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1 | CPAC.zip\Fee-Revenue Service Connected Condition Decision | 03-058Serv-ConnectDecision_RSD_v1.0_fully signed.docx | Thu Feb 9 15:03:56 2017 UTC |
2 | CPAC.zip\Fee-Revenue Service Connected Condition Decision | 03-058Serv-ConnectDecision_RSD_v1.0_fully signed.docx | Fri Feb 10 15:56:30 2017 UTC |
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1 | Department of Vetera ns Affairs | |
2 | ||
3 | ||
4 | ||
5 | ||
6 | Fee-Revenu e Service Connected (SC) Condi tion | |
7 | Decision | |
8 | ||
9 | ||
10 | Requiremen ts Specifi cation Doc ument | |
11 | ||
12 | ||
13 | ||
14 | ||
15 | ||
16 | ||
17 | ||
18 | ||
19 | ||
20 | September 2015 | |
21 | ||
22 | Version 1. 0 | |
23 | ||
24 | Revision H istory | |
25 | ||
26 | Date | |
27 | Version | |
28 | Descriptio n | |
29 | Author | |
30 | Reviewer | |
31 | Issue Date | |
32 | 06/02/2015 | |
33 | 0.01 | |
34 | Initial dr aft | |
35 | G. Howard | |
36 | S. Ambrose | |
37 | 07/10/2015 | |
38 | 07/17/2015 | |
39 | 0.02 | |
40 | Revised dr aft to inc lude addit ional Fee Basis prom pts to be removed. | |
41 | G. Howard | |
42 | S. Ambrose | |
43 | 07/21/2015 | |
44 | 08/28/2015 | |
45 | 0.03 | |
46 | Revised to remove re quirements related t o removal of prompts in Fee Ba sis and In tegrated B illing bas ed on proj ect IPT de cision/FBC S constrai nts. | |
47 | G. Howard | |
48 | S. Ambrose | |
49 | 09/01/2015 | |
50 | 09/14/2015 | |
51 | 0.04 | |
52 | Included m inor revis ions to wo rding base d on VA fi nal review and feedb ack. | |
53 | G. Howard | |
54 | S. Ambrose | |
55 | 09/15/2015 | |
56 | 09/22/2015 | |
57 | 1.0 | |
58 | First form al iterati on | |
59 | C. Dunn | |
60 | ||
61 | ||
62 | ||
63 | Table of C ontents | |
64 | ||
65 | 1.Introduc tion ..... .......... .......... .......... .......... .......... .......... .......... .......... ... 1 | |
66 | 1.1. Purp ose ...... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .. 1 | |
67 | 1.2. Scop e ........ .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .... 1 | |
68 | 1.3. Refe rences ... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 3 | |
69 | 2.Overall Descriptio n ........ .......... .......... .......... .......... .......... .......... ........ 3 | |
70 | 2.1. Acce ssibility Specificat ions...... .......... .......... .......... .......... .......... .......... .......... 3 | |
71 | 2.2. Busi ness Rules Specifica tion ..... .......... .......... .......... .......... .......... .......... ........ 3 | |
72 | 2.3. Desi gn Constra ints Speci fication.. .......... .......... .......... .......... .......... .......... ..... 3 | |
73 | 2.4. Disa ster Recov ery Specif ication .. .......... .......... .......... .......... .......... .......... ...... 3 | |
74 | 2.5. Docu mentation Specificat ions...... .......... .......... .......... .......... .......... .......... ...... 4 | |
75 | 2.6. Func tional Spe cification s ........ .......... .......... .......... .......... .......... .......... .......... . 4 | |
76 | Syst em Feature : VistA Fe e Basis PC RR ....... .......... .......... .......... .......... . 5 | |
77 | 2.7. Grap hical User Interface (GUI) Spe cification s ........ .......... .......... .......... ........ 5 | |
78 | 2.8. Mult i-division al Specifi cations... .......... .......... .......... .......... .......... .......... ......... 5 | |
79 | 2.9. Perf ormance Sp ecificatio ns........ .......... .......... .......... .......... .......... .......... ........ 5 | |
80 | 2.10.Quali ty Attribu tes Specif ication .. .......... .......... .......... .......... .......... .......... ....... 5 | |
81 | 2.11.Relia bility Spe cification s......... .......... .......... .......... .......... .......... .......... .......... .. 6 | |
82 | 2.12.Scope Integrati on........ .......... .......... .......... .......... .......... .......... .......... .......... ..... 6 | |
83 | 2.13.Secur ity Specif ications . .......... .......... .......... .......... .......... .......... .......... .......... .. 6 | |
84 | 2.14.Syste m Features ......... .......... .......... .......... .......... .......... .......... .......... .......... ..... 6 | |
85 | 2.15.Usabi lity Speci fications. .......... .......... .......... .......... .......... .......... .......... .......... .. 6 | |
86 | 3.Applicab le Standar ds ....... .......... .......... .......... .......... .......... .......... ..... 6 | |
87 | 4.Interfac es........ .......... .......... .......... .......... .......... .......... .......... .......... .... 7 | |
88 | 4.1. Comm unications Interface s ........ .......... .......... .......... .......... .......... .......... ........ 7 | |
89 | 4.2. Hard ware Inter faces..... .......... .......... .......... .......... .......... .......... .......... .......... .... 8 | |
90 | 4.3. Soft ware Inter faces..... .......... .......... .......... .......... .......... .......... .......... .......... ..... 8 | |
91 | 4.4. User Interface s ........ .......... .......... .......... .......... .......... .......... .......... .......... ......... 8 | |
92 | 5.Legal, C opyright, and Other Notices .. .......... .......... .......... .......... ...... 8 | |
93 | 6.Purchase d Componen ts ....... .......... .......... .......... .......... .......... .......... . 8 | |
94 | 6.1. Defe ct Source (TOP 5) .. .......... .......... .......... .......... .......... .......... .......... .......... ... 8 | |
95 | 7.User Cla ss Charact eristics.. .......... .......... .......... .......... .......... .......... .. 8 | |
96 | 8.Estimati on ....... .......... .......... .......... .......... .......... .......... .......... .......... ... 8 | |
97 | Attachment A – Appro val Signat ures ..... .......... .......... .......... .......... ....... 10 | |
98 | Attachment B – Acron ym List an d Glossary ......... .......... .......... .......... . 11 | |
99 | Attachment C – Enter prise Requ irements . .......... .......... .......... .......... ... 13 | |
100 | ||
101 | List of Ta bles | |
102 | Table 1: G oals and I mpacts ... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ......... 1 | |
103 | Table 2: F ee Revenue SC Decisi on Change BNs....... .......... .......... .......... .......... .......... .......... .......... .......... ... 2 | |
104 | Table 3: A cronym Lis t and Glos sary ..... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... . 11 | |
105 | Table 4: E nterprise Requiremen ts ....... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ... 13 | |
106 | ||
107 | ||
108 | List of Fi gures | |
109 | ||
110 | Figure 1: Cumulative Probabili ty (“S-cur ve”) Chart ......... .......... .......... .......... .......... .......... .......... .......... ... 9 | |
111 | ||
112 | 1. Introdu ction | |
113 | ||
114 | The Chief Business O ffice (CBO ), Purchas ed Care Pr ogram Offi ce is requ esting enh ancements to the Vet erans Heal th Informa tion Syste ms and Tec hnology Ar chitecture (VistA) F ee Basis a pplication that woul d remove t he respons ibility fr om Fee Cle rks for id entifying if service s provided by Non-De partment o f Veterans Affairs ( VA) health care provi ders are r elated to a Veteran’ s Service Connected (SC) condi tion. Curr ent Progra m Office p olicy requ ires all i nvoices su bmitted fo r services provided by Non-VA healthcare providers to be rev iewed by V A Revenue Staff to d etermine i f there is a potenti al for cos t recovery through t he Medical Care Cost Recovery (MCCR) Pro gram. | |
115 | ||
116 | 1.1.Purpos e | |
117 | ||
118 | This Requi rements Sp ecificatio n Document (RSD) spe cifies the requireme nts for th e Fee- Rev enue SC Co ndition De cision enh ancement o f the Elec tronic Dat a Intercha nge (EDI) Consolidat ed Patient Account C enter (CPA C) Revenue Enhanceme nts Progra m. The int ended audi ence is th e CBO Purc hased Care Program O ffice, CPA C key stak eholders i ncluding t he CPAC Re venue Syst ems Manage ment (RSM) organizat ion, and t he CPAC ED I Revenue Enhancemen ts develop ment team. | |
119 | ||
120 | 1.2.Scope | |
121 | ||
122 | This docum ent addres ses the Bu siness Nee d (BN) and requireme nts propos ed in the Fee Revenu e SC Decis ion Change Business Requiremen ts Documen t (BRD) da ted June 2 011, which outlines recommende d changes to the Vis tA Fee Bas is applica tion. | |
123 | ||
124 | The goals, impacts, and outcom e measures of the en hancements proposed in the BRD are shown in Table 1. | |
125 | ||
126 | Table 1: G oals and I mpacts | |
127 | ||
128 | Goal/Objec tive and D esired Out come | |
129 | Impact | |
130 | Measuremen t | |
131 | Provide t he ability to includ e all bill ed line it em charges for Non- VA Care on the Poten tial Cost Recovery R eport (PCR R), includ ing line i tem charge s previous ly exclude d based on responses to POTENT IAL COST R ECOVERY an d SC CONDI TION promp ts in Fee Basis. | |
132 | Decision of whether a service is relate d to a Vet eran’s SC illness/in jury is re moved from | |
133 | Fee Cleric al | |
134 | Staff. | |
135 | Increased opportuni ties for R evenue Sta ff to eval uate poten tially cos t recovera ble cases identified on PCRR. | |
136 | System wil l default to auto-re sponse to allow maxi mum review of cost r ecoverable cases. | |
137 | ||
138 | This docum ent addres ses only t he Fee-Rev enue SC Co ndition De cision enh ancement, one of fiv e enhancem ents compr ising the EDI CPAC R evenue Enh ancements Program. D etails reg arding oth er enhance ments in t he program are descr ibed in se parate RSD s. | |
139 | ||
140 | During req uirements elaboratio n for this enhanceme nt, the BN and requi rements we re discuss ed from th e perspect ive of the BRD, incl uding the changes re commended in the BRD to addres s the BN. | |
141 | ||
142 | The soluti on suggest ed by the BRD entail ed establi shing defa ult respon ses to cer tain VistA fields in order to meet the s tated goal of forcin g billed l ine item c harge tran sactions t o appear o n the Vist A Fee Basi s PCRR. | |
143 | ||
144 | After furt her discus sion and e laboration in the me eting, the actual BN was clari fied and i t was disc overed tha t the BN, goals, and outcomes could be e ffectively met by an approach that would be less i nvasive to other Vis tA Fee Bas is options . | |
145 | ||
146 | This revis ed underst anding of the BN and goals has rendered the origin al BN2 and goals fro m the BRD as obsolet e. To addr ess this c hange, the BN will b e amended in this RS D. The BRD will not be revised to reflec t the amen ded BN. Th e RSD shou ld be rega rded as th e source f or the mos t recent B N and requ irements b ased on re quirements elaborati on. | |
147 | ||
148 | The BNs/re quirements are shown in Table 2. Table 2 also refl ects the o bsolescenc e of BN2 a nd the inc lusion of new BN3. | |
149 | ||
150 | Table 2: F ee Revenue SC Decisi on Change BNs | |
151 | ||
152 | ReqPro | |
153 | Tag | |
154 | BN | |
155 | Owner Requ irement (O WNR) | |
156 | Number | |
157 | OWNR | |
158 | Priority* | |
159 | ||
160 | BN 1: Adhe re to the Enterprise Level req uirements within the Enterpris e Requirem ents Manag ement (ERM ) Reposito ry and as specifical ly address ed in Appe ndix B of this docum ent. | |
161 | ||
162 | BN 2: Capa bility in VistA Fee Basis appl ication fo r system a uto-respon se prompts in | |
163 | SC and Pot ential Cos t Recovery fields. ( Obsolete) | |
164 | ||
165 | ||
166 | 2.1 | |
167 | Provide th e ability to set the value of the POTENT IAL COST R ECOVERY fi eld (FBPCR 67*), to a utomatic d efault res ponse of “ YES” in th e VistA Fe e Basis Ci vil Hospit al (CH)/Co mmunity Nu rsing Home (CNH) Pro gram. (Obs olete) | |
168 | High | |
169 | ||
170 | ||
171 | 2.2 | |
172 | Provide th e ability to set the value of the SC fie ld (FBPCR2 ) to autom atic defau lt respons e of “NO” in VistA F ee Basis O UTPATIENT Program. ( Obsolete) | |
173 | High | |
174 | ||
175 | ||
176 | ReqPro | |
177 | Tag | |
178 | BN | |
179 | Owner Requ irement (O WNR) | |
180 | Number | |
181 | OWNR | |
182 | Priority* | |
183 | ||
184 | ||
185 | 2.3 | |
186 | Provide th e ability to set the value of the POTENT IAL COST R ECOVERY fi eld (FBPCR 3) to auto matic defa ult respon se of “YES ” in VistA Fee Basis PHARMACY Program. ( Obsolete) | |
187 | High | |
188 | ||
189 | BN 3: Incr ease oppor tunities f or Revenue Staff to evaluate p otential c ost recove rable case s on the V istA Fee B asis PCRR. | |
190 | ||
191 | ||
192 | 3.1 | |
193 | Provide th e ability to include all bille d line ite m charges for Non-VA Care on t he PCRR, i ncluding l ine item c harges pre viously ex cluded bas ed on resp onses to P OTENTIAL C OST RECOVE RY and SC CONDITION prompts in Fee Basis . | |
194 | High | |
195 | ||
196 | 1.3.Refere nces | |
197 | ||
198 | The follow ing docume ntation/hy perlinks c ontain inf ormation r elated to this RSD: | |
199 | ||
200 | Fee Reven ue SC Deci sion Chang e BRD, Jun e 2011 | |
201 | Please re fer to App endix A of the BRD f or additio nal refere nces relev ant to thi s enhancem ent | |
202 | ||
203 | 2. Overall Descripti on | |
204 | ||
205 | 2.1.Access ibility Sp ecificatio ns | |
206 | ||
207 | This proje ct will ad here to al l applicab le require ments of S ection 508 of the Re habilitati on Act of | |
208 | 1973, as a mended (29 U.S.C. 79 4d). A 508 complianc e review w ill be con ducted in accordance with Proj ect Manage ment Accou ntability System (PM AS) standa rds. | |
209 | ||
210 | 2.2.Busine ss Rules S pecificati on | |
211 | ||
212 | There are no specifi c business rules app licable to this enha ncement. | |
213 | ||
214 | 2.3.Design Constrain ts Specifi cation | |
215 | VA Standa rds and Co nventions for Massac husetts Ge neral Hosp ital Utili ty Multi- Programmin g System ( MUMPS) dev elopment | |
216 | VA Techni cal Refere nce Model (TRM) | |
217 | ||
218 | 2.4.Disast er Recover y Specific ation | |
219 | ||
220 | There are no new or specific d isaster re covery spe cification s for this project. The disast er recover y specific ations per taining to any VistA system is applicabl e to this project. | |
221 | ||
222 | 2.5.Docume ntation Sp ecificatio ns | |
223 | ||
224 | System doc umentation to be del ivered wil l be in ac cordance w ith PMAS a nd ProPath System | |
225 | Developmen t Processe s. | |
226 | ||
227 | Documentat ion to be delivered includes b ut is not limited to : | |
228 | ||
229 | Installat ion Guide | |
230 | User Guid e | |
231 | Technical Manual | |
232 | Security Guide | |
233 | Contingen cy Plan | |
234 | Disaster Recovery P lan (DRP) | |
235 | Deploymen t Plan | |
236 | Release N otes | |
237 | ||
238 | 2.6.Functi onal Speci fications | |
239 | ||
240 | If a Veter an is trea ted for a non-SC inj ury/illnes s by a Non -VA health care provi der, VA is able to b ill a Vete ran’s thir d party in surer for costs asso ciated wit h those se rvices. In consistenc ies have b een identi fied in th e current processes which have allowed c ost recove rable clai ms to be m issed and not evalua ted by Rev enue Staff for colle ction on c ompensable services. It has be en determi ned that t he root ca use of thi s problem resides on the Fee s ide of the claims pr ocess. Fee clerks ar e required to respon d when pro mpted, as to whether or not a billed lin e item cha rge is rel ated to a Veteran’s SC injury/ illness or is cost r ecoverable . Purchase d Care Pro gram Offic e Staff ha ve identif ied busine ss practic es in the Non-VA hea lthcare pr ovider cla ims proces s that cou ld be inhi biting rev enue optim ization. T hey includ e: | |
241 | ||
242 | Fee clerk s are not directed b y policy o r trained to make ap propriate decisions as to whet her or not a billed line-item charge is related to a Veteran ’s SC inju ry/illness per reven ue operati ons guidel ines. | |
243 | If Fee cl erks indic ate that a billed li ne item ch arge is fo r a condit ion relate d to a Vet eran’s SC illness/in jury, that charge is categoriz ed as non- cost recov erable. Re venue staf f would no t be provi ded an opp ortunity t o review t his line i tem charge /claim as it will be | |
244 | excluded f rom the PC RR. This r eport list s all clai ms that ar e potentia lly cost r ecoverable by VA. Th e exclusio n of this informatio n on the P CRR preven ts Revenue Staff fro m having a ccess to i nformation on all No n-VA healt hcare clai ms and is in direct conflict w ith curren t CBO poli cy which s tates that all Non-V A healthca re claims are to be presented to Revenue Staff for proper ev aluation t o determin e if they qualify as cost- rec overable c laims. As a result, Revenue st aff would not be abl e to bill a Veteran’ s third pa rty insura nce carrie r for pote ntially co st-recover able servi ces. These instances could res ult in los s of poten tial reven ue, as VA would not be able to bill for services i t is legal ly permitt ed to cost -recover. | |
245 | ||
246 | To address this issu e, the PCR R will be modified t o remove t he filteri ng that ex cludes Non -VA Care b illed line item char ges based on respons es entered in the Fe e Basis so ftware by Fee Clerks . By remov ing the re port filte ring that pertains t o the SC C ondition a nd Potenti al Cost Re covery | |
247 | ||
248 | data value s, line it em charges previousl y excluded based on responses to POTENTI AL COST RE COVERY and SC CONDIT ION prompt s in Fee B asis will appear on the PCRR, enabling t he Revenue Staff to optimize c ost recove ry. | |
249 | ||
250 | ||
251 | ||
252 | BN 3.1: Pr ovide the ability to include a ll billed line item charges fo r Non-VA C are on the PCRR. | |
253 | ||
254 | Sy stem Featu re: VistA Fee Basis PCRR | |
255 | ||
256 | Logic will be remove d from the existing PCRR that selects re port data based on P otential C ost | |
257 | Recovery a nd/or SC C ondition Y es/No resp onses in F ee Basis. | |
258 | ||
259 | 2.6.1.1.Fu nctional R equirement : FRSC-3.1 -01 | |
260 | ||
261 | The system shall inc lude all N on-VA Care CNH bille d line ite m charges on the Vis tA Fee Bas is | |
262 | PCRR. | |
263 | ||
264 | 2.6.1.2.Fu nctional R equirement : FRSC-3.1 -02 | |
265 | ||
266 | The system shall inc lude all N on-VA Care CH billed line item charges o n the Vist A Fee Basi s | |
267 | PCRR. | |
268 | ||
269 | 2.6.1.3.Fu nctional R equirement : FRSC-3.1 -03 | |
270 | ||
271 | The system shall inc lude all N on-VA Care Outpatien t billed l ine item c harges on the VistA Fee | |
272 | Basis PCRR . | |
273 | ||
274 | 2.6.1.4.Fu nctional R equirement : FRSC-3.1 -04 | |
275 | ||
276 | The system shall inc lude all N on-VA Care Pharmacy billed lin e item cha rges on th e VistA Fe e | |
277 | Basis PCRR . | |
278 | ||
279 | 2.7.Graphi cal User I nterface ( GUI) Speci fications | |
280 | ||
281 | This enhan cement doe s not invo lve a GUI. | |
282 | ||
283 | 2.8.Multi- divisional Specifica tions | |
284 | ||
285 | No new mul ti-divisio nal requir ements are being int roduced as part of t his enhanc ement. Thi s enhancem ent will u se existin g multi-di visional f unctionali ty and wil l continue to operat e in a mul ti-divisio n and/or m ulti-site environmen t. | |
286 | ||
287 | 2.9.Perfor mance Spec ifications | |
288 | ||
289 | No perform ance speci fications have been identified . | |
290 | ||
291 | It is impl ied that t his enhanc ement will not intro duce perfo rmance deg radation t o the exis ting syste m. | |
292 | ||
293 | 2.10. Qual ity Attrib utes Speci fication | |
294 | ||
295 | The softwa re associa ted with t his enhanc ement shal l be relea sed with z ero high o r medium i mpact defe cts. Test defect log s will be submitted after inte rnal Quali ty Assuran ce (QA) an d site tes ting for V A review. | |
296 | ||
297 | The MUMPS code devel oped for t his projec t will be compliant to all VA MUMPS Codi ng | |
298 | Standards and Conven tions. | |
299 | ||
300 | 2.11. Reli ability Sp ecificatio ns | |
301 | ||
302 | As specifi ed in the BRD, syste m availabi lity shoul d be 24 ho urs per da y, 365 day s per year except du ring perio ds of sche duled main tenance. | |
303 | ||
304 | 2.12. Scop e Integrat ion | |
305 | ||
306 | This enhan cement wil l be limit ed to chan ges to the VistA Fee Basis app lication, and will a ffect only the PCRR. | |
307 | ||
308 | 2.13. Secu rity Speci fications | |
309 | ||
310 | There are no explici t security specifica tions for this enhan cement. | |
311 | ||
312 | All VA and Veterans Health Adm inistratio n (VHA) se curity req uirements will be ad hered to. Cross-cutt ing securi ty require ments are contained in the VA Enterprise Requireme nts Reposi tory (ERR) . Efforts that invol ve the col lection an d maintena nce of ind ividually identifiab le informa tion must be covered by a Priv acy Act sy stem of re cords noti ce. | |
313 | ||
314 | 2.14. Syst em Feature s | |
315 | ||
316 | This enhan cement mod ifies an e xisting Vi stA applic ation. | |
317 | ||
318 | The System Features introduced by this p roject are detailed in Section Error! Re ference so urce not f ound.. | |
319 | ||
320 | 2.15. Usab ility Spec ifications | |
321 | ||
322 | The existi ng Fee Bas is interfa ce will be used for this enhan cement, in cluding ex isting usa bility spe cification s. The use r interfac e features of the ex isting Vis tA Fee Bas is Applica tion will not be mod ified, and therefore no perfor mance degr adation wi ll be intr oduced. | |
323 | ||
324 | Additional functiona lity will be describ ed from a user stand point in t he user gu ide. Train ing needed to begin using the new functi onality is expected to be mini mal. | |
325 | ||
326 | 3. Applica ble Standa rds | |
327 | ||
328 | Configurat ion Manage ment (CM) processes provide th e release and contro l of the s ystem, har dware, and software to which t his docume nt applies , includin g identifi cation num ber(s), ti tle(s), ab breviation (s), versi on number( s), and re lease numb er(s). | |
329 | ||
330 | Listed bel ow are VA reference and guidan ce documen tation and standards applicabl e to or ta ilored for the CPAC EDI Projec t. This gu idance is used to fu lfill the performanc e requirem ents of th is contrac t. | |
331 | ||
332 | 44 U.S.C. § 3541, “ Federal In formation Security M anagement Act (FISMA ) of 2002” | |
333 | Federal I nformation Processin g Standard s (FIPS) P ublication 140-2, “S ecurity | |
334 | Requiremen ts For Cry ptographic Modules” | |
335 | Software Engineerin g Institut e, Softwar e Acquisit ion-Capabi lity Matur ity Modeli ng (SA- CM M) Level 3 procedure s and proc esses | |
336 | ||
337 | VA Direct ive 6102, “Internet/ Intranet S ervices,” July 15, 2 008 | |
338 | 36 C.F.R. Part 1194 “Electron ic and Inf ormation T echnology (IT) Acces sibility | |
339 | Standards, ” July 1, 2003 | |
340 | Office of Managemen t and Budg et (OMB) C ircular A- 130, “Mana gement of Federal | |
341 | Informatio n Resource s,” Novemb er 28, 200 0 | |
342 | 32 C.F.R. Part 199, “Civilian Health an d Medical Program of the Unifo rmed Servi ces | |
343 | (CHAMPUS)” | |
344 | An Introd uctory Res ource Guid e for Impl ementing t he Health Insurance Portabilit y and | |
345 | Accountabi lity Act ( HIPAA) Sec urity Rule , March 20 05 | |
346 | Sections 504 and 50 8 of the R ehabilitat ion Act (2 9 U.S.C. § 794d), as amended b y the | |
347 | Workforce Investment Act of 19 98 (P.L. 1 05-220), A ugust 7, 1 998 | |
348 | Homeland Security P residentia l Directiv e (12) (HS PD-12) | |
349 | VA Direct ive 6500, “Informati on Securit y Program, ” August 4 , 2006 | |
350 | VA Handbo ok 6500, “ Informatio n Security Program,” September 18, 2007 | |
351 | VA Handbo ok, 6500.5 , Incorpor ating Secu rity and P rivacy in System Dev elopment | |
352 | Lifecycle. | |
353 | VA Handbo ok 6500.6, “Contract Security, ” March 12 , 2010 | |
354 | PMAS port al (refere nce Perfor mance Work Statement (PWS) Ref erences – Technical | |
355 | Library | |
356 | Office of Enterpris e Developm ent (OED) ProPath Pr ocess Meth odology (r eference P WS Referen ces –Techn ical Libra ry and Pro Path Libra ry. Note: In the eve nt of a co nflict, OE D ProPath takes prec edence ove r other pr ocesses or methodolo gies. | |
357 | TRM | |
358 | National Institute Standards and Techno logy (NIST ) Special Publicatio ns (SP) 80 0-60 and 8 00-53 | |
359 | IT Asset Management (ITAM) an d Enterpri se Managem ent Founda tion (EMF) BR-0006, version 00 2.1-140520 08, dated 10/30/2007 [Note inf ormational , Context, and ITAM- EMF Conce ptual link ] | |
360 | HIPAA of 1996; Pub. L 104-191. | |
361 | VA Sectio n 508 poli cies and p rocedures 6221 Acces sible Elec tronic and IT, Direc tive/Handb ook, publi shed by VA ’s Section 508 Produ ct Develop ment Produ ct Assessm ent Compet ency Divis ion | |
362 | VA M Prog ramming St andards an d Conventi ons. Revis ed 04/03/2 007 | |
363 | VA Sectio n 508 poli cies and p rocedures 6221 Acces sible Elec tronic and IT, Direc tive/Handb ook, publi shed by VA ’s Section 508 Produ ct Develop ment Produ ct Assessm ent Compet ency Divis ion (refer ence at ht tp:/ DNS viewPublic ation.asp? Pub_ID=435 &FType=2) | |
364 | ||
365 | 4. Interfa ces | |
366 | ||
367 | 4.1.Commun ications I nterfaces | |
368 | ||
369 | No new com munication s interfac es are req uired for this enhan cement. | |
370 | ||
371 | 4.2.Hardwa re Interfa ces | |
372 | ||
373 | No new har dware inte rfaces are required for this e nhancement . | |
374 | ||
375 | 4.3.Softwa re Interfa ces | |
376 | ||
377 | No new sof tware inte rfaces are required for this e nhancement . | |
378 | ||
379 | The Fee Ba sis packag e interfac es with ot her VistA Applicatio ns like Ad mission, D ischarge, Transfer ( ADT)/Regis tration, I ntegrated Funds Dist ribution C ontrol Poi nt Activit y, Account ing and Pr ocurement (IFCAP), a nd Integra ted Billin g (IB). Th e Fee Basi s package transmits MailMan me ssages to Central Fe e. Refer t o the Fee Basis Tech nical Manu al for lis t of integ ration agr eements wi th other V istA Appli cations. | |
380 | ||
381 | 4.4.User I nterfaces | |
382 | ||
383 | This enhan cement wil l use the existing V istA Fee B asis user interface. No modifi cations ar e specifie d for the user inter face. | |
384 | ||
385 | 5. Legal, Copyright, and Other Notices | |
386 | ||
387 | This effor t is spons ored by an agency of the Unite d States G overnment. Neither t he United States | |
388 | Government nor any a gency ther eof, nor H arris Corp oration no r any of i ts subcont ractors, n or any of their empl oyees, mak es any war ranty, exp ress or im plied, or assumes an y legal li ability or responsib ility for the accura cy, comple teness, or usefulnes s of any i nformation , apparatu s, product , or proce ss disclos ed, or rep resents th at its use would not infringe on private ly owned r ights. Ref erence her ein to any specific commercial product, process, o r service by trade n ame, trade mark, manu facturer, or otherwi se does no t necessar ily consti tute or im ply its en dorsement, recommend ation, or favoring b y the Unit ed States Government or any ag ency there of, or Har ris Corpor ation or a ny of its subcontrac tors. The views and opinions o f authors expressed herein do not necess arily stat e or refle ct those o f the Unit ed States Government or any ag ency there of. | |
389 | ||
390 | 6. Purchas ed Compone nts | |
391 | ||
392 | Not applic able. | |
393 | ||
394 | 6.1.Defect Source (T OP 5) | |
395 | ||
396 | Not applic able. | |
397 | ||
398 | 7. User Cl ass Charac teristics | |
399 | ||
400 | The Fee Ba sis enhanc ements des cribed in this docum ent will b e used by VA Medical Center (V AMC) Reven ue/MCCR st aff, CBO N ational Fe e Program Office (NF PO) and Pu rchased Ca re Program Office st aff, Veter ans Integr ated Servi ce Network (VISN) st aff, and V A Central Office (VA CO) CBO st aff. | |
401 | ||
402 | 8. Estimat ion | |
403 | ||
404 | TBD. | |
405 | ||
406 | Project So ftware Fun ctional Si ze and Siz e-Based | |
407 | Effort and Duration Estimate | |
408 | ||
409 | ||
410 | Applicatio n | |
411 | ||
412 | Item | |
413 | A | |
414 | B | |
415 | C | |
416 | D | |
417 | E | |
418 | Total | |
419 | Counted Fu nction | |
420 | Points | |
421 | ||
422 | ||
423 | ||
424 | ||
425 | ||
426 | TBD | |
427 | Estimated Scope | |
428 | Growth | |
429 | ||
430 | ||
431 | ||
432 | ||
433 | ||
434 | TBD | |
435 | Estimated Size at | |
436 | Release | |
437 | ||
438 | ||
439 | ||
440 | ||
441 | ||
442 | TBD | |
443 | ||
444 | Size-Based Effort Es timates | |
445 | Labor Hour s | |
446 | Probabilit y | |
447 | Low-Effort Estimate – With ind icated pro bability, project wi ll consume no more t han: | |
448 | TBD | |
449 | ||
450 | High-Effor t Estimate – With in dicated pr obability, project w ill consum e no more than: | |
451 | TBD | |
452 | ||
453 | ||
454 | Size-Based Duration Estimates | |
455 | Work Days | |
456 | Probabilit y | |
457 | Low-Durati on Estimat e – With i ndicated p robability , project will consu me no more than: | |
458 | TBD | |
459 | ||
460 | High-Durat ion Estima te – With indicated probabilit y, project will cons ume no mor e than: | |
461 | TBD | |
462 | ||
463 | ||
464 | ||
465 | ||
466 | ||
467 | ||
468 | ||
469 | TBD | |
470 | Figure 1: Cumulative Probabili ty (“S-cur ve”) Chart | |
471 | ||
472 | Attachment A – Appro val Signat ures | |
473 | ||
474 | ||
475 | ||
476 | ||
477 | ||
478 | ||
479 | Signed:Dat e: | |
480 | ||
481 | Greg Estes | |
482 | Business S ponsor | |
483 | ||
484 | ||
485 | ||
486 | ||
487 | ||
488 | ||
489 | Signed:Dat e: | |
490 | ||
491 | Charles Du nn | |
492 | CPAC Progr am Manager , Integrat ed Project Team (IPT ) Co-Chair | |
493 | ||
494 | ||
495 | ||
496 | ||
497 | ||
498 | ||
499 | Signed:Dat e: | |
500 | ||
501 | Ann Kliegl | |
502 | CPAC Proje ct Manager , IPT Co-C hair | |
503 | ||
504 | Attachment B – Acron ym List an d Glossary | |
505 | ||
506 | Table 3: A cronym Lis t and Glos sary | |
507 | ||
508 | Term | |
509 | Meaning | |
510 | ADT | |
511 | Admission, Discharge , Transfer | |
512 | BN | |
513 | Business N eed | |
514 | BRD | |
515 | Business R equirement s Document | |
516 | CBO | |
517 | Chief Busi ness Offic e | |
518 | CCD | |
519 | Continuity of Care D ocument | |
520 | CH | |
521 | Civil Hosp ital | |
522 | CHAMPUS | |
523 | Civilian H ealth and Medical Pr ogram of t he Uniform ed Service s | |
524 | CM | |
525 | Configurat ion Manage ment | |
526 | CNH | |
527 | Community Nursing Ho me | |
528 | CPAC | |
529 | Consolidat ed Patient Account C enter | |
530 | DRP | |
531 | Disaster R ecovery Pl an | |
532 | EDES | |
533 | Emergency Department Encounter Summary | |
534 | EDI | |
535 | Electronic Data Inte rchange | |
536 | EMF | |
537 | Enterprise Managemen t Foundati on | |
538 | ERM | |
539 | Enterprise Requireme nts Manage ment | |
540 | ERR | |
541 | Enterprise Requireme nts Reposi tory | |
542 | FIPS | |
543 | Federal In formation Processing Standards | |
544 | FISMA | |
545 | Federal In formation Security M anagement Act | |
546 | GUI | |
547 | Graphical User Inter face | |
548 | HIPAA | |
549 | Health Ins urance Por tability a nd Account ability Ac t | |
550 | HITSP | |
551 | Health IT Standards Panel | |
552 | HL7 | |
553 | Health Lev el Seven | |
554 | HSPD-12 | |
555 | Homeland S ecurity Pr esidential Directive (12) | |
556 | IB | |
557 | Integrated Billing | |
558 | IFCAP | |
559 | Integrated Funds Dis tribution Control Po int Activi ty, Accoun ting and P rocurement | |
560 | IHE | |
561 | Integratin g the Heal thcare Ent erprise | |
562 | IPT | |
563 | Integrated Project T eam | |
564 | IT | |
565 | Informatio n Technolo gy | |
566 | ITAM | |
567 | IT Asset M anagement | |
568 | ||
569 | ||
570 | Term | |
571 | Meaning | |
572 | MCCR | |
573 | Medical Ca re Cost Re covery | |
574 | MUMPS | |
575 | Massachuse tts Genera l Hospital Utility M ulti-Progr amming | |
576 | System | |
577 | NFPO | |
578 | National F ee Program Office | |
579 | NIST | |
580 | National I nstitute S tandards a nd Technol ogy | |
581 | OED | |
582 | Office of Enterprise Developme nt | |
583 | OI&T | |
584 | Office of Informatio n and Tech nology | |
585 | OMB | |
586 | Office of Management and Budge t | |
587 | OWNR | |
588 | Owner Requ irement | |
589 | PCRR | |
590 | Potential Cost Recov ery Report | |
591 | PMAS | |
592 | Project Ma nagement A ccountabil ity System | |
593 | PWS | |
594 | Performanc e Work Sta tement | |
595 | QA | |
596 | Quality As surance | |
597 | RMR | |
598 | Requiremen ts Managem ent Reposi tory | |
599 | RSD | |
600 | Requiremen ts Specifi cation Doc ument | |
601 | RSM | |
602 | Revenue Sy stems Mana gement | |
603 | SA-CMM | |
604 | Software A cquisition -Capabilit y Maturity Modeling | |
605 | SC | |
606 | Service Co nnected | |
607 | SDS | |
608 | Standard D ata Servic es | |
609 | SP | |
610 | Special Pu blications | |
611 | TRM | |
612 | Technical Reference Model | |
613 | VA | |
614 | Department of Vetera ns Affairs | |
615 | VACO | |
616 | VA Central Office | |
617 | VAMC | |
618 | VA Medical Center | |
619 | VETS | |
620 | VA Enterpr ise Termin ology Serv ices | |
621 | VHA | |
622 | Veterans H ealth Admi nistration | |
623 | VISN | |
624 | Veterans I ntegrated Service Ne twork | |
625 | VistA | |
626 | Veterans H ealth Info rmation Sy stems and Technology | |
627 | Architectu re | |
628 | ||
629 | Attachment C – Enter prise Requ irements | |
630 | ||
631 | Below is a subset of Enterpris e-level Re quirements that are of particu lar intere st to the business c ommunity. These requ irements M UST be add ressed wit hin each p roject res ulting fro m this wor k effort. If Office of Informa tion and T echnology (OI&T) can not addres s these En terprise- level requ irements, the Busine ss Owners responsibl e for each area MUST be engage d in any w aiver disc ussions pr ior to any decisions being mad e. This se ction is n ot meant t o be a com prehensive list of a ll Enterpr ise-level requiremen ts that ma y apply to this work effort an d should n ot preclud e the tech nical comm unity from reviewing all Enter prise-leve l requirem ents, and identifyin g others t hat should apply to this work effort as well. | |
632 | ||
633 | Enterprise -level req uirements are contai ned in the VA Requir ements Man agement Re pository ( RMR). Cont act the RM R Team to gain acces s to the R MR and to obtain the comprehen sive alloc ation of E nterprise- level requ irements f or the pro ject devel opment ite ration at PI I
|
|
634 | ||
635 | Table 4: E nterprise Requiremen ts | |
636 | ||
637 | ReqPro | |
638 | Tag | |
639 | Requiremen t | |
640 | Type | |
641 | Descriptio n | |
642 | ENTR99 | |
643 | Security | |
644 | All VA sec urity requ irements w ill be adh ered to. B ased on FI PS 199 and NIST SP 8 00-60, rec ommended S ecurity Ca tegorizati on is High . | |
645 | ||
646 | ||
647 | The Securi ty Categor ization wi ll drive t he initial set of mi nimal secu rity contr ols requir ed for the informati on system. Minimum s ecurity co ntrol requ irements a re address ed in NIST SP 800-53 and VA Ha ndbook 650 0, Appendi x D. | |
648 | ENTR10 | |
649 | Privacy | |
650 | All VA Pri vacy requi rements wi ll be adhe red to. Ef forts that involve t he collect ion and ma intenance of individ ually iden tifiable i nformation must be c overed by a Privacy Act system of record s notice. | |
651 | ENTR95 | |
652 | 508 Compli ance | |
653 | All Sectio n 508 requ irements w ill be adh ered to. C ompliance with Secti on 508 wil l be deter mined by f ully meeti ng the app licable re quirements as set fo rth in the VHA Secti on 508 che cklists (1 194.21, 11 94.22, 119 4.24, 1194 .31 and 11 94.41) loc ated at: h ttp:// DNS /508/resou rces_508.h tml
|
|
654 | ENTR7 | |
655 | Executive Order | |
656 | All execut ive order requiremen ts will be adhered t o. | |
657 | ||
658 | ||
659 | ReqPro | |
660 | Tag | |
661 | Requiremen t | |
662 | Type | |
663 | Descriptio n | |
664 | ENTR8 | |
665 | Identity | |
666 | Management | |
667 | All Enterp rise Ident ity Manage ment requi rements wi ll be adhe red to. Th ese requir ements are applicabl e to any a pplication that adds , updates, or perfor ms lookups on person s. | |
668 | ENTR103 | |
669 | Terminolog y | |
670 | Services | |
671 | Applicatio n/services shall ref erence the Standard Data Servi ces (SDS) as the aut horitative source to access no n- clinica l referenc e terminol ogy. | |
672 | ENTR104 | |
673 | Terminolog y | |
674 | Services | |
675 | Applicatio n/Services shall use the VA En terprise T erminology Services (VETS) as the author itative so urce to ac cess clini cal refere nce termin ology. | |
676 | ENTR105 | |
677 | Terminolog y | |
678 | Services | |
679 | Applicatio ns recordi ng the ass essments a nd care de livered in response to an Emer gency Depa rtment vis it shall | |
680 | conform to standards defined b y the VHA- endorsed v ersion of C 28 – Hea lth IT Sta ndards Pan el (HITSP) Emergency Care Summ ary Docume nt Using I ntegrating the Healt hcare | |
681 | Enterprise (IHE) Eme rgency Dep artment En counter | |
682 | Summary (E DES) Compo nent. | |
683 | ENTR106 | |
684 | Terminolog y | |
685 | Services | |
686 | Applicatio ns exchang ing data s ummarizing a patient ’s medical status sh all confor m to stand ards defin ed by the VHA-endors ed version of C 32 – HITSP Sum mary Docum ents Using Health Le vel Seven (HL7) Cont inuity of Care Docum ent (CCD) Component. |
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