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1. PROJECT GOVERNANCE
ASPEN – SBM (State Based Marketplace)
PROJECT NAME
PROJECT SHORT
NAME(S)
DATE
September 23, 2015
LEAD AGENCY
Human Services Department
OTHER AGENCIES
NM Health Insurance Exchange (NM HIX)
EXECUTIVE SPONSOR
Sean Pearson
AGENCY HEAD
Brent Earnest
AGENCY CIO/IT LEAD
Susan Pentecost
PROJECT MANAGER
Kathy Martinez
2. PROJECT ABSTRACT
(PROVIDE A BRIEF DESCRIPTION AND PURPOSE FOR THIS PROJECT.)
On March 23, 2010, President Obama signed comprehensive health reform, the Patient
Protection and Affordable Care Act, into law. The changes made to the law by subsequent
legislation, focused on provisions to expand coverage, control health care costs, and improve
the health care delivery system. The following are the basic components of the Patient
Protection and Affordable Care Act:
 Requires most U.S. citizens and legal residents to have health insurance.
 Create state-based American Health Benefit Exchanges through which individuals can
purchase coverage, with premium and cost sharing credits available to
individuals/families with income between 133-400% of the federal poverty level (the
poverty level is $19,530 for a family of three in 2013)
 Create separate Exchanges through which small businesses can purchase coverage.
Require employers to pay penalties for employees who receive tax credits for health
insurance through an Exchange, with exceptions for small employers.
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
Impose new regulations on health plans in the Exchanges and in the individual and
small group markets. Expand Medicaid to 133% of the federal poverty level.
Concurrent with the development and implementation of the ASPEN system, the State of New
Mexico elected to transfer ownership for the creation and implementation of the American
Health Benefit Exchanges for both individuals and small business to the New Mexico Health
Insurance Exchange (NMHIX or the “Exchange”).
The New Mexico Health Insurance Exchange (NMHIX) decided to pursue a full State Based
Marketplace (SBM) with an expected production date of October 1, 2014. In accordance with
the Center for Medicare and Medicaid Services (CMS) requirements, the Human Services
Department (HSD) was to make the following changes to ASPEN to accommodate the
transition to a SBM:
 Create real time eligibility service for the NMHIX SBM based upon account transfer
information.
 Determine Advanced Premium Tax Credit (APTC) or Cost Sharing Reduction
(CSR) values based upon account transfer information.
An amendment was done to the existing ISD2R contract with the ASPEN vendor to provide
these modifications. During the UAT phase of the project, the NMHIX Board determined that
the NMHIX was not prepared to implement the SBM on October 1, 2014. HSD completed the
work planned for the SBM through UAT sign off at the direction of NMHIX. Original intent
was to postpone the implementation by one year to October 1, 2015. Subsequent directives
from CMS to NMHIX resulted in redesign of the SBM plans and an indefinite hold on the
implementation of a State Based Marketplace in New Mexico.
HSD intends to modify and implement the real time eligibility service with the Federally
Facilitated Marketplace (FFM) and within our customer facing portal YES NM in FY 2016.
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3A. Scope Verification
REQUIREMENTS REVIEW
Yes
Were the project objectives (expected
outcomes) accomplished?
Were all Deliverables submitted and
accepted?
Did the IV&V vendor verify that all
deliverables met the requirements?
Have all contracts been closed?
Have all final payments been made (i.e.,
invoices paid)
Have all project documents/records been
appropriately stored for future reference?
Has adequate knowledge transfer been
completed?
No
Explanation/Notes
X
NMHIX Board postponed
implementation in July 2014. UAT
completed based on original
requirements.
X
X
X
X
X
X
3B. MAJOR PROJECT DELIVERABLES AND PERFORMANCE MEASURES MET
Major Project Deliverable and Performance
Measure
(Include an explanation if deliverable or performance
measure was not met.)
Budget
Date
Project Phase
Project Charter
2/1/2014
Planning
Certification Form & Documentation
2/1/2014
Planning
Project Management Plan
2/15/2014
Planning
ASPEN Contract Amendment
2/23/2014
Planning
Project Schedule
1/15/2014
Planning
Requirements/Design
$4,177,640
6/13/14*
Implementation
Development/QAT
$5,570,186
9/10/14**
Implementation
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3B. MAJOR PROJECT DELIVERABLES AND PERFORMANCE MEASURES MET
Major Project Deliverable and Performance
Measure
(Include an explanation if deliverable or performance
measure was not met.)
Budget
$4,177,639
UAT
Total
Date
Project Phase
12/3/14***
Implementation
$13,925,465
*Completed on time – review and approval
of deliverable took longer than anticipated.
** Initial Deliverable version submitted
8/25/14 – approved 9/10/14
***Initial Deliverable version submitted
10/22/14. Approved by State 12/3/14.
Cert. Date
4A. CERTIFICATION HISTORY
Funding Source(s) – Funding Total Amount
Cert. Amount
(Cite the specific laws, grants, etc. and total amount.)
2/24/2014
$5,116,570 New Mexico Health Insurance Exchange 3rd Level 1
Establishment Grant(1.3)
 $2,865,815 Maintenance & Operations
5/21/2014
$9,985,551 New Mexico Health Insurance Exchange 3rd Level 1
Establishment Grant(1.3) HBEIE140193-01-00.
$15,102,121 Total
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4B. RFP / Contract History
(LIST ALL RFP’S AND CONTRACTS ISSUED FOR THE PROJECT.)
List RFP and Contract
(Purpose and/or Description)
ISD2 Replacement - #10-630-00-17771.
Optional deliverable was a Health
Insurance Exchange Interface.
Total
Contract
Number
Amendment #5
to contract #12630-4000-001
Compensation
Amount or NA
$14,490,084
%
Complete
100
$14,490,084
5. Schedule and Budget
Planned Start Date
2/1/14
Actual Start Date
2/1/14
Planned End Date
12/31/14
Actual End Date
12/31/14
Planned Cost:
(Budget)
 Professional
Services
$15,102,121
$13,925,465
Actual Cost:
(Total)
 Professional
Services
$14,490,084
$13,925,465
 Hardware
$170,000
 Hardware
 Software
$768,930
 Software
$285,893
 Network
$0
 Network
$0
 Other
$237,726
 Other
$0
$237,726
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6A. Independent Verification & Validation
(INCLUDE SUMMARY OF THE LAST IV&V REPORT OR RISK MANAGEMENT SUMMARY REPORT.)
The overall status of the ASPEN-SBM project as of 12/31/2014 is GREEN.
The New Mexico Health Information Exchange (NMHIX) Board of Directors voted on
7/25/2014 to remain on the Federally Facilitated Marketplace (FFM) for another year.
Although the delay reduces the risk related to a premature launch of the New Mexico State
Based Exchange (SBM), it creates uncertainties and challenges as set forth in the Project
Summary in Section 1.4 of this report.
Deloitte submitted the final deliverable State Based Marketplace Eligibility User Acceptance
Test and Implementation, v1.1, on 11/13/2014. At the close of this reporting period, HSD was
in the process of verifying that any remaining issues had been resolved through the Change
Request process.
HSD and the New Mexico Health Insurance Exchange (NMHIX) continue to review the
feedback and guidance provided by the Centers for Medicare and Medicaid (CMS) regarding
the integration of Eligibility and Account Transfer processes. The combined workgroup had
targeted mid-December for completion of a detailed design and approach addressing the CMS
recommendations. CMS has indicted it was focused upon creating a “common consumer
experience” for these processes, and urged the design of a “single door” for New Mexico
processing. In a conference call with CMS, the NM HIX leadership was informed the New
Mexico Exchange would not be receiving any new funds to support the modifications CMS
had identified. The impact of the reduced resource level was being assessed by the ASPENSBM leadership team. As of this report, the ASPEN-SBM software modification approach that
had been planned for implementation in September 2015 may require significant change.
The project is in close-out phase, but new efforts will likely be required to implement the
state-based exchange as required by CMS.
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6B. LESSONS LEARNED
1. Co-location with vendors preferable – particularly when three different entities are working
toward same goal and timelines with varying priorities.
2. Flexibility is important with politically sensitive projects that have ongoing changes at the
Federal and State levels during implementation.
3. Vendors have differing understanding of deadlines, SDLC processes, and project management.
Need better agreements up front prior to timeline commitments.
7. TRANSITION TO OPERATIONS
Yes
No
Are there recurring
maintenance/operational
costs for the
product/service?
X
Are there any
recommended
enhancements or updates?
X
Explanation/Notes
Seven months (10/1/14 – 4/30/15) of M&O was paid via
NMHIX funding at a rate of $318,424 per month while
trying to develop alternative implementation based on
new CMS guidelines. This ceased following April 30,
2014 payment.
When project completed there were two outstanding
Change Order requests for future enhancements.
Summary of agency plan to support project solution in production.
Implementation is on indefinite hold from the Federal level with the NM HIX. HSD will proceed to
utilize the eligibility service built in other areas (Federally Facilitated Marketplace and YES NM) to
provide better customer experience related to Medicaid eligibility in New Mexico. Any additional
changes and enhancements will be done under the ASPEN Maintenance and Operations contract not
related to this project.
Summary of agency plans to fund the maintenance and Operations of this project.
See above.
Revision: 6/18/13
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