CalHEERS Solicitation Update

Transcription

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

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

3 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

4 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

5 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

6 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

7 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

8 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

9 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

10 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

11 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

12 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

13 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 12

14 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

15 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 Finalize approach April 14

16 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

17 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

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

19 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

20 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

21 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

22 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

23 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

24 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,