IN-PERSON ASSISTANCE PROGRAM October 29, 2013 JULIE WEIGAND, RHA DEPUTY DIRECTOR 2 TOPICS COVERED IN THIS PRESENTATION • Covered California • In-Person Assistance (IPA) Program • Certified Enrollment Entity and Certified Enrollment Counselor Roles • IPA Program Eligibility • IPA Program Compensation • Becoming a Certified Enrollment Entity • Becoming a Certified Enrollment Counselor • Fingerprinting and Criminal Background Checks • Overview of CEC Training 3 COVERED CALIFORNIA 4 OF 63 COVERED CALIFORNIA'S VISION AND MISSION Vision: Improve the health of all Californians by assuring their access to affordable, high quality care. Mission: 1. Increase the number of insured Californians 2. Improve health care quality 3. Lower costs 4. Reduce health disparities through an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value 5 PRIMARY TARGET POPULATION Covered California’s primary target population is 5.3 million California residents who stand to benefit from expanded coverage options: • 2.6 million who qualify for subsidies and are eligible for Covered California Health Plans • 2.7 million who do not qualify for subsidies, but now benefit from guaranteed coverage and can enroll inside or outside of Covered California OF 63 6 PRIMARY TARGET POPULATION (CONT.) Covered California’s target population by region California’s vast geographically diverse mix of rural and urban communities are unique and present outreach challenges. Source: CalSIM model, Version 1.8 7 IN-PERSON ASSISTANCE PROGRAM 8 ENROLLMENT ASSISTANCE PROGRAM 9 IPA PROGRAM OVERVIEW In-Person Assistance (IPA) Program: The program whereby Certified Enrollment Entities may be compensated per successful application that results in the effectuation of coverage into a Covered California Health Plan. Covered California In-Person Assistance Program Certified Enrollment Entity Certified Enrollment Counselor 10 IPA PROGRAM OVERVIEW Certified Enrollment Entity (CEE): An entity or individual registered by Covered California to provide oneon-one consumer assistance. A Certified Enrollment Entity will be registered in the In-Person Assistance Program. Covered California In-Person Assistance Program Certified Enrollment Entity Certified Enrollment Counselor 11 IPA PROGRAM OVERVIEW • CERTIFIED ENROLLMENT COUNSELOR (CEC): • An individual who is certified by Covered California pursuant to Section 6654, Title 10, of the California Code of Regulations to provide face-toface, one-on-one consumer assistance. Covered California In-Person Assistance Program Certified Enrollment Entity Certified Enrollment Counselor 12 CEE AND CEC ROLES 13 CEES AND CECS RESPONSIBILITIES • Certified Enrollment Entities (CEEs) Enter into Contract with Covered CA CEC/Individual Affiliates with CEE Oversee CEC • Certified Enrollment Counselors (CECs) conduct the following activities on behalf of Covered California: Education Eligibility Enrollment Retention 14 CERTIFIED ENROLLMENT ENTITIES Certified Enrollment Entities are responsible for recruiting and retaining Certified Enrollment Counselors that will reflect the cultural and linguistic make up of the target markets. Efforts by CEEs include: • Ensuring that all individuals affiliated with the CEE who plan to become Certified Enrollment Counselors submit to the fingerprint-based criminal background check, as required by the Agreement • Ensuring that all Certified Enrollment Counselors are trained and certified by Covered California and are provided the guidance needed. • Distributing information and communications provided by Covered California in a timely fashion • Updating Covered California on any status changes of Certified Enrollment Counselors affiliated with the organization 15 CERTIFIED ENROLLMENT COUNSELORS Under the guidance of the Enrollment Entities, Certified Enrollment Counselors are expected to: • Provide information about available Covered California Health Plans and financial help in the form of premium assistance and cost-sharing reductions • Explain the enrollment options; with a Certified Enrollment Counselor, via CoveredCA.com or through the Covered California Service Center • Educate consumers about the value of health insurance and answer their questions • Inform consumers about premium costs and the benefits of enrolling in Covered California Health Plans • Provide consumers with support and access to tools and resources that assist in comparing costs, benefits and coverage options 16 ELIGIBILITY 17 CEE ELIGIBLE ENTITIES 18 ENTITIES NOT ELIGIBLE FOR COMPENSATION *With the exception of: Community Clinics, free clinics, federally qualified health center (FQHC), FQHC look-alikes, and urban health centers. 19 COMPENSATION 20 COMPENSATION SCENARIOS QUALIFIED HEALTH PLANS 21 COMPENSATION SCENARIOS QUALIFIED HEALTH PLANS 22 COMPENSATION SCENARIOS MEDI-CAL 23 COMPENSATION SCENARIOS MEDI-CAL 24 Becoming a Certified Enrollment Entity 25 ONLINE APPLICATION PROCESS 26 Timeline for Certified Enrollment Entity (CEE) and Certified Enrollment Counselor (CEC) Process 2 days 4 days 6 days 10 days 15 days 20 days 25 days CEE Submits Application CEE Process CEE application approved CEE receives email regarding CEE Mgmt. Webinar training CEE completes Mgmt. Webinar training online ( CEE should complete in 30 days – but here lets assume CEE finishes the training immediately ) CEE is Active CEC Process CEC submits the criminal disclosure form by mail to Covered California and provides fingerprinting at the available LiveScan locations ( Will take up to 2 weeks to receive the Approval report ) CEC receives email with Login information for Learning Management System (LMS) ( 3-5 business days after CEE application Submission ) CEC login to LMS and registers for their ILT Session CEC completes 2.5 days ILT training CEC logs into LMS to 1. Complete Survey 2. Take CBT course 3. Complete Exam CEC will be certified if they meet all the requirements 1. Must pass CEC exam 2. Must clear background 3. CEC agreement must be on file 4. CEE must be Active CEC completes CoveredCA.com training and passes the exam CEC will receive an email from Covered California reg. process to acquire CEC badges. CEC will receive information to create account in CoveredCA.com 4 STEPS TO BECOMING A CERTIFIED ENROLLMENT ENTITY 1. COMPLETE THE CERTIFIED ENROLLMENT ENTITY (CEE) APPLICATION ONLINE • • • • • • Access CEE Application online Download and review CEE Application Worksheet Gather necessary information and documentation Login or create username and password Complete ALL required application fields Download and complete Certified Enrollment Entity Agreement 28 4 STEPS TO BECOMING A CERTIFIED ENROLLMENT ENTITY 1. COMPLETE THE CERTIFIED ENROLLMENT ENTITY (CEE) APPLICATION ONLINE (CONT.) • Add Covered California as an additional insured to General Liability Insurance policy • Upload Required Documents: • o Certified Enrollment Entity Agreement o Proof of business status documentation o Proof of Insurance - general liability and workers compensation o State of California Payee Data Record Form o Proof of current or valid business license Submit CEE Application! 29 ONLINE APPLICATION PROCESS CEE Application Landing Page https://ipas.ccgrantsandassisters.org/ 30 ONLINE APPLICATION PROCESS - IPAS Entity Information Screen 31 ONLINE APPLICATION PROCESS WORKSHEET The CEE Application Worksheet provides a way to collect all necessary information to complete required application fields. It also lists the required documents to gather. 32 4 STEPS TO BECOMING A CERTIFIED ENROLLMENT ENTITY 2. REVIEW OF CEE APPLICATION BY COVERED CALIFORNIA • Once submitted, applications default to “Pending” status o • • • Triggers application review process Application is reviewed for completeness and program eligibility Organization receives notification by email or phone regarding missing application information needed for approval (if applicable) Review process takes 5 - 7 business days 33 4 STEPS TO BECOMING A CERTIFIED ENROLLMENT ENTITY 3. RECEIVE APPROVAL OF SUBMITTED CEE APPLICATION • Receive notification by email • Regarding status of application approval • Directions for next steps to follow to complete the required Certified Enrollment Entity Management Training 34 4 STEPS TO BECOMING A CERTIFIED ENROLLMENT ENTITY 4. MEET CERTIFIED ENROLLMENT ENTITY TRAINING REQUIREMENTS • Receive email with link to the training • Individual designated as the Primary Contact must complete CEE Management Training • Webinar is approximately 2.5 hours and must be completed within 90 days • Concurrent with the CEE Management Training, CEE should begin developing a roster of active Certified Enrollment Counselors 35 CEE TRAINING OBJECTIVES CEE Training will cover • • • • • • • • Covered California Overview In-Person Assistance Program Overview Certified Enrollment Entities Roles and Responsibilities Certified Enrollment Counselor Recruitment, Role, Services, and Support Compensation Expectations for Monitoring, Reporting and Quality Assurance Collateral Materials Management Certified Enrollment Entity Agreement 36 FINGERPRINTING AND BACKGROUND CHECK PROCESS FOR INDIVIDUALS 37 CEE ROLE • The Certified Enrollment Entity is required to facilitate a fingerprint based criminal background check on all its affiliated personnel who plan to become Certified Enrollment Counselors, as CECs will have access to CoveredCA.com and confidential consumer information. • Confidential consumer information includes personal identifying information, personal health information, federal tax information, or any other information as required by federal law or guidance applicable to Covered California. • Must use an approved Covered California Live Scan site 38 4 STEPS TO BECOMING A CERTIFIED ENROLLMENT COUNSELOR 1. AFFILIATE WITH A CERTIFIED ENROLLMENT ENTITY • CEE provides individuals with a Certified Enrollment Counselor (CEC) Application (from the worksheet) and Agreement • Individual completes and returns the one-page CEC Application and the signed Agreement to the CEE • CEE reviews information and completes CEC section of the application online and uploads signed Agreement o CEE has the ability to add additional counselors in the online CEE application at anytime 39 4 STEPS TO BECOMING A CERTIFIED ENROLLMENT COUNSELOR 2. COMPLETE FINGERPRINTING-BASED CRIMINAL BACKGROUND CHECK • Download and complete Criminal Record Disclosure form at: http://www.healthexchange.ca.gov/Documents/CECdisclosure.pdf • Mail Completed Criminal Record Disclosure form to: • Covered California PO Box 1199 Sacramento, CA 95814 NOTE: Any communication in connection with the Criminal Disclosure Form is between the individual applicant and Covered California. The CEE will not be involved in the collection or review of the content of this document. 40 4 STEPS TO BECOMING A CERTIFIED ENROLLMENT COUNSELOR 2. COMPLETE FINGERPRINTING-BASED CRIMINAL BACKGROUND CHECK • Receive Request for Live Scan Service Form from CEE or download at: • Request for Live Scan Service at: http://www.capitallivescan.com/covered_ca/forms/CC%20Request% 20for%20Live%20Scan%20form%20v1.1%20(9_19_2013).pdf • Fingerprinting will be provided on-site at the training location • Must bring TWO completed Request for Live Scan Service Forms 41 4 STEPS TO BECOMING A CERTIFIED ENROLLMENT COUNSELOR 3. COMPLETE CERTIFIED ENROLLMENT COUNSELOR TRAINING • Attend a 3-Day CEC Training o Must attend ALL three consecutive days • Complete Covered California Certification Exam online • Score 80% or better on the exam to become a Certified Enrollment Counselor o The systems allows three attempts to score 80% or better • Receive email notification of successful exam completion o Including login information to create profile in CoveredCA.com 42 4 STEPS TO BECOMING A CERTIFIED ENROLLMENT COUNSELOR 4. CREATE USER PROFILE IN COVEREDCA.COM • Login to CoveredCA.com to create CEC profile o Receive your Certified Enrollment Counselor identification badge *CEE must upload headshot picture of each CEC in CEE application o Begin assisting consumers! 43 CEC TRAINING 44 CERTIFIED ENROLLMENT COUNSELOR TRAINING MODULES • For each course, participants will receive a comprehensive Participant Guide and the instructor’s PowerPoint slides • 3 days of training led by a Covered California trainer • In order to achieve certification, attendees must achieve a score of 80% • Must attend annual recertification 45 TO SIGN UP AND SCHEDULE TRAINING • Once approved for certification process, individual will receive email from Learning Management System (LMS) with login and password information for training • Training will be offered weekly statewide • Login to LMS to access schedule of Certified Enrollment Counselor Training sessions and register for a suitable session 46 TRAINING SCHEDULE FOR CALIFORNIA Week # Start Date End Date City Nov 4 - 10 Nov 4 - 10 Nov 4 - 10 Nov 4 - 10 Nov 4 - 10 Nov 4 - 10 11/4/2013 11/4/2013 11/4/2013 11/4/2013 11/4/2013 11/4/2013 11/6/2013 11/6/2013 11/6/2013 11/6/2013 11/6/2013 11/6/2013 Chino Los Angeles Long Beach Whittier San Bruno Sacramento Nov 4 - 10 11/6/2013 11/8/2013 Newport Beach The training schedule is continuously updated, so please check back for additional information. 47 For More Information • To complete the CEE Application, go to: http://www.healthexchange.ca.gov/Pages/EnrollmentAssi stanceProgram.aspx • For questions or assistance, please call the Covered California Enrollment Assistance Help Desk 1-888-402-0737 Monday – Friday, 8:00 AM to 5:00 PM • Email support is available at: assisterinfo@ccgrantsandassisters.org • Enrollment Assistance Specialists are available in your area to provide support 48 QUESTIONS & ANSWERS 49