Exchange - Healthplanfinder 2012 to 2013

Transcription

1 Level 1C Establishment Grant Request These summarized activities are for the additional Level 1C Establishment Grant. Activities requested through the grant may only be used for design, development and implementation of new functionality in the Exchange or Healthplanfinder. Operations and maintenance of the Exchange may not be funded through the grant. Operations 1. Title of Activity: Training for each upcoming release (including training manuals and training sessions) training completed 4 weeks prior to each release Fund request: $4,000,000 Timeframe: March 2015 December 2015 Description: Develop a training program to support the WAHBE and its application and enrollment assistance network to cover the system enhancements related to future releases of Healthplanfinder. This training program will include training course materials, training exercises and training environment enhancements to keep pace with the release system code. 2. Title of Activity: New process development and business practice development Fund request: $500,000 Timeframe: January 2015 March 2015 Description: A process development consultant will establish new processes and business practices in response to the new functionality that is introduced with upcoming releases. The consultant will look for ways to improve response to customers experience by providing rapid resolution. 3. Title of Activity: Identify, develop and implement a workload management tool Fund request: $500,000 Timeframe: January 2015 March 2015 Description: Review existing tools, specifically Zendesk and Microsoft Dynamics CRM to identify Zendesk ticket to case capabilities, define universal procedures that include issue ownership and documented agreements to define and balance ticket to case load with available resources. Implement a tool and develop related processes to a tool and related processes to strengthen customer service for application, enrollment and finance issues. Information Technology One emergency release and three releases to improve system functionality and user experience have been identified through operating the Exchange in the previous year: Each release will focus on enhancing a specific area. The description and cost estimate of each release will be further refined through the grant development process. 4. Title of Activity: Emergency Release Fund Request: $750,000 Washington Health Benefit Exchange Level 1C Establishment Grant Request Draft Page 1 of 9

2 Timeframe: January 2015 February 2015 Description: This release implements required functionality to complete APTC tax reporting. 5. Title of Activity: Release One HPF system stability & operations support Timeframe: February 2015 July 2015 Description: This release will improve system stability and sustainability to allow for greater system efficiencies. a. Title of Activity: Design and develop IT tools and services to better manage HPF Develop IT framework to support system administrative tools and utilities that help to monitor HPF and allow staff to adjust customer accounts. Fund request: $2,000,000 Timeframe: January 2015 March 2015 Department requesting: Information Technology Description: The tools will help to achieve greater operational stability through: Performing code review of current architecture Establishing a Web service Framework Managing Batch Retry Queue Updating APTC statuses from approved to denied and vice versa Merging and Manage Person IDs within households Managing Logical and Physical Applications (discard duplicates, update statuses from submitted to draft and vice versa, etc.) Loading and repair ACES IDs Adjusting financial transactions Establishing operational processes in support of new tools/services b. Title of Activity: Procure EDI tools and/or services for timely management of EDI files Fund request: $1,500,000 Timeframe: April 2015 June 2015 Department requesting: Information Technology Description: Evaluate 3rd party EDI services and tools to generate, validate, and reconcile of 834 and 820 files in a timely manner. This will result in less reliance on the system integrator for managing HPF data, files, batch jobs, and interfaces. Funds for design and development will result in: A suite of tools and or services from an established vendor purchased as a result of the evaluation sited above Development and testing of tools and/or services c. Title of Activity: Healthplanfinder Business Fix Special Enrollment Fund request: $1,300,000 Description: Fix special enrollment issues in SHOP. Fix the change events that open a special enrollment for SHOP enrollees, according to regulations. Change reporting that triggers Special Enrollment should allow the Primary Applicant/Qualified Employee 60 days from date of event to make changes and the system is currently set to 30 days. System is currently non-compliant. Washington Health Benefit Exchange Level 1C Establishment Grant Request Draft Page 2 of 9

3 d. Title of Activity: True Fix Adult Disabled Dependents Fund request: $1,300,000 Department requesting: Operations/SHOP Description: Healthplanfinder must be able to capture the correct information for disabled dependents (age 0+) to be considered for HIPTC and allow the applicant to purchase insurance with the current household in both individual and SHOP market regardless of the age of the disabled dependent. A workaround is currently in place. e. Title of Activity: Implement new address validation tool Fund request: $950,000 Department requesting: Operations Description: Conduct a limited study to identify the best address validation tool to meet WAHBE Business needs. Implement an address validation tool to integrate a real-time address verification/compliance in Healthplanfinder. This would reduce the volume of undelivered mail which in turn improves customer service and reduces print and postage costs. f. Title of Activity: Washington Healthplanfinder User Interface - Content Management System Fund request: $1,895,820 Timeframe: April 2015 June 2015 Department requesting: Communications Description: Integrating a content management system with wahealthplanfinder.org, specifically for the homepage, online customer support (searchable FAQs), error codes and consumer info center, will give the WAHBE communications team ability to provide accurate and timely information about the status of HPF and customer support tools and information to customers as well as customer support assisters in real time, on-demand. g. Title of Activity: Washington Healthplanfinder User Interface - Online chat development Fund request: $750,000 Timeframe: January 2015 October 2015 Department requesting: Operations Description: A finding of usability and consumer testing was the interest in online chat on Washington Healthplanfinder. Implementing online chat would allow users to ask questions to a Customer Support Representative (CSR) instead of calling. This would occur within their Healthplanfinder web session. A chat function is not only customer friendly but it is a much more efficient method for consumers to communicate with the Customer Support Center. A CSR can manage 4-5 chat sessions in approximately the same amount of time one phone call would take. Implementing chat could have a positive impact on the Customer Support Center budget as well. The cost of running the Customer Support Center could be $500,000 - $600,000 a year less because of the efficiency of online chat communications. Washington Health Benefit Exchange Level 1C Establishment Grant Request Draft Page 3 of 9

4 6. Title of Activity: Release Two Implement HPF enhancements to improve customer experience Timeframe: May 2015 October 2015 Description: This release will enhance HPF functionality and user experience to begin in October a. Title of Activity: Discontinue use of premium aggregation functionality for the individual Exchange Fund request: $4,250,000 Timeframe: Implement in the third quarter of 2015 so that it s discontinued before the open enrollment period performed in 2015 Department requesting: Executive Description: Remove the payment aggregation functionality within HPF for the individual market. Functionality changes to include: 1. Remove Premium Payment Processing for both initial and monthly payments, 2. Remove invoicing 3. Remove Monthly and Recurring payments 4. Remove adjustment calculations 5. Remove 820 transactions to and from carriers 6. Enhance the 834 module to accept effectuations, terminations due to nonpayment and demographic changes from carriers b. Title of Activity: Navigator/Broker Account Structure Changes Fund request: $1,000,000 Description: Restructure the way a broker/navigator agency/lead organization is set within Healthplanfinder. Currently all broker/navigator accounts are a single account, one-to-one relationship. The change would create a tiered structure for the broker agency and navigator lead orgs with the agency/lead as the first tier and then the respective agents/navigators as the second tier. This would allow the lead org/agency to provide improved customer service to all clients serviced within the agency/lead org, to reassign clients when needed and to manage other desired functionality within their agency/organization. c. Title of Activity: Develop content management for correspondence Fund request: $1,500,000 Timeframe: April 2015 June 2015 Department requesting: Information Technology Description: We need to simplify the current printing process and enhance communication with our consumers. IT will evaluate the current printing process provided by HPF/KP (print vendor) and develop options that could involve different roles and interfaces between HPF, KP, and HBE staff. Options will need to be coordinated with Operation s request to remove correspondence functionality from HPF. Washington Health Benefit Exchange Level 1C Establishment Grant Request Draft Page 4 of 9

5 d. Title of Activity: Update APTC calculation Fund Request: $300,000 Timeframe: April 2015 September 2015 Department requesting: Policy Description: Update the manner in which APTC is applied to the premium for a selected plan to account for additional, non-ehb benefits. Individuals will be responsible for paying premiums allocable to non-ehb benefits. 7. Title of Activity: Additional Case Management Functionality to HPF Fund Request: TBD Timeframe: TBD Description: Adding case management functionality to the Exchange to will allow both HCA and HBE staff to document actions taken on specific case. Enabling both agencies to more efficiency serve our customers. 8. Title of Activity: Release Three - Develop HPF functionality Timeframe: July December 2015 Description: This release will implement changes in the system to meet regulatory and compliance issues that arise through a. Title of Activity: Washington Healthplanfinder User Interface - Mobile development Fund request: $946,891 Timeframe: January 2015 September 2015 Department requesting: Communications Description: WAHBE will extend the text-messaging functionality from the Level One Establishment Grant to a larger, more impacting scope to include developing a Washington HPF mobile application. The mobile application would include reminders to HPF account holders about their upcoming renewal and open-enrollment periods, premium payment due dates, and customer feedback opportunities. Messages to potential customers will include information about upcoming enrollment events in their local communities, and reminders to apply for free and low-cost health insurance through wahealthplanfinder.org. b. Title of Activity: Generation of 1095-B form for Medicaid enrollees Fund Request: TBD Timeframe: January 2015 February 2015 Department requesting: HCA Description: Starting in 2016, HCA will be required to issue a 1095-B form to Medicaid enrollees to prove MEC for tax purposes. c. Title of Activity: Healthplanfinder Business Identify, Track and Report-out on Medicare and COBRA Enrollees within Healthplanfinder Business Fund request: $1,000,000 Washington Health Benefit Exchange Level 1C Establishment Grant Request Draft Page 5 of 9

6 Description: Create the ability for an employer to identify Medicare and COBRA enrolled employees within the application. Allow Healthplanfinder to track these employees, report them to their respective carriers and other agencies such as CMS. d. Title of Activity: Healthplanfinder Business SHOP Employer Cancel Application Button Fund request: $325,000 Description: Move the cancel application button in the employer application to an earlier portion of the application process or add the cancel button to the Quick Links when an application is in draft status and has not yet been submitted. e. Title of Activity: Healthplanfinder Business SHOP Participation Threshold for Renewals and Employee Roster Changes Fund request: $650,000 Description: If employers were not eligible to participate in Healthplanfinder upon initial account creation, they may be eligible upon reporting changes and recalculating the participation threshold determination. Since this is not currently being done, the system may be preventing eligible small groups from enrolling in coverage. The reverse may be true for employers who become ineligible upon reporting changes in their FTEs enrollment status. f. Title of Activity: New functionality for customer service support tools Fund request: $1,500,000 Timeframe: July 2015 September 2015 Description: Customer Service Support b Information Technology Description: The process development consultant will establish new processes and business practices in response to the new functionality that is introduced with upcoming releases. The consultant will look for ways to improve productivity, reduce costs, and make the best use of the business s resources and identify the most effective workload management tool. g. Title of Activity: Adult dental Fund request: $3,280,000 Timeframe: April 2015 December 2015 Department requesting: Policy Description: WAHBE will develop an enhanced consumer experience with respect to dental benefit options, including offering plans that include adult dental benefits in the Exchange. We will work with a consultant and stakeholders to define the type of dental product(s) that will be offered and to determine how certification criteria should apply to family dental plans. We will work with our systems integrator and consumer interface design vendor to design a system platform and user interface in Healthplanfinder to support these new plan offerings and enhanced shopping experience. We will work with a market analysis consultant to study and develop recommendations for outreach Washington Health Benefit Exchange Level 1C Establishment Grant Request Draft Page 6 of 9

7 strategies to understand and reach the target populations for family dental plans. Training materials will be developed to provide guidance for privileged users on the new design and dental plan shopping experience. The overall shopping flow for enrollees purchasing dental plans will be enhanced to provide a streamlined and user-friendly consumer experience. h. Title of Activity: Exemptions program Fund Request: $2,500,000 Timeframe: January 2015 October 2015 Department requesting: Policy Description: Prior to the start of open enrollment for 2016, the Exchange must develop and implement a program for conducting eligibility determinations for exemptions from the shared responsibility payment. This includes the creation of forms and tools to efficiently process and track applications for exemptions, as well as store documentation in support of exemption applications. The Exchange must also update various CMS and IRS data reporting transmissions to include information related to eligibility determinations for exemptions. i. Title of Activity: Catastrophic Plan Enrollment due to Hardship Exemption Fund Request: $1,250,000 Timeframe: April 2015 September 2015 Department requesting: Policy Description: Creates functionality within the Healthplanfinder system to support verification of hardship exemptions for applicants to allow enrollment in Catastrophic health plans for individuals over the age of 30. Added functionality will include the ability for Healthplanfinder to capture an applicant s unique Exemption Certificate Number (ECN) or indicate a pending application for a hardship exemption and upload documentation in support of an exemption. Once an exemption has been verified, provide qualified applicants or Account Workers with the ability to enroll an applicant in a catastrophic health plan in the HPF. j. Title of Activity: Design requirements to provide an interface with DSHS and HCA to process Medicaid clients in HPF. Fund request: $1,000,000 Timeframe: January March 2015 Description: Design a complete set of requirements in conjunction with DSHS and HCA to provide streamlined processing of Medicaid clients. This will involve evaluating the current system in light of new requirements and then designing system to address those requirements. This will involve changes for both the ACES system and HPF and will necessarily involve new transaction types, logic flows, and data structure changes. This work will encompass aligning the Medicaid client information with the system of record ACES database and ensuring that the renewal and termination processes are accurate, comprehensive, timely, and fully automated. This will also provide detail error report and as much automation as possible for mixed households (Medicaid and HIPTC). k. Title of Activity: Develop and implement an interface with DSHS and HCA to process Medicaid clients in HPF. Washington Health Benefit Exchange Level 1C Establishment Grant Request Draft Page 7 of 9

8 Fund request: $3,000,000 b March September 2015 Description: Develop and implement an interface with DSHS and HCA to provide streamlined processing of Medicaid clients. This will include changes for both the ACES system and HPF and will necessarily involve new transaction types, logic flows, and data structure changes. This work will encompass aligning the Medicaid client information with the system of record ACES database and ensuring that the renewal and termination processes are accurate, comprehensive, timely, and fully automated. Develop and test of all the features defined by the design. Robust testing will be needed to ensure data integrity, security and for error recovery. Will require coordinated support and testing with the ACES system. Communications 11. Title of Activity: IRS Form 1095-A Fund request: $750,000 Timeframe: January 2015 April 2015 Description: In 2015, when HPF customers file their 2014 tax forms, the IRS will use Form 1095-A to reconcile the amount of the advance premium tax credits paid to the customers Qualified Health Plan (QHP) carrier with the amount of tax credits the customers were actually supposed to get. The HPF will generate a notice along with the 1095-A form at year end to households that receive a health insurance premium tax credit. A communication strategy and materials providing information to customers related to the notices and actions they may need to take will be developed. Training staff related to the new functionality that will be implemented in the HPF is included in the upcoming release training (Release 2.1). 12. Title of Activity: Build consumer-friendly pages on the WAHBE corporate website Fund request: $150,000 Timeframe: January 2015 June 2015 Description: As of November 2014, consumers will have a direct link from wahealthplanfinder.org to the Application Quick Tips at wahbexchange.org. In the aim of providing resources that enable customers and customer support assisters to troubleshoot and find answers to their questions, a section of the corporate website will be enhanced to be more consumer-friendly. The new consumer-friendly pages could include visual design and interactive information (video & audio). Additionally, the consumer-facing pages will be tested for usability (Spanish and English) and ADA compliance. 13. Title of Activity: Digital Customer Engagement Initiative Fund request: $300,000 Timeframe: January 2015 September 2015 Description: Alongside enhancing the user interface of Washington Healthplanfinder, the communications team will develop customer support tools related to getting and maintaining coverage through Washington HPF. These website training tools could include video tutorials, webinars, and collateral that will be made available on consumer-facing pages on the WAHBE corporate website. Additionally, these tools and digital customer engagement strategies will be socialized with Navigators/In-Person Assisters and Brokers. Washington Health Benefit Exchange Level 1C Establishment Grant Request Draft Page 8 of 9

9 Policy 14. Title of Activity: Health Care Provider Directory Fund Request: $750,000 Timeframe: March 2015 September 2015 Description: Increase the functionality of the health care provider directory by adding the ability to search by the name of a clinic and widening the geographic search area. Health Care Authority (HCA) 15. Title of Activity: Imaging System Enhancements Fund Request: TBD Timeframe: January December 2015 Description: Enhancements to the Kofax imaging system that supports HBE enhancements and will include the ability to view documents historically, to create reports, and track workload. 16. Title of Activity: Adding attachments to correspondence Fund Request: TBD Timeframe: January December 2015 Description: Expand correspondence functionality to include the ability to add attachments to letters, bundle letters and the ability for HCA/HBE workers to manually suppress letters Washington Health Benefit Exchange Level 1C Establishment Grant Request Draft Page 9 of 9