Vendor Conference: Enrollment Broker EB RFI 529-07-0156 June 11, 2007

1. Vendor Conference: Enrollment Broker(EB)RFI# 529-07-0156June 11, 2007

2. Welcome and Introductions

3. Integrated Eligibility History

4. How is eligibility currently performed? The Health and Human Services Commission (HHSC) is responsible for determining eligibility for state services, including: Children�s Health Insurance Program (CHIP) Medicaid Food stamps Temporary Assistance for Needy Families (TANF) Long-term care for the elderly and people with disabilities (financial eligibility)

5. How is eligibility currently performed? CHIP Since the inception of the CHIP program, CHIP eligibility has been determined by a private contractor. HHSC transition to a new CHIP contractor in Dec. 2005 Children�s Medicaid and CHIP have a single application form. State workers must determine eligibility for Medicaid Eligibility information is submitted by telephone, fax and mail.

6. How is eligibility currently performed? Adult Medicaid, TANF, Food Stamps A single application is used to apply for these programs. Requires contact with a designated eligibility office and state worker. Assigned to an office based on proximity Case files are paper based.

7. Current Eligibility System There is a clear and compelling need to modernize the eligibility system. The current model is based on a service delivery framework designed in the 1970s and continues to reflect certain inherent limitations: Outdated computer technology which is difficult and costly to maintain and update Inflexible office-based system that cannot easily respond to demographic or workload changes, consumer preferences, or other external factors

9. Limited use of technological tools and modern business practices to support eligibility processing Staff and resource intensive process that cannot respond to caseload growth without substantial increases in appropriations In FY 1995 there were 12,487 annual average eligibility determination FTEs. In FY 2006 there were 5,975 annual average eligibility determination FTEs. If staffed at the FY 2002 level, the current eligibility model would require more than 13,000 staff � an increase of 7,000 over current staffing levels. This level of staffing would cost more than $250 million per year in All Funds.

10. New Eligibility System The 78th Legislature, 2003, enacted statutory provisions to �achieve the cost savings and revenue necessary to finance certain health and human services.� The legislation in part: Directed HHSC to establish call centers, if cost-effective Required HHSC to outsource call centers unless HHSC determined that contracting for the operation of the call centers would not be cost-effective Business case completed in March 2004 determined that the use of call centers would be cost-effective. Competitive procurement through an RFP determined that outsourcing was more cost-effective than state-operated call centers.

11. Convenient Access Convenient access for consumers through multiple channels including phone, fax, Internet and mail. Texans will not have to take off work, pay for transportation or arrange child care to apply for services. Easier recertification process � consumers will be able to complete most re-certifications and make basic changes, such as addresses, without an office visit. One application for many services � clients will be able to access a variety of services � even across agency lines. Field offices strategically located across the state providing in-person services.

12. What is IE? Integrated Eligibility (IE) is an initiative to modernize the eligibility system by: Replacing outdated technology Changing business processes Creating electronic case records which allows: Additional channels of access for clients Benefits can be accessed through local offices, fax, Internet, telephone or mail. Clients are no longer tied to a particular eligibility office. More efficient use of state resources by balancing workload Workload can be distributed around the state. Provides additional flexibility during a disaster.

13. What is IE? HHSC is redesigning programs around consumers, with extended hours and multiple ways Texans can apply for services at times and places that are convenient to them. Application options will include: In person at a field office (8 am - 5 pm, Monday - Friday) By phone by dialing 2-1-1 (extended hours, 8 am - 8 pm, Monday - Friday) Over the Internet (24 hours a day, 7 days a week) By fax or mail The new system will expand options for clients.The new system will expand options for clients.

14. Implementing the New Eligibility System In June 2005, HHSC contracted with the Texas ACCESS Alliance (TAA) for multiple responsibilities: Responsibilities assumed from previous vendors: CHIP eligibility Medicaid and CHIP managed care enrollment broker services Maintenance of the Texas Integrated Eligibility Redesign System � TIERS � automated system New responsibilities: Integrated eligibility services for Medicaid, Food Stamps, and TANF Piloted in 4 out of over 300 eligibility offices

15. Functional Components of the TAA Contract Children�s Health Insurance (CHIP and Children�s Medicaid): Eligibility determination for CHIP Call center intake, operations and processing Document imaging and processing Data collection and case maintenance IE Call Center Intake & Operations (TANF, Food Stamps, Adult and LTC Medicaid): Call center intake and operations Document imaging and basic data collection Basic inquiries about eligibility process IE Eligibility Processing (TANF, Food Stamps, Adult and LTC Medicaid): IEE Pilot Activities Application processing Case maintenance Screening, application and general case update activities

16. Functional Components of the TAA Contract Enrollment Broker: Enrollment into managed care plans for STAR, STAR+PLUS, NorthSTAR, and CHIP programs Education and Outreach Services to Managed Care Beneficiaries Texas Health Steps Outreach, Informing and Support Services Federal requirements stipulate that managed care enrollment must not be performed by an HMO TIERS Maintenance: System Maintenance and Modification System Testing Conversion of data from SAVERR to TIERS Help Desk for support for eligibility staff using TIERS

17. IE Pilot IE Pilot Conclusions: The concept is sound and clients are eager for a more flexible eligibility system. The new system must efficiently support state workers and keep complex decision-making in the hands of trained, experienced state employees. The pilot has shown us that we needed to redraw the line between the state and private sector to clarify that the private sector is there to provide a support role to state staff. Financial assessment for long-term care assistance. Functional assessment done by DADS staff.Financial assessment for long-term care assistance. Functional assessment done by DADS staff.

18. IE Contract Transition On March 13, 2007, HHSC announced it would begin winding down its contract with TAA. Responsibilities in the contract are: Children�s Health Insurance Eligibility Processing Medicaid and CHIP enrollment into a health plan (managed care enrollment broker services) Maintenance of the new automation system -- Texas Integrated Eligibility Redesign System (TIERS) Integrated eligibility services for Medicaid, Food Stamps, and TANF

19.  IE Contract Transition HHSC is now responsible for direct management of some parts of the project and has entered into short-term contracts to ensure services continue without disruption. Timelines for transition will be different for each component. In the short term, work is continuing to be performed by existing subcontractors. HHSC will evaluate whether to hire state staff or use different contractors for those tasks. The State assumed management of Maximus� CHIP contract. In the short term, Maximus is processing applications. Maintenance of TIERS will transition to state staff and contracted staff. Maximus will continue to enroll Medicaid and CHIP clients into managed care plans. The State assumed management of Maximus� call center/ processing support contract.

20.  IE Contract Transition HHSC executed 3 short-term contracts for: Children�s Health Insurance processing Call centers Enrollment broker The short-term contracts ensured no disruption to client services and access to benefits. During this period HHSC: Completed a plan defining procurement strategies, goals and services to be procured Issued three Requests for Information (RFI) on May 31, 2007; responses are due by June 29, 2007

21. What is TIERS? How does it relate to IE? New Computer System -- TIERS Established by the 76th Legislature in 1999 to design and replace multiple client eligibility determination systems. TIERS is as modern as today�s Internet technology and will integrate the application process for more than 50 HHS programs. A TIERS pilot began in June 2003 in eligibility offices in Travis and Hays counties and was expanded to Williamson county in November 2006. In February 2007, 51,468 foster care client records were converted and added to TIERS. At a cost of about $279 million, TIERS does more and costs less than similar systems in other large states.

22. What is TIERS? How does it relate to IE? New Computer System -- TIERS TIERS is the new computer system that will allow the state to modernize the eligibility system and make access to services easier for clients. TIERS is a complex computer system designed to administer complex eligibility policies. Approximately 4.6 million lines of code 320 system interfaces 167 pieces of unique client correspondence 223 distinct reports � State, Federal and Operational Eligibility and reporting requirements are always changing 977 application changes implemented in FY 2006 impacting approximately 25% of TIERS application code.

23. TIERS Deliverables TIERS will: Replace multiple outdated existing automated systems with a single integrated automated system that uses state of the art technology to support eligibility determination process; systems to be replaced include the 25 year old SAVERR mainframe system Ensure effective and efficient business processes Add process improvements to the face-to-face business model Improve client access to benefits and services Better coordinate service delivery for different HHS programs

24. What is TIERS? How does it relate to IE? To date, TIERS: Serves Texas Works and Long Term Care clients each month Texas Works Clients: 220,993 Long Term Care Clients: 29,497 Has successfully converted 678,296 clients from SAVERR to TIERS Has issued $415,670,421 in client benefits (Food Stamp and TANF)

25. TentativeTimelines

26. Timelines - CHIP Children�s Health Insurance Program (CHIP) Issue request for information May 31, 2007 Issue final request for proposals December 2007 Contract Award May 2008 External review of contract June-August 2008 Transition of services Completed by Jan. 2009

27. Timelines - Enrollment Broker Enrollment Broker Issue request for information May 31, 2007 Issue final request for proposals December 2008 Contract Award December 2009 Transition of services Completed by July 2010

28. Timelines - Call center and Integrated Eligibility Support Call Center and Integrated Eligibility Support Issue request for information May 31, 2007 Issue final request for proposals December 2007 Contract Award May 2008 External review of contract June-August 2008 Transition of services Completed by Jan. 2009

29.  Next Steps After defining tasks that will be contracted, HHSC will: Develop an RFP Evaluate proposals Select appropriate vendors HHSC will continue to employ interim contracts to sustain client services during the procurement and transition period.

30. The state workforce remains an essential part of the eligibility system. The statewide network of field offices will be maintained and staffed with state employees. HHSC continues to look for effective ways to manage the increasing workloads at local offices. The most effective workload management is to continue to modernize technology and to allow consumers to choose how to apply for services.

31. Information Technology Process

32. Purpose of APD is to get Federal Funding for IT System Development. Written prior approval is required before releasing RFP, executing contracts or contract amendments that exceed thresholds. Feds have 60 days to review and respond. State must wait for approval before signing.

34. Program OverviewEnrollment Broker

35. The Enrollment Broker serves: Medicaid Managed Care NorthSTAR Texas Health Steps, and CHIP

36. The programs are designed to achieve five main objectives to improve: Access to care Quality of care Recipient and provider satisfaction Cost effectiveness Health status

37. The Enrollment Broker provides outreach, education and enrollment services to: STAR Program STAR+ Program NorthSTAR Program PCCM

38. The STAR program covers the traditional Medicaid health care services plus an adult annual exam, unlimited medically necessary prescriptions for adults, no limit on necessary days in a hospital for adults, and other value added services.

39. Serves SSI recipients receiving Medicaid and is designed to integrate delivery of acute and long-term services and support through a managed care system. It also covers Medicaid services for Aged and Disabled Individuals such as home health care, adult day care, and nursing home care.

40. NorthSTAR is in the Dallas Service Area and provides mental health and chemical dependency services through a Behavioral Health Organization (BHO).

41. Receive traditional Medicaid benefits, 3 Rxs per month for adults, unlimited for individuals under age 21, 30 day hospital stay limitation, unlimited for individuals under age 21, a nurse helpline, a recipient services helpline, member handbooks, health education, and case management for recipients with special health care needs.

42. THSteps provides a periodic evaluation of a child�s health, development and nutritional status, as well as vision, dental and hearing care. The EB provides outreach and informing services to this program.

43. CHIP provides health insurance for children under age 19 at a price that fits the budgets of Texas families. Rates are flexible and are based on the number of people in the family and the family's income Children do not have to be United States (U.S.) citizens to apply.

44. The Enrollment Broker: Provides education and enrollment services Calculates the cost-share amount Assesses an enrollment fee

45. Describe the approach to carry out the enrollment function Identify best practices Identify trends in public policy in service delivery that may affect enrollment Describe the approach to implement and operate a customer service line Describe the method to establish the cost of carrying out each topic and recommend potential fee approaches Describe how you would involve consumers, providers, advocates, and other stakeholders Describe the method to evaluate the program effectiveness Provide performance monitoring and enforce appropriate outcomes

46. Describe the approach to carry out the cost sharing functions within enrolment broker Address options to CHIP beneficiaries as it relates to payment of enrollment fees Describe the integrity of the cost-sharing process Describe the approach to operate the THSteps Program including Frew requirements Describe the Enrollment Broker functions Describe outreach and information services to designated THSteps-eligible Medicaid beneficiaries Describe your approach for outbound correspondence Describe your approach to prepare/distribute brochures, pamphlets and/or posters

47. Describe the approach to acquire, deploy, implement and maintain � see Section 4 of RFI Reference any studies or reports that support your approach Identify best practices Describe the method to establish the cost of carrying out each topic and recommend potential fee approaches Describe how you would involve consumers, providers, advocates, and other stakeholders Describe the method to evaluate the effectiveness of this approach Provide monitoring of vendor performance and enforce appropriate client outcomes

48. DiscussionQ & A