CO
Close Out Contract
Contract Management
Description
The Close Out Contract business process begins with an expired contract or an order to terminate a contract. The business process ensures the obligations of the current contract are complete and the turnover to the new contractor proceeds according to contractual obligations.
Business Process Template
Trigger events
Environment-based
- Contract reaches the end of its effective period.
Interaction-based
- Receive alert from Determine Adverse Action Incident business process to cease activities with contractor.
Results
- The contract closes.
- Alert sent to notify contractor of termination of contract.
- Tracking information as needed for measuring performance and business activity monitoring.
Business process steps
- 1. START: Receive expired contract or instruction to terminate a contract.
- 2. Validate information submitted is correct and as complete as possible. Information complies with syntax criteria and submitter has completed all required fields.
- 3. If applicable, request additional information.
- 4. Validate information provided is authentic.
- 5. Identify all requirements for termination of contract.
- 6. Monitor closure activities.
- 7. Officially terminate contract.
- 8. END: Send alert to notify contractor of termination of contract.
Predecessor processes
Successor processes
Shared data
- Contractor data store including contract information
Constraints
Each state may have its own requirements for contract termination.
Failures
- The State Medicaid Agency (SMA) receives incomplete termination instructions.
- Contractor data store contains invalid information.
Performance measures
- Time to complete process = ___ months; ___ weeks
- Accuracy of information = ___ %
- Accessibility of information for terminating contract = ___ months; ___ weeks
- Consistency of decisions and disposition = ___ %
- Error rate = __% or less
Source: CMS MITA 3.0 Business Process Template, Contractor Management BPT.pdf, pages 16-17.
Business Capability Model (12 questions)
Each capability question defines five maturity levels, from Level 1 through Level 5.
Business Capability Descriptions
How integrated or central is the process?
- LEVEL 1There is no central oversight of the contract close out within SMA. There is no coordination among SMA programs or between SMA and other state agencies in relation to closing out contracts.
- LEVEL 2SMA introduces central tracking of contracts and policies to oversee the close out process, and coordinate efforts between SMA programs.
- LEVEL 3SMA automates central tracking of contracts to the full extent possible. SMA coordinates the contract close out process with other SMA or other state agencies’ programs.
- LEVEL 4SMA adopts MITA Framework, industry standards, and other national standards by interstate agencies and entities allow for shared business services.
- LEVEL 5SMA adopts MITA Framework, industry standards, and other national standards by national agencies and entities allow for shared business services.
Is the process primarily manual or automatic?
- LEVEL 1The process consists primarily of manual, paper-based activity to accomplish tasks.
- LEVEL 2SMA uses a mix of manual and automatic processes to accomplish tasks. The close out contract process uses electronic storage of contract information and internal electronic communications.
- LEVEL 3SMA automates process to the full extent possible within the intrastate.
- LEVEL 4SMA automates process to the full extent possible across the interstate.
- LEVEL 5SMA automates process to the full extent possible across the nation.
What is the primary mechanism for exchange of contract information?
- LEVEL 1Exchange of contract information is primarily via mail, telephone, in person, and facsimile.
- LEVEL 2Exchange of contract information utilizes some electronic means (e.g., e-mail, web portals to push information) but mail, telephone, in person, and facsimile communication remains a significant part of the process.
- LEVEL 3SMA automates process to the full extent possible within the intrastate.
- LEVEL 4SMA automates process to the full extent possible across the interstate.
- LEVEL 5SMA automates process to the full extent possible across the nation.
Does the State Medicaid Agency use standards in the process?
- LEVEL 1SMA focuses on meeting compliance thresholds for state and federal regulations using state-specific standards.
- LEVEL 2SMA applies a mix of nationally recognized and state-specific standards.
- LEVEL 3SMA adopts MITA Framework, industry standards, and other nationally recognized standards for intrastate exchange of information.
- LEVEL 4SMA adopts MITA Framework, industry standards, and other nationally recognized standards for clinical and interstate information exchange.
- LEVEL 5SMA adopts MITA Framework, industry standards, and other nationally recognized standards for national exchange of information.
How does the State Medicaid Agency collaborate with other agencies or entities in performing the process?
- LEVEL 1Very little collaboration occurs with other agencies to standardize information exchange or business tasks.
- LEVEL 2SMA collaborates with other agencies and entities to adopt nationally recognized standards and Electronic Data Interchange (EDI) transactions.
- LEVEL 3SMA collaborates with other intrastate agencies and entities to adopt national standards, and to develop and share reusable business services.
- LEVEL 4SMA collaborates with other interstate agencies and entities to adopt national standards, and to develop and share reusable processes including clinical information.
- LEVEL 5SMA collaborates with agencies and entities for national (and international) interoperability improvements that maximize automation of routine operations.
Business Capability Quality: Timeliness of Process
How timely is the end-to-end process?
- LEVEL 1Process meets threshold or mandated requirements for timeliness (i.e., the process achieves results within the time specified by law or regulation). The manual contract close out process can exceed three (3) months or more.
- LEVEL 2Process timeliness improves through use of automation. Timeliness exceeds legal requirements.
- LEVEL 3Timeliness improves via state and federal collaboration, use of information sharing, standards, and regional information exchange hubs. Timeliness exceeds Level 2.
- LEVEL 4Information is available in near real time. Processes that use clinical information result in immediate action, response, and results. SMA has interstate interoperability, which further improves timeliness over Level 3.
- LEVEL 5Information is available in real time. Processes improve further through connectivity with other States and with federal agencies. Most processes execute at the point of service. Results are almost immediate.
Business Capability Quality: Data Access and Accuracy
How accurate is the information in the process?
- LEVEL 1Use of direct data entry for information collection is manually intensive and susceptible to inconsistent or incorrect information. Stakeholders are unable to rely on information for decision-making.
- LEVEL 2Nationally recognized and state-specific standards improve accuracy of information but the decision-making process may be erroneous or misleading. Accuracy is higher than at Level 1.
- LEVEL 3Automation of information collection increases the reliability of SMA’s internal information. External sources of information use MITA Framework and industry standards for information exchange. Decision-making is automatic using standardized business rules definitions. Accuracy rating is at 99% or higher.
- LEVEL 4Automation of information collection increases the reliability of SMA’s internal and external sources of information. SMA adopts MITA Framework and industry standards for information exchange with interstate agencies. Decision-making is automatic using regional standardized business rules definitions. Accuracy rating is at 99% or higher.
- LEVEL 5SMA adopts MITA Framework and industry standards for information exchange with national agencies. Decision-making is automatic using national standardized business rules definitions. Accuracy rating is at 99% or higher.
How accessible is the information in the process?
- LEVEL 1SMA stores information in disparate systems including paper storage and obtains information manually. The manual nature of the process causes delays in information retrieval, e.g., information in off-site storage may take up to two (2) weeks to retrieve.
- LEVEL 2SMA stores information in disparate systems, but automation and nationally recognized and state-specific standards increase accessibility over Level 1.
- LEVEL 3SMA obtains information easily and exchanges with intrastate agencies and entities based on MITA Framework and industry standards. Accessibility is greater than Level 2.
- LEVEL 4SMA obtains information easily and exchanges with interstate agencies and entities. Accessibility is greater than Level 3.
- LEVEL 5SMA obtains information easily and exchanges with national agencies and entities. Accessibility is greater than Level 4.
Business Capability Quality: Cost Effectiveness
What is the cost of the process compared to the benefits of its results?
- LEVEL 1High relative cost due to low number of automatic, standardized tasks.
- LEVEL 2Automation improves process and allows focus on exception resolution. Staff focuses on cost management and ongoing quality improvement. Cost effectiveness ratio increases over Level 1.
- LEVEL 3SMA adopts MITA Framework, industry standards, and other nationally recognized standards. Staff focuses on an outcome-oriented approach to closing out contracts. Increases cost effectiveness ratio over Level 2.
- LEVEL 4SMA adopts MITA Framework, industry standards, and other nationally recognized standards for interstate information exchange. SMA increases cost effectiveness ratio over Level 3.
- LEVEL 5SMA adopts MITA Framework, industry standards, and other nationally recognized standards for national (and international) information exchange. SMA increases cost effectiveness ratio over level 4.
Business Capability Quality: Effort to Perform; Efficiency
How efficient is the process?
- LEVEL 1Process is labor intensive. There is wasted effort or expense to accomplish tasks. Process The primarily manual contract close out process is often inefficient and results in disputes and delays in resolution. Efficiency is low.
- LEVEL 2Automation and state standards increase productivity. Staff is able to follow consistent steps in the close out process. Efficiency is higher than Level 1.
- LEVEL 3SMA adopts MITA Framework, industry standards and information exchange with intrastate agencies and entities. Reusable services facilitate full coordination between SMA and other state SMA programs. The automation of the central tracking of contracts eliminates duplication of effort improving efficiency to 95% or higher.
- LEVEL 4SMA adopts MITA Framework, industry standards and information exchange with interstate agencies and entities improving efficiency to 98% or higher.
- LEVEL 5SMA adopts MITA Framework, industry standards and information exchange with national agencies and entities improving efficiency to 98% or higher.
Business Capability Quality: Accuracy of Process Results
How accurate are the results of the process?
- LEVEL 1Manual processes result in greater opportunity for human error. Accuracy is low.
- LEVEL 2Automation and standardized business rules definitions reduce error. The central tracking of contracts simplify data access increasing the quality and consistency of the contract close out process. SMA improves accuracy above Level 1.
- LEVEL 3SMA adopts MITA Framework, industry standards and information exchange with intrastate agencies and entities improving accuracy to 90% or higher.
- LEVEL 4SMA adopts MITA Framework, industry standards and information exchange with interstate agencies and entities improving accuracy to 98% or higher.
- LEVEL 5SMA adopts MITA Framework, industry standards and information exchange with national agencies and entities improving accuracy to 98% or higher.
Business Capability Quality: Utility or Value to Stakeholders
Does the business process satisfy stakeholders?
- LEVEL 1Stakeholders lack confidence in information negatively affecting stakeholder satisfaction with the process. Delays and disputes over close out issues are common.
- LEVEL 2Automation and standardization provides clear and useful information. Stakeholder satisfaction is greater than Level 1.
- LEVEL 3SMA adopts MITA Framework, industry standards and information exchange with intrastate agencies and entities improving stakeholder satisfaction to 90% or higher. SMA uses survey or questionnaire for information collection.
- LEVEL 4SMA adopts MITA Framework, industry standards and information exchange with interstate agencies and entities improving stakeholder satisfaction to 95% or higher.
- LEVEL 5SMA adopts MITA Framework, industry standards and information exchange with national agencies and entities improving stakeholder satisfaction to 98% or higher.
Source: CMS MITA 3.0 Business Capability Model, Contractor Management BCM.pdf, pages 62-68.