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
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COVERED CALIFORNIA
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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
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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
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IN-PERSON ASSISTANCE
PROGRAM
8
ENROLLMENT ASSISTANCE PROGRAM
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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
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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
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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
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CEE AND CEC ROLES
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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
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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
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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
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ELIGIBILITY
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CEE ELIGIBLE ENTITIES
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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.
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COMPENSATION
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COMPENSATION SCENARIOS QUALIFIED
HEALTH PLANS
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COMPENSATION SCENARIOS QUALIFIED
HEALTH PLANS
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COMPENSATION SCENARIOS MEDI-CAL
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COMPENSATION SCENARIOS MEDI-CAL
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Becoming a Certified
Enrollment Entity
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ONLINE APPLICATION PROCESS
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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
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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!
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ONLINE APPLICATION PROCESS
CEE Application Landing Page https://ipas.ccgrantsandassisters.org/
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ONLINE APPLICATION PROCESS - IPAS
Entity Information Screen
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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.
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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
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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
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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
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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
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FINGERPRINTING AND
BACKGROUND CHECK PROCESS
FOR INDIVIDUALS
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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
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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
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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.
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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
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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
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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!
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CEC TRAINING
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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
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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
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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.
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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
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QUESTIONS & ANSWERS
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