HRSA Health Center Outreach and Enrollment Technical Assistance Call August 13, 2013 Updated August 21, 2013

1. HRSA Health Center Outreach and Enrollment Technical Assistance Call August 13, 2013 Updated August 21, 2013

2. 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

3. PCA and Health Center Roles 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. Health Centers • Hire and train O/E assistance workers • 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. Slide updated 8/21/13

4. Training

5. 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 health center O/E assistance workers. • Training 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. Slide updated 8/21/13

6. Marketplace Requirements Plus HRSA Requirements • Health center O/E assistance workers in organizations with O/E supplemental funding must comply with federal and/or state Marketplace requirements and HRSA requirements. • Example: Non-health center enrollment workers are generally not required to do outreach, but health center O/E assistance workers in organizations with O/E supplemental funding are required to do both in-reach with current patients and outreach in their approved service area. Slide updated 8/21/13

7. Support of Health Center Training and Related Expectations • Your PCA should be your primary resource for all necessary information about all health center O/E assistance worker training and related requirements in the state. • If you encounter any barriers to accessing training or completing organizational assistance worker requirements, please contact your PCA. Slide updated 8/21/13

8. A Note about Navigators • If Navigator, IPA or other training beyond the minimum required for individuals who will facilitate enrollment of individuals into affordable insurance options offered through the Marketplace, Medicaid and CHIP in that state, health center O/E assistance workers can participate in that additional training and perform any additional functions afforded by that training, as long as they remain consistent with the intent of the HRSA O/E supplemental funding opportunity i.e., to hire O/E assistance workers and facilitate enrollment of individuals into the Marketplace, Medicaid and/or CHIP. • Health centers must be accountable for the HRSA O/E supplemental dollars and use them consistent with allowable costs and the intent of the funding, i.e., to hire O/E assistance workers and facilitate enrollment of individuals into the Marketplace, Medicaid and/or CHIP. HRSA O/E supplemental dollars must not supplant other federal or state Navigator or related funding or vice versa. Any additional funding for enrollment assistance must be additive. • For example, if your organization proposed to hire 3.0 new FTEs in your O/E supplemental application and 3.0 new FTEs will be supported by federal Navigator dollars, you must hire a total of 6.0 FTEs; 3.0 new FTEs who must meet HRSA’s CAC or equivalent minimum training threshold, and all other HRSA O/E supplement requirements and 3.0 new FTEs who must meet all Navigator training and related requirements Slide updated 8/21/13

9. Training Requirements for Health Centers in FFM/SPM States • Health centers in FFMs must, at a minimum, 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.   • In SPMs, health center O/E assistance workers may be required to complete a state-specific training program in lieu of and/or in addition to the federal CAC training in order to facilitate enrollment.   • Health centers in FFMs or SPMs that have the option of participating in training beyond that which is required for CACs can pursue this training and perform any additional functions afforded by that higher level of training, as long as they remain consistent with the intent of the HRSA O/E supplemental funding opportunity i.e., to hire O/E assistance workers and facilitate enrollment of individuals into the Marketplace, Medicaid and/or CHIP. • If you have not done so already, it is important to apply for designation as a CAC organization as soon as possible. Slide updated 8/21/13

10. Certified Application Counselors The following slides apply to states located in Federally-facilitated Marketplaces(FFMs). 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. Slide updated 8/21/13

11. Certified Application Counselor (CAC) Details* • 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 * Applies to FFM states.

12. How Organizations Can Apply to be a CAC* • For the FFM and State Partnership Marketplaces • Applications are now available for interested organizations to complete • Must be submitted online to the applicable Marketplace * Applies to FFM states. http://marketplace.cms.gov/help-us/cac.html

13. CAC Application Information* • 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 * Applies to FFM states.

14. CAC Designation Process* • 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 * Applies to FFM states.

15. Designated CACs* • 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 * Applies to FFM states.

16. Web-Based Training for Assisters* • 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 * Applies to FFM states.

17. Training Requirements for Health Centers in SBMStates • At a minimum, health centers and health center O/E assistance workers in State Based Marketplaces (SBMs) must complete all requirements in their state that will allow health center O/E assistance workers to facilitate the enrollment of individuals into affordable insurance options offered through the Marketplace, Medicaid and CHIP in that state. • Health centers in SBM states are not required to apply to CMS for CAC designation. Slide updated 8/21/13

18. Health Center Reporting

19. Health Center O/E Quarterly Progress Report (QPR) Metrics • TRAINING: Number of health center O/E workers trained as health center O/E assistance workers. • This includes all O/E assistance workers (staff, contractors, volunteers) who will be providing O/E assistance . • 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 health center O/E assistance worker. 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). Slide updated 8/21/13

20. 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 assistance session (e.g., an adult receives assistance from the health center O/E assistance worker for all 5 members of their family, even though all 5 members are not present). Slide updated 8/21/13

21. 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 the appropriate 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. Slide updated 8/21/13

22. Common Questions

23. 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.

24. 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.

25. 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.

26. Q&A Questions?

27. For More Information PCA Contact List http://bphc.hrsa.gov/technicalassistance/partnerlinks/associations.html BPHC Outreach and Enrollment Team Inbox bphc-oe@hrsa.gov BPHC O/E supplemental funding technical assistance web page http://bphc.hrsa.gov/outreachandenrollment/ BPHC O/E trainings http://bphc.hrsa.gov/technicalassistance/trainings/index.html Other important websites: https://www.healthcare.gov/ http://marketplace.cms.gov/ http://www.hrsa.gov/affordablecareact/ / Slide updated 8/21/13