Presentation - CalHEERS Update - California Health Benefit ...

CalHEERS
Solicitation Update
Yolanda Richardson
California Health Benefit Exchange
Ken Jacobs
UC Berkeley
Dianne Koelzer
Interim Project Director
January 17, 2012

Agenda
• CalHEERS Partnership
• Program Design Goals
• Scope
• Open Comment Period
• Comment Highlights
• Vendor Input/Questions
• Eligibility and Enrollment Estimates
• What’s Next
• Schedule
1

CalHEERS Partnership
The California Healthcare Eligibility, Enrollment
and Retention System (CalHEERS) project is
jointly sponsored between the California Health
Benefit Exchange, the Department of Health
Care Services, and the Managed Risk Medical
Insurance Board, with the assistance of the
Office of Systems Integration. The Exchange will
serve as the point of contact for the solicitation
and manage CalHEERS.
2

Program Design Goals
• “No Wrong Door” service system that provides
consistent consumer experiences for all entry
points
• Culturally and linguistically appropriate oral and
written communications which also ensure
access for persons with disabilities
• Seamless and timely transition between health
programs
• Minimize burden of establishing and maintaining
eligibility
3

Program Design Goals
• Assures security and privacy of consumer
information
• Enables real-time, accurate eligibility
determinations
• Enables transparency and accountability
• Enables consumers to have no gaps in
coverage
• Enables consumers to make informed choices
4

Scope of Solicitation
• Acquire contractor to design, develop and
deploy functionality to meet the requirements of
the ACA relating to CalHEERS for the
Exchange, Medi-Cal and Healthy Families
• To maintain and operate software and other
functionality
5

Open Comment Period
• Draft solicitation was released for comment
between December 20 and December 30, 2011
• Comments represented 36 organizations
• 1,343 comments were received
• Profile of comments:
Compliments on various aspects of the solicitation
Corrections needed (e.g., verbiage, references)
Clarification requests (e.g., processes)
Policy Issues (e.g., other program functions)
6

Comment Highlights
1. Compliments on draft solicitation
2. Clarification on the integration of health (e.g., special
programs) and non-health (e.g., CalFresh) services
programs and existing systems
3. Assure language access
4. Assister program functions
5. Assuring First Class User Experience
6. Program functions to select assisters
7. Privacy and security requirements to protect
consumers
8. Clarification for in-person, mail and phone services
9. Governance structure for CalHEERS
10. Clarification for MEDS functionality integration
7

Expressions of Support
• Received wide range of stakeholder comments
affirming content and approach of solicitation.
Some of those comments include:
Incorporation of input
Inclusion of requirements for calculating
assister fees
Anticipation of various reporting needs for both
the individual and SHOP populations
The inclusion of consumer friendly functionality
such as e-chat
8

Potential Integration of Health and
Non-Health Services Programs
• January 2014, CalHEERS will include all core functionality
including eligibility and enrollment functionality for MAGI
Medi-Cal, APTC, CSR, Healthy Families and AIM
• Post 2014, CalHEERS will be designed to accommodate
the future vision for program integration of other health
programs
• Post 2014, CalHEERS will provide capacity to transmit
collected data to the appropriate county systems for nonhealth
programs (e.g., CalFresh)
Section 4-Vendor Scope of Work
9

Assuring Language Access
• July 2013, CalHEERS will present the consumer
web portal and the interactive voice response
system (IVR), in English and Spanish
• January 2014, all written communications and the
IVR system will be expanded based on Medi-Cal
threshold language methodology (currently 13
languages)
Section 4-Vendor Scope of Work
10

Assister Program Functions
• CalHEERS will provide functionality that will
allow consumers the ability to identify and
confirm selected assisters
• Functionality will also allow for tracking assister
activities to ensure compliance with program
requirements
Section 4-Vendor Scope of Work
11

Assuring First Class User
Experience
• Vendors are required to illustrate how they will
provide a first class user experience for
consumers and include an analysis of the
UX2014 Experience in their proposal
Section 1- Information and Background
Section 4- Vendor Scope of Work
Section 5 – Preparation Instructions
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Privacy and Security
• CalHEERS will provide “time out” functionality to protect
consumer privacy for public venue users
• CalHEERS will provide identity management processes
to protect consumer information
• CalHEERS will continually add best practices to ensure
that consumer privacy is addressed
Section 4-Vendor Scope of Work
13

In-Person, Mail and Phone
Services
• A separate service center planning process has
been established by the CalHEERS partnership
to consider options that will provide best service
and best value
Develop inventory report of
service
February 15
Consultation with stakeholders February 15 – 28
Finalize approach
April
14

Governance Structure
• The Exchange, DHCS and MRMIB are jointly
responsible for the design and governance of
CalHEERS
• The Exchange will hold the vendor contract and is
responsible for ensuring the development and
implementation of CalHEERS
• DHCS, MRMIB and the Exchange are each
responsible for providing oversight on the
administration of their respective programs
Section 1- Information and Background
15

MEDS Functionality Integration
• By December 31, 2015, CalHEERS will be modified to
integrate the Medi-Cal Eligibility Data System (MEDS)
functions:
• This effort will allow CalHEERS to:
Advance the goal of providing a seamless consumer
experience across various programs
Contribute to the building of a more integrated
enterprise architecture
Meet federal requirements for re-use strategies for
technology projects
• Section 1-Information and Background
16

Vendor Input
• Received approximately 430 vendor
responses
• Profile of comments:
Recommendations to improve overall
solicitation
Questions about processes
17

Profile of Vendor Comments
• Recommendation: bundle optional services for pricing
advantage
Addressed: cost schedule will allow bidders to provide all
inclusive cost for services if state elects to buy all services
• Attachment 8-Cost Schedule
• Questions regarding process: identify number of users for
CalHEERS
Addressed: metrics table to be provided in the solicitation
• Section 1-Information and Background
Section 4- Vendor Scope of Work
18

Profile of Vendor Comments
• Roles and responsibilities of counties, MRMIB
and DHCS
• Addressed: will be addressed through the
service center planning process
Section 4-Vendor Scope of Work
19

Profile of Vendor Comments
• Questions regarding:
How data will be transferred between
CalHEERS, SAWS and potentially MaxE2
• Addressed: requirements were clarified
regarding system capabilities with
assistance from each county consortia,
MRMIB, and DHCS
Section 4-Vendor Scope of Work
20

Enrollment and Eligibility
Estimates
• Retained UC Berkeley-UCLA team to conduct
review of enrollment estimates
• Convened expert session on simulation models
• Planned report due February 2012
21

Next Steps
• CalHEERS solicitation will be released on
January 18, 2012
• CalHEERS solicitation update for January 26,
2012 will include:
Model contract with service level agreement and
terms and conditions
SHOP enrollment estimates
22

Schedule
Task
Date
Release Solicitation January 18, 2012
Solicitation Update January 26, 2012
Bidders Conference January 27, 2012
Bids Due February 24, 2012
Award Contract April 17, 2012
Pre-enrollment Implementation July 1, 2013
First day of Exchange and Expanded
Medi-Cal Coverage
January 1, 2014
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