HRSA Health Center Outreach and Enrollment Technical Assistance

Call

August 13, 2013

Presentation Overview

• Review PCA and health center roles • Training requirements for health center O/E assistance

workers• Health center reporting requirements• Common questions• Grantee enrichment series and other TA opportunities• Questions and answers

PCAs• Provide training and

related information to health centers

• Coordinate O/E efforts at the state level

• Provide technical assistance

• Share real-time Intelligence with HRSA

• Report state level barriers and successes.

PCA and Health Center Roles

Health Centers• Hire and train O/E assistance

workers as certified application counselors

• Conduct in-reach and outreach and assist with the enrollment process

• Share barriers and successes with PCAs

• Report metrics, successes, and barriers to HRSA quarterly.

Training

The Federally-facilitated Marketplace will designate organizations to certify application counselors who perform many of the same functions as Navigators and non-Navigator assistance personnel—including educating consumers and helping them complete an application for coverage.

Certified Application Counselors

CACs will provide information to consumers and to help facilitate consumer enrollment in QHPs and insurance affordability programs

The process provides assurance to consumers that they are receiving assistance from persons trained by the Marketplace who are overseen by organizations that are required to protect personally identifiable information

All Marketplaces must have a certified application counselor program

Certified Application Counselor (CAC) Details

For the FFM and State Partnership Marketplaces• Applications are now

available for interested organizations to complete

• Must be submitted online to the applicable Marketplace

How Organizations Can Apply to be a CAC

http://marketplace.cms.gov/help-us/cac.html

Organization’s name and contact information The nature of the organization’s business Whether the organization has already been designated by a state

Medicaid or CHIP agency as a Medicaid or CHIP application assistance program

Whether the organization is a governmental entity or organized under 501(c) of the Internal Revenue Code

Whether the organization screens the employees and volunteers it will certify as application counselors

Whether the organization or the employees and volunteers it intends to certify already handle personally identifiable information

The organization’s experience, if any, assisting individuals applying for health coverage

CAC Application Information

Organizations apply to the FFMs to participate in the CAC program A Marketplace may designate organizations to certify staff or

volunteers to perform CAC duties The FFMs will only designate organizations that

• Have processes in place to screen staff and volunteers who are CACs to ensure they protect personally identifiable information

• Are positioned to help those they serve with health coverage issues• Have experience providing social services to the community

State-based Marketplaces may follow Federal or establish their own processes for their CAC program

CAC Designation Process

Must enter into a written agreement with the FFM• FFMs will establish a standard agreement • Agreement must be signed by authorized agency

representative Will be required to have their individual CACs sign an

agreement promising to keep personal consumer information private and secure

Will have contact info listed on HealthCare.gov

Designated CACs

Will be available• August 1 for Agents and Brokers• August 15 for CACs• August 28 for Navigators and in-person

Training information will be provided to designated organizations

Web-Based Training for Assisters

July 30, 2013

Health Center Training Requirements and Related

Expectations

• Health center outreach and enrollment (O/E) assistance workers are any health center staff, contractors or volunteer personnel who will educate consumers and help them complete applications for coverage.

• All health center O/E assistance workers (both newly hired and existing health center staff), must complete all required federal and/or state requirements for certified application counselors (CACs).

• CAC requirements apply to both Health Center Program grantees supported by the O/E supplement and health centers that choose to conduct outreach and enrollment activities, e.g., look-alikes.

CAC Requirements Plus HRSA Requirements

• Health center O/E assistance workers in organizations with O/E supplemental funding must comply with federal and/or state CAC requirements and HRSA requirements. – Example: Non-health center CACs are generally not required

to do outreach, but health center O/E assistance workers who become CACs in organizations with O/E supplemental funding are required to do both in-reach with current patients and outreach in their approved service area.

Support of Health Center Training and Related Expectations

• Your PCA should be your primary resource for all necessary information about all CAC training and related requirements in the state.

• If you encounter any barriers to accessing training or completing organizational CAC requirements, please contact your PCA.

A Note about Navigators

• As described in the previous slides, health center O/E assistance workers will be CACs.

• Health centers in FFMs and SPMs that receive federal Navigator funding can serve as and be identified to the public as both a CAC and a Navigator organization.

• Health centers supported by Navigator funding must comply with all the requirements of that funding, separate from the activities proposed for HRSA O/E supplemental funding.

• Navigator funding must not supplant HRSA O/E supplemental funding; activities supported by Navigator funding must be in addition to those supported by HRSA O/E supplemental funding.

• If needed, HRSA and CMS will provide additional guidance to health centers and/or PCAs that receive both HRSA O/E supplemental funding and Navigator funding.

Training Requirements for Health Centers in FFM/SPM States

• Health centers in federally-facilitated Marketplaces (FFMs) and state partnership Marketplaces (SPMs) must apply for and be designated as a CAC organization; and

• Ensure that all health center O/E assistance workers successfully complete the federal CAC training and any additional state requirements for CACs.

• If you have not done so already, it is important to apply for designation as a CAC organization as soon as possible.

Training Requirements: FFM and SPM States

Federal CAC Training1. Complete organization CAC designation application. (http://marketplace.cms.gov/help-us/cac.html)2. Train all health center O/E assistance workers as CACs.

Federal CAC Training + Additional CAC Requirements

1. Complete organization CAC designation application (http://marketplace.cms.gov/help-us/cac.html)2. Train all health center O/E assistance workers as CACs.3. Complete all additional CAC training requirements. Contact your state or regional PCA for additional information.

No Yes

Does the state have additional requirements for certified application counselors (CACs)?

No Yes

Train staff to provide support to O/E assistance workers as appropriate

Are health center staff assisting with enrollment?

Training Requirements for Health Centers in SBM States

• State-based Marketplaces may follow the Federal process or establish their own processes for their CAC program– Some SBMs may designate organizations and/or

individuals as CACs, and may use different terminology to describe their CAC program.

• Health centers must apply for and become designated as a CAC organization if required by the state; and

• Ensure that all health center O/E assistance workers successfully complete the state’s CAC training and any additional state requirements for CACs.

• If you have not done so already, it is important to complete all SBM requirements for organizational and/or individual CAC designation as soon as possible.

Training Requirements: SBM States

1. Complete organization CAC designation process if required by the SBM.2. Complete any additional state individual or organizational CAC requirements. 3. Train all health center O/E assistance workers as CACs according to state requirements.

Contact your state or regional PCA for additional information.

No Yes

Train staff to provide support to O/E assistance workers as appropriate

Are health center staff assisting with enrollment?

Health Center Reporting

Health Center O/E Quarterly Progress Report (QPR) Metrics

• TRAINING: Number of health center O/E workers trained as certified application counselors (CACs). – This includes all O/E assistance workers (staff, contractors,

volunteers) who will be providing O/E assistance as CACs.

• ASSISTANCE: Number of individuals assisted in any part of the enrollment process, e.g., individuals or families assisted to set up a profile in the portal, helped to file affordability assistance information, receiving an eligibility determination, and/or facilitating enrollment into affordable health insurance. – Outreach or education can only be counted for interactions that occur

face-to-face, in person, with a trained CAC. These can take place in small group settings which are small enough to allow for customizable interactions to address specific questions

• ELIGIBILITY: Number of individuals assisted who receive an eligibility determination regardless of the outcome of the determination.

• ENROLLMENT: Number of individuals who enroll (e.g., select a qualified health plan or Medicaid/CHIP).

Counting Individuals vs. Families

The estimated total number of consumers assisted through the eligibility and enrollment process should include individuals who are represented by another member of their family during the CAC session (e.g., an adult receives assistance from the CAC for all 5 members of their family, even though all 5 members are not present).

Health Center O/E Quarterly Progress Reports (QPRs)

Qualitative Data

• Health centers will also describe significant barriers and successes in a brief narrative.

• Health centers’ first QPR will be due in October and will primarily capture the number of O/E assistance workers who have successfully completed CAC training and any Medicaid/CHIP enrollment that has taken place prior to the open enrollment period.

• HRSA plans to share the health center O/E QPR data with PCAs.

Common Questions

Common O/E Supplement Questions

• If all O/E funds are not used by 6/30/14, will there be a no-cost extension option available?– Since O/E funds are a supplement to 330 grant awards,

they are subject to the same drawdown rules. • If we will be using additional sites that should be on form

5C, do we need to fill out a change in scope?– No. While any sites where O/E activities occur that are

not currently listed in scope should be represented on form 5C, a Change in Scope prior approval request is not needed.

Common Questions

• When is O/E supplement rebudgeting necessary? – Health centers do not need to submit a revised budget

as long as the changes are aligned with the intent of the original funding opportunity announcement and the budget includes only allowable costs.

• Is printing of materials an allowable cost?– Federal O/E materials are available electronically for

copying and alteration here: http://marketplace.cms.gov/getofficialresources/get-official-resources.html. While these materials are not provided in printed form, all printing and alteration expenses from these materials are allowable under this award.

Upcoming TA Opportunities

• HRSA will continue its O/E Grantee Enrichment Series. We anticipate the second in the series will take place in September.

• To access the first in the series, “Health Insurance Marketplace and Medicaid Expansion Outreach and Enrollment in Health Centers Part 1”, go to http://services.choruscall.com/links/hrsa130709.html

• We will continue to host TA calls specific to the O/E supplemental funding requirements and expectations as needed.

Q&A

Questions?

For More Information

Contact Your PCABPHC Outreach and Enrollment Team Inbox

bphc-oe@hrsa.govBPHC O/E supplemental funding technical assistance web page

http://bphc.hrsa.gov/outreachandenrollment/BPHC Helpline for EHB questions

1-877-974-2742 or bphchelpline@hrsa.gov BPHC O/E trainings

http://bphc.hrsa.gov/technicalassistance/trainings/index.htmlOther important websites:

https://www.healthcare.gov/ http://marketplace.cms.gov/

http://www.hrsa.gov/affordablecareact/

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