in April 2000 and be completed no later than July 2003 (which includes a 6-month parallel operational testing period).  Stage 2: Redesign of the current MCO payment module -- this is the functionality provided by the current APPS system. Stage 2 is expected to be completed no later than September of 2003. (Stage 2 is not part of this acquisition.)  Stage 3: Develop a Medicare managed care data warehouse, designed to better integrate the information available to HCFA (e.g., utilization, quality of care, payment), thereby providing improved management of the Medicare managed care program. (Stage 3 is not part of this acquisition.) The major objectives of MMCS Stage 1 are to: (1) Clearly understand the MMCS business requirements required for Stage 1 development; (2) Develop a detailed system design which shall: (a)Meet the set of MMCS business requirements for Stage 1, (b) Allow for a flexible means of an incremental development of MCO payment, and a data warehouse in a later stage, (c) Be based on the high-level design from the MMCS Implementation Recommendation Report dated June 15, 1999, (d) Support HCFAs IT Architectures guiding principles and objectives, and be consistent with the ITA constraints and standards; (3) Create a validation plan, and link test scenarios to the requirements in HCFAs requirements management software tool (QSS DOORS); (4) Produce and implement a conversion plan for converting from the existing GHP system to the new MMCS; (5) Develop the interfaces with MMCS and the existing legacy systems; (6) Develop a user training manual and conduct training on MMCS (7) Produce system documentation regarding MMCS; (8) Conduct parallel operational testing between the new MMCS and legacy system to verify beneficiary level payments over a six month period; and (9) Integrate the new MMCS into the HCFA Data Center environment to support production. The contractor shall provide the facilities to develop and test the new system prior to parallel operation at HCFA. This will require use of test data subject to the restrictions in the Privacy Act. The development facility and contractor will need to adhere to system security guidelines, as developed by HCFA. HCFA requires an experienced partner to perform the software development on this project. HCFA will require the development contractor to be performing, at a minimum, at a Software Development Capability Maturity Model level 2 (ref SEI SCE methodology V.3.0), and will require potential contractors to demonstrate, through appropriate means, that they are performing at this level (or higher). HCFA also requires that the partner selected for this project be experienced in the use of Earned Value Management techniques on software development projects. HCFA will require that the development contractor possess, and utilize on this project, an Earned Value Management System (EVMS) that is compliant with: (1) DoD 5000.2-R, Mandatory Procedures for Major Defense Acquisition Programs and Major Automated Information Systems Acquisition Programs, (2) NASA Policy Directive 9501.3, Earned Value Management, or (3) ANSI/EIA-748-1998, Earned Value Management Systems. HCFA will be requiring potential contractors to demonstrate how they have applied EV methods (e.g., report formats and contents, analyses and reporting, software used, etc.) on similar software development projects. HCFA intends to use performance-based contracting methods and performance incentives on this project. HCFA is exploring the possible contracting options and existing contract vehicles available to accomplish this effort. HCFA anticipates a Request For Proposal (RFP) release in November 1999 and a bidders conference in December 1999 with an anticipated contract award in April 2000. The contract is expected to contain the following phases: analysis (4/2000 through 8/2000), design (9/2000 through 8/2001), development (7/2001 through 5/2002), integration (6/2002 through 12/2002), and parallel operation and testing (1/2003 through 6/2003) with initial operational capability beginning 7/2003. HCFA also intends to monitor technical performance by using technical metrics. Please provide information related to technical performance metrics that you have used effectively on similar software development projects. HCFA is currently evaluating software development methodologies. HCFA is interested in getting comments on the considerations of using a model-driven development versus a more traditional structured development approach for this project. If HCFA were to specify one of these approaches, how would this impact your proposal? How would this decision impact EV requirements, technical performance metrics, and performance incentives? How would the design artifacts be affected? How does the preferred method impact overall project schedule and cost? The following information is available on the Internet (http://www.hcfa.gov/stats/mmcsweb): 1) A sample of the business requirements. 2) The MMCS Implementation Recommendation Report (dated June 15, 1999). 3) A general overview of HCFAs IT Architecture policies and procedures. In the RFP, HCFA will provide a validated set of MMCS business requirements required for Stage 1 development and the detailed documentation on the architecture. What other information would help you estimate cost and schedule? It is not HCFA's intent to disclose proprietary information to the public. Interested parties are invited to submit written information addressing the following topics: 1) How you have applied EVM methods on similar software development projects, 2) Suggested contract types and contracting vehicles (e.g., GWACs), and pricing strategies for the work, 3) Technical performance metrics suitable for this type of effort, 4) Considerations concerningthe development methodology, 5) How the development methodology might impact earned value requirements, technical performance metrics, and performance incentives, 6) How the design artifacts are affected by the selected development method, 7) Impacts of the development method on schedule and cost, and 8) Other information that would help you estimate cost and schedule. Submit your written information to HCFA by COB 5 November 1999 to HCFA, ATTN: Andrew Mummert, 7500 Security Blvd, Mailstop C2-21-15, Baltimore, MD 21244. Comments can also be e-mailed to Andrew Mummert at amummert@hcfa.gov. WEB: click here to download reference information, http://www.hcfa.gov/stats/mmcsweb. E-MAIL: click here to contact the contract specialist via, amummert@hcfa.gov. Posted 10/15/99 (W-SN392067).

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