1. Purpose & Governance Principles

This document establishes the decision-making authority, escalation paths, and accountability structure for the Enrollment & Claims Platform Modernization program. It is distinct from the Project Management Plan: the PM Plan describes how the work will be executed; this document defines who has the authority to decide, and how disputes or exceptions are resolved when the plan needs to change.

Five principles guide this governance model:

2. Governance Structure

The program is governed through four bodies:

Steering Committee Roster

For the full reporting-line structure, including matrixed/loaned resources shown with dotted-line relationships, see the companion Organizational Chart.

3. Roles, Responsibilities & Decision Rights

Every decision on this program falls into one of three authority tiers. This tiering is the same model applied consistently across the Change Control Log, RAIDD Log, and PM Plan §16 — this document is its authoritative definition.

Key Role Responsibilities

3.1 Governance-Process RACI Matrix

This matrix covers governance-process activities only — approving changes, accepting risk, authorizing exceptions. It is deliberately narrower than, and complementary to, the deliverable sign-off RACI already defined in PM Plan §9.2 (Requirements Sign-off, Vendor Selection, UAT Sign-off, Go-Live Decision, etc.). The two matrices should never duplicate the same row — if an activity is already governed by PM Plan §9.2, it is intentionally not repeated here.

Also available as its own page, alongside the PM Plan's deliverable sign-off RACI: RACI Matrix.

4. Escalation Process

Escalation is triggered automatically once a defined threshold is crossed — it is not left to individual judgment about whether something "feels" significant enough to raise.

Standard escalation path: Team Member → Workstream Lead → Program Manager → PMO Director / Steering Committee → Executive Sponsor. Issues unresolved at the PM level within 5 business days (2 business days for Critical/High-rated items) escalate automatically to the next tier — the originator does not need to justify why it's "worth" escalating.

5. Meeting Cadence & Reporting

6. Change Control Governance

All formal changes to scope, schedule, or cost baselines follow the tiered authority model in Section 3, formalized through the program's Change Control Log. This document is the authoritative source for why those tiers exist and what they cover; the Change Control Log is the operational record of every request evaluated against them.

7. Vendor Governance

The program carries two major vendor contracts — Platform Upgrade ($1,850,000) and Integration Middleware ($620,000) — combined, roughly 35% of the base budget. This section defines vendor-specific decision authority, distinct from the general Change Control tiers in Section 6.

8. Stage Gates & Phase Approval Criteria

Each of the program's 8 WBS phases has a formal gate that must be passed before the next phase begins in earnest — modeled on the stage-gate approach common in regulated, multi-stakeholder programs.

Every gate requires two things, not one: the specific go/no-go criteria in the table below, and continued business justification — a brief reconfirmation that the assumptions underlying the Cost-Benefit Analysis still hold. A gate can meet every schedule and quality criterion and still legitimately not pass if the business case has materially changed. This principle is drawn from PRINCE2's continued-business-justification requirement and applies at every gate below, not only Go-Live.

9. Independent Assurance

Performance Monitoring (Section 12) is self-reported: the Program Manager and PMO track and report status upward through the normal chain. Independent Assurance is a distinct, separate check — performed by someone outside the reporting chain being assessed — to catch an incomplete or overly optimistic self-report before it reaches the Steering Committee.

10. Risk & Issue Governance

The RAIDD Log records what the risks and issues are; this section defines who has the authority to accept, fund, or escalate a response to them.

11. Compliance & Regulatory Oversight

Because the program touches financial systems subject to SOX controls (Billing, Payment Processing, Commission Management), compliance sign-off carries a standing exception to the normal authority tiering:

12. Performance Monitoring

The Steering Committee monitors program health against the quality KPIs defined in PM Plan §8, reported monthly via the Steering Committee Deck:

• Schedule Performance Index (SPI) and Cost Performance Index (CPI) ≥ 0.95
• Data Conversion Accuracy ≥ 99.5%
• Critical/High Defect Escape Rate to UAT ≤ 5%
• UAT Pass Rate (first cycle) ≥ 90%
• Critical/High security findings open at Go-Live: 0
• Training Completion ≥ 95% prior to Go-Live
• Hypercare Severity-1 Incidents ≤ 2

13. Governance of This Framework

This document is owned by the PMO Director and reviewed quarterly. Amendments to the decision-rights tiers, escalation thresholds, or stage-gate criteria require Steering Committee approval; amendments to meeting cadence or reporting format may be approved by the PMO Director alone.

14. Approval

This governance model is approved for use across the Enrollment & Claims Platform Modernization program.