Transcription of Tribal Assister Information Meeting. Presentation by Kelly Boston

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1 Transcription of Tribal Assister Information Meeting Presentation by Kelly Boston Background on the development of the Tribal Assister Services RFP: We have been working on the development of the Navigator Program over the past several months. The primary group giving input on the Navigator Program is the Navigator Technical Advisory Committee (TAC). Vicki Lowe, representing the Jamestown S Klallam Tribe, is on the Navigator TAC and provided good input. When we first began developing the In Person Assister Model, we thought it would be the model we could use for tribal and non-tribal programs. As we continued getting stakeholder and public input, both from tribal and non-tribal programs including input from the Exchange Advisory Committee we started to learn that there were some elements of the non-tribal In Person Assister Program that posed challenges for the tribes. We finished the non-tribal model and published the draft implementation plan in December That plan was approved by the Exchange Board in January We released a request for proposal for the In Person Assister Program Lead Organization Services on March 8, Once we posted the implementation plan we received a letter from the American Indian Health Commission on behalf of their member tribes pointing out that the In Person Assister model posed challenges for the tribes and requested that we develop alternatives for the Tribal Programs. As a result, we developed a separate program and Tribal Assister RFP to meet the needs of the Tribes. Fortunately for us, Sheryl Lowe came on board as the Exchange s Tribal Liaison just before we published the Tribal Assister RFP. She was able to review the RFP and give us additional feedback that enabled us to make some adjustments and get those included in the model before publishing the RFP. We had a lot of input and a lot of work went into developing the Tribal Assister model. Hopefully you ll see that it reflects some of the needs that we heard from your community. There are a couple of key differences in the Tribal Assister model from the non-tribal model. One of the biggest differences is that there is more flexibility on how you structure your contract. We heard that the lead organization approach might work for some tribal groups but it really wouldn t work very well for many of the tribes. There are a lot more options in the Tribal Assister RFP for how you can structure your program. It is also not necessarily geographically based and it also allows for other tribal entities to submit proposals, like Urban Indian Health Programs or associations or other tribal entities that might serve in a lead role for other tribal programs or might serve a population that is not reservation based. We also heard a lot of feedback about the compensation model in our non-tribal program and it would be difficult for tribes to be able to work under that compensation model. In the non-tribal program, fifty percent of the funding was tied to enrollment targets and in the Tribal Assister model ninety percent of the funding will be paid in monthly increments and ten percent of the funding is an incentive payment tied to meeting enrollments. The Exchange is in a black out period regarding the RFP. Our staff is not permitted to talk about the RFP with any tribal entities or others interested in applying or the public in general. We have one point of contact so all the questions will go to Kathy as the RFP Coordinator. We do that to ensure the process is fair and answers or information given is given to everyone. Kathy will screen the questions, help provide responses and get the information published on the website so everyone will have the same information.

2 The RFP schedule was reviewed. We ll have an optional Vendor Conference on April 30 th and opportunity to ask more in-depth questions about the RFP. Proposals are due June 28 th and we hope to announce successful vendors by mid-july. The contract will begins date is August 15 th or whenever we can get the contracts executed with your signature. Questions break: 1. Will we be able to get a copy of the presentation? Yes and we will also post a transcription of the webinar presentation. 2. Is the Letter of Intent binding? The letter of intent is something we ask you to do to let us know that you re intending to submit a proposal under the RFP. It is not binding, you can submit a letter of intent and if your entity decides for whatever reason not to apply, that is okay. Also if you don t submit a letter of intent but still want to submit a proposal, we will accept your proposal by the due date. Highlights of the RFP HBE RFP : You can use the Table of Contents to navigate through the document. Just hover over the topic and click and you will be taken to that topic location. I am going to move through some of these topics fairly quickly so we can spend more time on larger issues where there may be more questions. Section 2 contains a lot of background information that we provided about the Affordable Care Act, the Health Benefit Exchange, our statutory authority and how we came into being an organization and some of the rules that apply to us. It also includes special provisions related to American Indian and Alaska Native tribes and an overview of what we are looking for in terms of a Tribal Assister program. You ll see the term Tribal Assister Entities throughout this RFP. That is the term we are using for a Tribal Entity applying under this RFP. It could be as an entity serving as a lead organization or a single tribe, an association or Urban Indian Health program. We didn t want to list out all the different names, so when you see the term Tribal Assister Entity, that s what we are calling those organizations applying to receive a contract under this RFP. This section also outlines the responsibilities of a Tribal Assister Entity under this RFP. Some of those responsibilities are: outreach and awareness activities to inform people about the Exchange and about the options available under the Exchange; informing people about the special provisions in the Affordable Care Act pertaining to American Indians and Alaskan Natives; develop and maintain expertise in eligibility and enrollment; learn specifications for the plans that are offered under the Exchange; and provide information to consumers that you are serving in a fair, accurate and impartial way to facilitate an individual s selection in a qualified health plan (give them information, answer their questions and help them compare plans so they can make a selection); assist them to apply for premium tax credits. Those premium tax credits can be used to lower their premiums. Assisters will also provide the consumers with referrals to other agencies when it makes sense to do that and how to use their health care benefits, for individuals who haven t had health care coverage before and need some help in getting connected with a primary physician and better understanding how they can use their coverage options. Assisters have a responsibility to provide information that is culturally and linguistically sensitive and ensures accessibility for people with disabilities. Assisters will enter all application and enrollment information into the Washington Healthplanfinder, the tool we will be using to collect and track information about individuals who are applying for and enrolling in coverage. Section 2.5 of the RFP details some of the resources from the Exchange available to you as you work on the RFP: the Washington Healthplanfinder is the tool we ll all be using for application and enrollment; a Call Center; outreach and awareness materials available to use and customize; training to Tribal Assister

3 staff to learn how to deliver these services. And Exchange staff available to assist: Sheryl Lowe is the Exchange s Tribal Liaison, the Training Manager and Navigator/In Person Assistance Program Manager. Section 2.6 details some of the options available for how you submit your proposals. You do have the option of using the lead organization approach, so one tribe could serve as the lead organization for a number of other tribes or another entity or association could serve as a lead organization for a number of tribes. There could be a formal or informal tribal coalition, an Urban Indian Health program, a single tribe, or other approaches so if one of these doesn t fit your needs, you could propose an alternative. The period of performance will be the date we execute the contract, we re targeting mid-august, and will go through December 31, The letters of intents are due by May 17 th. This will give us an idea of areas where there may be gaps in coverage and help us determine how we would fill those gaps. Section 4 contains a lot of instructions around how to complete and submit your proposal, including Kathy s contact information at the RFP coordinator, how to submit questions about the RFP, and other instructions about the process of applying for the RFP. It is really important that you read the RFP as not all the sections are being discussed today. Section 5 Tribal Entity Requirements and Qualifications There are three different types of questions: mandatory questions have a designation of M after the item. This means the application template must have a response to the question for the RFP to be completed properly. We need the information requested but it also means the response is not scored. Some of the questions are marked MS this is a mandatory section and the response will be scored. There are a few questions that are designated as DS. This response is not required, but is desirable and will be scored. Section 5 is designated as mandatory and requests information about your organization. Most of the items in this section come out of the ACA. The ACA requires any agency that the Exchange contracts with to have experience and knowledge about the Affordable Care Act. Some of the items require a narrative response and some of them need a yes or no response. The correct response is required in order to pass the yes or no elements to this section and receive a contract under this RFP. Section is about nonduplication of funding as tribes you receive funding from many different sources, local state and federal. It s important for you to understand when you do receive funding from various sources that you will have recordkeeping and documentation requirements around making sure you are accounting for services you deliver under this contract separate from the services you deliver under other contracts. One of the funding sources this has come up with where there have been questions is Medicaid Administrative Match. Many tribes receive Medicaid Administrative Match and many tribes are also interested in being Tribal Assisters. These are similar services so tribes would be receiving federal funding from two different programs to provide similar services. You would need to document delivering Medicaid Administrative Match services separately from Tribal Assister services. You are probably already familiar with these types of procedures and have systems in place to document. We have been working with our federal oversight agency to get additional guidance that we can provide you and anticipate that the Health Care Authority will also be providing guidance about the Medicaid Administrative Match. Before we get to the point of entering into and implementing these

4 contracts, we ll have additional guidance about how to assure your recordkeeping is appropriate and services are being tracked properly. Section Background Checks some of you are already working with agencies like DSHS where you are serving individuals one-on-one and it is very common to require that background checks are in place for individuals delivering those services. The Exchange has a similar requirement under this RFP. The two RCWs referenced in this item are the same ones that DSHS uses for their program. Question Break: 1. What will the certification entail? This will be discussed in Section Is it correct that HBE grant incentive funding cannot used for services through the healthplanfinder for persons eligible for Medicaid? No, this is not correct. The HBE funding can be used to provide services either to individuals who turn out to be eligible for Medicaid or if they are not eligible for Medicaid to help them enroll in a Qualified Health Plan. 3. If a tribe will be serving its own tribal members, other Indian people, and non-natives who are part of the community, do they skip the Lead Organization sections of the application template? Yes, if you are not partnering with other tribal entities, you can skip those sections having to do with being a Lead Organization and establishing a network. Before we continue reviewing the RFP, we want to show you the application template. The RFP is the guide. It has all the information and instructions, all the questions and explanations for all questions. You will use the application template to respond to the RFP. All of the answers that you will provide to the questions are going to be answered on this template. The item numbers on the application template correspond to the item number in the RFP. It might be helpful to print out the RFP and have the application template open so when you are completing the template you can easily refer to the RFP. This document can be saved so you can come back to it as you complete your proposal. If your Tribal Entity is only planning to serve your own members, you can skip certain questions, the ones that reference serving as a Lead Agency such as questions in section 7. Numerous sections of the application template establish a word limit for the response. If you exceed the word limit, your proposal won t be disqualified, but your response on that item will only be evaluated up to the 350 word limit. In addition to the application template, there are three other documents that you ll submit as part of your proposal: Item 6.3 Community Outreach and Awareness Plan; Section 7 Network Assister Profiles; Section 12 Budget Proposal. Back to the RFP: in section 5.3 you will be providing us with some background about your organization, the purpose and programs, identifying which structure you are going to use for this RFP; if you will be partnering with other entities, then providing a list of those partners; estimate the number of individuals you plan to serve and how you developed those estimates. The rest of section 5.3 is about how your organization is going to coordinate those services; who the project manager will be; your experience in doing this kind of work; and if you are establishing a network, coordinating with partners. Question: We serve tribal members from all over the country who are not a part of the tribe. How are we going to take them into account? In looking over the RFP, it appears that we are only serving our own tribal members. We are a tribal clinic and less than 50% of the people we serve are our own tribal members. Kelly s response indicated that this entity would apply as a single tribe. Tribes can serve their members, family members, non-tribal individuals, members of other tribes who live in your community

5 or in the vicinity of your program and would prefer to be served at your location. Once you are a certified assister, under this proposal you are able to serve any one who comes to you. Section 6 Tribal Outreach and Awareness is a plan to tell us how you are going to reach out to your community and let them know about these services; how are you going to provide them with the information they need; and how are you going to reach those hard to reach groups who are probably the most in need of services but who sometimes fall through the cracks and are more difficult to find and enroll. We are calling target populations in this outreach plan, those populations (looking at your data) in your areas that are tribal members. Look at those populations who are more likely to be uninsured. Are there groups of people who are uninsured at higher rates than other groups? For example, in looking at your data, or a lot of you just know this because you know your community, is it more likely that men are uninsured than women. This is true in the general population young men in their twenties and early thirties are one of the groups who are uninsured at much higher rates. You will look at your own data and determine who those groups are that we most need to reach. Your outreach plans is a way to target the groups identified and develop specific strategies or steps you are going to take to reach those groups. In Section 6.1 we are asking who the person responsible for doing the outreach planning is, then develop and submit to us your initial outreach plan. We have outlined two types of activities: awareness activities and outreach activities. We also want you to reach the broadest number of people that you can. These people may not be in a target population but who need to know about these services. These are ways that you get out and provide a lot of information to your community. You might go to a community event and hand out brochures or information or go to a library or clinic and want to make sure information is available to anybody who comes in. Community awareness activities involve getting the word out to as many people as possible. Outreach activities are those where you are focusing on those specific groups that you have identified as uninsured or underinsured at higher rates and what steps are you going to take to make sure that you reach out to those harder to reach groups on try to bring them in. These are the elements that will be included in that plan. Item 6.3 is one of the items from the application template that has a separate attachment. We are asking you to tell us what information you used to develop your outreach plan, identify the target populations, provide an estimate of the number of people who are in those target populations, define the strategies you are going to put into place to address those target populations. Use the Outreach/Awareness template to complete this part of the application. Question: the majority of tribal members of the Colville Reservation use Indian Health Services (IHS) as their primary care giver. How will they benefit from this program? If Indian Health Services is a provider and they receive reimbursements, for example from Medicaid or from other insurance companies then by getting your members enrolled in Medicaid if they are eligible for Medicaid or enrolled in another health coverage plan like a qualified health plan, then the services they receive from an Indian Health Services program would be able to receive reimbursement. Sheryl Lowe, HBE Tribal Liaison, indicated this would be a question the Exchange would need to further pursue information in order to respond. Are these facilities able to access third party reimbursement? If yes, then IHS would benefit from community enrollment into health care coverage. IHS are providers, but have not gone out to communities to try to enroll for Medicaid or Medicare. We have approximately 10,000 people on the reservation a lot of these people are not members. We have four districts covering 4 million acres a lot of distance to cover. Kelly asked if IHS is able to accept third

6 party billings. Only a couple of their districts are third party billers. These are through 638 contracts. These two facilities would be able to benefit from people enrolling. If the facilities are strictly IHS run they may not be able to benefit. The facilities that are currently getting Medicaid reimbursement would. Back to the RFP: language access is probably a bigger issue for non-tribal programs, but we are required under the ACA to ensure access. If your program serves individuals who are limited English speaking, then you need to have a process in place so you would be able to serve them. Section 6.5 Outreach Partners is a desirable element in the RFP. You will describe how you will work with organizations in your community who are currently doing health care reform education and outreach. These agencies have indicated they would be willing to partner with assister agencies to leverage your efforts. For example, the SHIBA program already gets out in the community on a regular basis and does presentations about insurance, primarily around Medicare. They have indicated they would be very willing to work with assister agencies on their presentations so when they are giving presentations they could cover add information for the Health Benefits Exchange. In this section we are asking you to look at resources in your community that you could partner with. Section 7 Establishing the Assister Network. If you are not planning to be part of a network you would not need to complete this section of the application template. If you are planning to be a Lead Organization or work with a group of tribes, this is the area where you will tell us what that network looks like. We are asking you to tell us how you selected entities in your network. One of the RFP appendices is called In-Person Assister Selection Criteria. The Navigator Technical Advisory Committee recommended some criteria that could be used to select assister entities. You don t have to use this criteria, but it is out there to provide some guidance in what makes a good assister entity. We want to know the names of the assisters that have agreed to participate and we ve asked you to complete a brief profile on each tribal assister entity using the template in the application packet. Also, if your organization is going to perform assister services (you are going to oversee other organizations and also perform assister services) then we need you to describe how that will work on the application template. IHS direct service sites can benefit as covered services needed by clients outside the clinic can be reimbursed by a QHP or Medicaid. This allows for the contract health dollars to be extended. This can pay for hospitalizations, treatments, doctor reservations, and allow clients to see specialists. It is required under policy to utilize any third party dollars the client may qualify for before using contract health dollars. Section 8 Training the Exchange is developing training and will be delivering training to tribal assister entities that apply under this RFP. If you applying to serve as a lead organization, then it will be the lead organization s responsibility to train the assisters in the network. There is also a certification exam required for assisters. Prior to the time the assisters start delivering services, they will complete the certification examination and once they pass will be given a certification and access to the Healthplanfinder to be able to perform those functions in the system. We ll be able to leverage the training work that is being done for the non-tribal In-Person Assister program and also plan to work with the American Indian Health Commission to develop the training that is specific to the tribal provisions. That training will become a part of the non-tribal and tribal program training. Individuals who are tribal members can receive services at a non-tribal or tribal program so the training will be needed by everyone. In this section we are asking entities to tell us about their experience delivering training, who the person is for the project who is going to be responsible for making sure that assisters get the training they need and that they have met all of the conditions needed, for example having a background check.

7 Questions: As mentioned earlier, the lead organization approach will not be appropriate for many tribes. Can you tell us how the funding will be allocated and how this will affect tribal programs? We will talk about this in Section 12 of the RFP. We noticed under section 2.4 you strongly encouraged the use of the lead organization approach as the Exchange resources are limited to fund single tribes. We will talk about this in Section 12 of the RFP. Is training for tribal certification dependent upon submitting an RFP for a tribe? We are making a lot of training material available on line and designing our training in a way so it can be used for multipurposes. There will definitely be some training available. We are starting a training series at the end of April called Countdown to Coverage. With this series we will start providing online webinars regarding topics assisters will need to know. The first session is on the Affordable Care Act at a pretty high level. We ll be diving down into more detail in the coming weeks and months leading up to implementation. The webinars will be available to anyone. As we move forward we will look at other ways we can get information out to people who might not be assisters but who want more information. The American Indian Health Commission has put together a workgroup to put together similar education and training and outreach specific to tribes. This will also be a good resource. Vicki Lowe is heading that effort. We expect there will be many people in the community helping people enroll that won t be part of an assister contract with the Exchange. There are a lot of agencies who are helping people now, just as many of you are helping people now. We are looking at and talking about what type of training we can provide so that individuals who are just helping people in the regular course of their business will have the information they need about the Exchange and the Healthplanfinder to help people. However, these individuals won t be paid by the Exchange to do that work. Only certified assisters who have a contract with the Exchange will be paid for that work. The contract could be with their tribe or as part of the lead organization s network of tribal assisters. Section 9 is performance monitoring to make sure we are making progress with enrollments and getting the results we need. We are asking tribal assister entities to tell us how they are going to stay on top of performance and make sure services are happening in the way they need to. If your organization or one of your entities is not making progress, how are you going to help them get back on track. If after a while it turns out it wasn t a good fit for one of your entities and you want to end that relationship that is fine, you can do that. You can redistribute those funds to another entity to provide services or you can end the contract with an entity that either it s not a good fit or they decide it s not working out for them. Section 10 is reporting requirements. Most of the reporting will happen in the Healthplanfinder. There will be a huge amount of information available through the Healthplanfinder for reporting and we will also be developing reports at the Exchange that we will definitely get your input about those reports. There are a few pieces of information that are not available in the Healthplanfinder right now and that the Exchange stakeholders felt were very important to collect. We have a few questions that we are planning to ask assister entities to collect from consumers one time at the time of application. You ll be submitting that information to the Exchange on a regular basis. We will provide a tool for you to use to report that information. Section 11 is for complaint processes. It is standard language on a proposal to ensure you have a complaint process in place so that if there is a problem or an error occurs, you have a process in place for resolving that.

8 Section 12 is on compensation. This is a different model from the non-tribal program. We have allocated $560,000. This can be applied for as either a small, medium or large grant. We have asked that if your entity is expecting to enroll fewer than 100 individuals that you join one of the other coalitions or groups. We have modeled our contracts for enrollment at a minimum of 100. If you expect fewer than 100 enrollments we think it would be best for you to team with another group. We do have a limited amount of money. Our hope is to get as much coverage statewide as possible. One of the ways to be able to get coverage to a broader group is by using the lead organization model. That way a number of tribes would come together under one lead organization and that lead organization will act as the coordinator for the other tribes that are participating. For those who don t want to do that or it doesn t work for you, you can apply either as a small, medium or large grant. These are based on the number of enrollments that you expect. We have examples of how the funds could be distributed. We won t necessarily have this exact number of grants awarded. If we only receive a proposal for one large grant we would redistribute the funds for more small or medium grants. What we will look at are proposals that will help us serve the greatest number of people. Small grants are for consideration of $30,000, eighteen equal monthly installments and one payment for achieving an enrollment target of 200. Medium grants are for $60,000 and large is $100,000. A large contract is where you expect to have enrollments of more than 800. How we have estimated the size of the contracts if your total uninsured tribal population or the population that you are targeting was 1500, the target we are going for is to get 16% of the uninsured population insured in this first eighteen month period. If you have a target of 240 enrollments, the enrollment target would be about 13 people per month. Your compensation would be $30,000. There are examples in the RFP what would be a medium and large contract. Outcomes that contribute to these targets are both enrollment in a Medicaid program or in a Qualified Health Plan. In your RFP document, there is an attachment called the Budget Proposal. It s mandatory. This is where you are going to show us the amount of money you are requesting and how that money will be used. We have provided a worksheet for you to complete to give us that information. If you are a lead organization and have a number of tribes you are working with, we re asking you to list those tribes and tell us how much will be allocated to each tribe and what the enrollment target is for each tribe. (There is an example of the allocation model in Section 12 of the RFP to see the breakdown for allocation to network partners.) The allocation may change throughout the contract period. You may find one tribe is having a much higher demand than another tribe. It is fine throughout the contract period to adjust the amounts or the enrollment targets among your tribes. Question: Is the 100 enrollment target for QHP or both (Medicaid)? It is for any enrollment for coverage. It s both QHPs and Medicaid. We understand there are certain roles that tribal assisters may be able to do that would not apply to Navigator assisters. One of those is the ability of tribal assisters to be able to perform American Indian/Alaska Native verification which is an ACA requirement. Response: there will be a separate mechanism for assisters to verify that the person they are enrolling is an American Indian or Alaska Native of their particular tribe. The system will send a form to that tribe for verification so that tribal assister can verify member. The particular details haven t been worked out yet. If the individual is a tribal member outside of the state, this is a different issue that we will need to address later. We will do more research and post more information when questions are posted.

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