Certified Application Counselor Program, Individual Market

Certified Application Counselor Program, Individual Market Shopping Paths and Ancillary Products

Individual Experience Advisory Group

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Certified Application Counselor Program

Background

• Program established to designate organizations (Designated

Organizations) as Connect for Health Colorado partners to provide

application assistance to Marketplace customers

• Program will comply with federal regulations

• Distinct from the Connect for Health Assistance Network and Health

Coverage Guides:

o No prohibitions on conflicted organizations/individuals (but, must disclose conflict

and must act in best interest of customer)

o No education and outreach requirement

o No post enrollment support expectation

o Will provide information about qualified health plans, plan selection and

enrollment, but not support with plan selection and enrollment

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Designated Organizations

• Successful applicants are likely to be providers (hospitals and

clinics), and organizations that currently provide application

assistance or enrollment support.

• Responsible for ensuring staff are trained and certified

(Connect for Health Colorado will provide training)

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Designated Organization Criteria - 1

• Currently help with financial assistance, application assistance,

or enrollment into financial or health programs

• Have existing policies and procedures in force that protect the

privacy of personal information and personal health

information;

• Have existing policies and procedure in place for staff and

volunteer background checks;

• Have existing non-discrimination and inclusion policies;

• Have existing policies and procedures for providing ADA-

accessible locations and services and for providing reasonable

accommodations;

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Designated Organization Criteria - 2

• Have existing policies and procedures for assessing and

evaluating customer service programs for quality and

escalating customer complaints for resolution.

• Have liability insurance including but not limited to at least

$1,000,000 per occurrence and $2,000,000 aggregate General

Liability, $250,000 in Employee Crime/Dishonesty coverage

and $1 million in Privacy coverage.

• Agree to provide Connect for Health Colorado Application

Counselor training for staff or volunteers who will act as

Application Counselors.

• Agree to provide a plan to certify, monitor, evaluate, re-certify,

and de-certify Application Counselors.

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Designated Organization Criteria - 3

• Agree to not charge customers or make assistance conditional

on any other relationship, purchase, etc.

• Agree to adhere to Connect for Health Colorado Privacy and

Security Standards

• Agree to disclose to customers role of the CAC and any

conflicts of interest

• Agree to act in the best interests of customers.

• Agree to refer customers with unmet language interpretation or

translation needs

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Designated Organization Criteria - 4

• Agree to provide information and assistance that acknowledges

insurance affordability programs and qualified health plan

options for which a customer is eligible.

• Agree to Connect for Health Colorado reporting and auditing

requirements.

• Agree to adhere to Connect for Health Colorado’s branding and

marketing standards.

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Certified Application Counselors

• Certified Application Counselor duties:

o Provide information about insurance affordability programs and

coverage options;

o Assist individuals to apply for coverage in a qualified health plan

through the Marketplace and for insurance affordability programs; and

o Help to facilitate enrollment of eligible individuals in qualified health

plans and insurance affordability programs by providing information

about qualified health plans and the plan selection and enrollment

process.

• Must act in the best interest of customers

• Must disclose conflicts of interest to customers

• Must not provide advice

• Must not charge for services

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Application Process

1) Please read the CAC Program Announcement carefully

2) Complete the application

3) Sign the agreement

4) Upload the applicant AND agreement to :

http://C4HCO.Upload.connectforhealthco.com

• Applications will be accepted from organizations only. No

individual applications or resumes will be accepted.

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Deadlines

• Application deadline is September 30, 2013.

• For organizations that wish to receive training prior to October,

applications must be submitted by September 6th.

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Training

• 10-11 hours of online training

o Overview courses on the ACA, Connect for Health Colorado, the

Insurance Industry

o Privacy and Security courses

o State and Federal regulations courses

o ADA and cultural and linguistically appropriate services courses

• In person training (may move to webinar format)

o Marketplace and insurance affordability program eligibility and

application process

o CAC role

o How to help customers understand plan selection and enrollment

• 3 Trainings currently scheduled in Denver area Sept 18, 25, 26

• Contract with Connect for Health Colorado trainer option

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Next Steps

• Connect for Health Colorado will notify applicants in writing of

acceptance or denial and will execute the agreement.

• Connect for Health Colorado will send successful applicant

organizations a blank roster for training purposes

• Upon receipt of training roster, Connect for Health Colorado will

upload identified staff into the online learning system

• Additional trainings and training locations may be added

depending on demand

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Individual Market Shopping Paths

Path #1: Browse Plans

Customize plans based on ZIP, number in family seeking coverage, age and tobacco

product usage

Sort and filter plans based on preferences

Place plan in cart—proceed to shopping path #3

Path #2: Quick Check for Financial Assistance

Enter household size and ages of members, projected annual income, ZIP code, pregnancy and disability

screening questions, tobacco product usage

Sort and filter plans based on preferences

Place plan in cart—proceed to shopping path #3

Path #3: Create Account and

Complete Application for Enrollment

Non-financial assistance application

Financial assistance application

--eligibility for Medicaid, CHP+, APTC/CSR determined

Decision Support Tools

Provider Directory

Sort and filter plans based on preferences

Place plan in cart and purchase

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Connect For Health Colorado--Medical Financial

Assistance Application and Enrollment Steps

Create Account

Anyone helping you?

• Broker/agent

• Health coverage guide

• Authorized Representative

Start Application and Review Privacy Language

Want to see if you qualify for financial help with medical coverage?

If yes, has applicant been denied for Medicaid and

CHP+ since October 2013? If yes, enter Case ID and proceed to APTC

questions

If no, start first step in application—check

Medicaid/CHP+ eligibility

Eligibility results displayed for

Medicaid/CHP+. If ineligible, continue with

APTC/CSR determination step

Review application data and answer additional APTC/CSR questions

Eligibility for APTC/CSR displayed

Shop for Plans

Select Plan and Purchase

CMS Ruling on Provision of Ancillary Products and C4HCO’s Response September 2013

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Background

• Since late 2011 C4HCO and other State Based Marketplaces (SBMs) have been seeking direction from CMS related to offering Ancillary services to consumers via the Marketplace

• CMS provided guidance to SBMs in March 2013 related to the offering of Ancillary coverages and services through the Marketplaces

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CMS Guidance – Ancillary Services

• Ancillary insurance products, which are not QHPs, may be offered via separate and distinct programs that can share resources and infrastructure with an SBM

• The Markeplace IT infrastructure can be reused by the separate program to facilitate sales of Ancillary products

• The program facilitating the Ancillary services must be legally and publicly distinct from the Marketplace

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CMS Guidance – Ancillary Services

• Federal funds, user fees or assessments may not be used to support non-Marketplace efforts

• Marketplace funds should not be co-mingled with the funds used to support the separate program facilitating sales in Ancillary products

• A percentage of the costs of rent, maintenance, etc., must be charged across from the Marketplace to the separate program

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Implications for C4HCO and Consumers

• C4HCO must be compliant with Federal guidance

• C4HCO’s sustainability and consumer enrollment plans

contemplated the ability to offer Ancillary products

• C4HCO received Board approval to provide access to Vision coverage in August 2013

• C4HCO will receive “income” through the partnership with VSP for vision coverages sold through the Marketplace

• C4HCO must be financially self sustaining by 1/1/15 and income derived from Ancillary services reduces the overall cost needed to operate the Marketplace

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Implications for C4HCO and Consumers

• Consumers will be attracted to the Marketplace for subsidies, access to affordable and quality health plans and other meaningful products/services

• Products should further C4HCO’s mission and complement efforts to improve health status and access and support C4HCO’s mission

• Examples are: wellness, cost/quality and self help tools, other insurance coverages (Vision,etc).

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Legal Structure of the Separate and Distinct Program

• The sale of Ancillary products is a commercial activity and likely not construed as “charitable, educational or scientific” for the purposes of tax exempt status. Thus, the sale of Ancillary products is likely a for-profit venture

• The establishment of a separate for-profit program under the umbrella of the Colorado Health Benefit Exchange allows the profit to be returned to Connect for Health Colorado and be used to reduce the costs of running the non-profit organization

• The staff is currently evaluating the legal structures available

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What C4HCO Should Do

• Comply with CMS’ guidance to establish a separate legal entity to develop and coordinate Ancillary products

• Obtain legal and stakeholder input on viable options

• Develop a strategy to comply with CMS guidance while fulfilling the mission of C4HCO, putting the customer at the heart of product offerings and supporting sustainability goals

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Stakeholder Input

• Questions?

• Feedback?

• Suggested coverages and services to consider?