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California Health Benefit Exchange Decision Roadmap. Peter V. Lee November 15, 2011. Major Issues and Working Contractor Engagement Timeline. 1. Scope of Background Material To Be Developed. 1) Legal Scope Regulatory requirements Prohibited approaches Allowable alternatives

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California health benefit exchange decision roadmap l.jpg

California Health Benefit ExchangeDecision Roadmap

Peter V. Lee

November 15, 2011



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Scope of Background Material To Be Developed

1) Legal Scope

  • Regulatory requirements

  • Prohibited approaches

  • Allowable alternatives

    2) “Just the Facts”

  • Current California activities

  • California and National relevant data

    3) Stakeholder Perspectives

    4) Options and Recommendations

    5) Detailed budget and timeline for Level II grant


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Engagement and Input Processes

  • Stakeholder Engagement; small and large group across all stakeholders.

  • Develop questions for input in consultation with Exchange Stakeholder Advisory Workgroups.

  • Solicitation by the Exchange for input on key questions.

  • Exchange engagement of expert consultants to gather data and provide options.

  • Review of options with stakeholder input at Exchange Board Meetings and other forums.


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California Affordable Coverage Enrollment System RFP Development and Proposal Evaluation: Working Timeline

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Marketing, Promotion and Outreach

Partial Issue List

Potential Stakeholder Questions

  • What sales, outreach and assistance channels are most effective for which populations?

  • How can the Exchange marketing efforts be best coordinated with national and state government partners and private sector partners (e.g., providers, plans, foundations)?

Resource: New Contractor (s) for Research; New Contractor for Outreach and Communications

  • Sales channels

  • Special population outreach

  • Costs and flows

  • Focus groups

  • Navigator roles

  • Scope of work for Navigators, Brokers/Agents, etc.

  • Certification and licensing

  • Payment for Navigators

  • Exchange need for immediate communications support

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Navigators, Agents and Brokers

  • Potential Stakeholder Questions:

  • What minimum criteria should navigators meet? What training/certification requirements should navigators meet?

  • What performance standards should navigators have (e.g., requirements for case volume, language access, etc.)?

  • What responsibilities should navigators have relative to enrollment in non-Exchange health programs including Medi-Cal? What responsibilities/linkages to other social service programs?

  • How will the work of navigators be coordinated with other consumer assistance groups to provide effective, non-redundant services?

  • What should be the terms of participation be for agents and brokers in the SHOP and individual exchange?

  • What are the potential payment amounts/levels for brokers in the SHOP and individual exchange?

  • Should payment to brokers be made by the Exchange or plans in the SHOP and individual exchange?

  • What is the relationship of brokers to navigators?

  • What is the relationship of brokers to public health care program and/or non-health social service programs?

Resource: New Contractor for Outreach and Communications

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Enrollment & Information Technology

Partial Issue List

Potential Stakeholder Questions

  • What roles should the following entities play in Exchange enrollment, what are payment options and appropriate outcome measures for their work:

    • Community/consumer groups

    • Counties

    • Brokers/agents

    • Providers/community clinics

    • Health plans

  • What language and accessibility standards should the Exchange use and require use of?

  • What role should the Exchange play in the enrollment of any non-health service programs?

  • What process can be used to minimize gaps in coverage and facilitate transitions between programs?

  • Resources: ClearBest; New Contractor; PCG; New Contractor(s) for Outreach Issues

    • Cost allocation between Exchange, and partners

    • County role and potential payments for enrollment

    • Processes for design and scope minimizing gaps in coverage

    • Design and scope of call-center functions

    • Assuring language and diversity capacity of service providers

    • Provisions for in-person services

    • Enrollment estimates

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