June 9, Ms. Sherrill Wise, Chair Arkansas Health Insurance Marketplace Board 1501 N. University Ave., Suite 970 Little Rock, AR 72207

Transcription

1 June 9, 2015 Ms. Sherrill Wise, Chair Arkansas Health Insurance Marketplace Board 1501 N. University Ave., Suite 970 Little Rock, AR Dear Ms. Wise: I am writing to submit for your consideration a budget for a contract extension of PCG s Program Management Office (PMO) work for the period of October 1, 2015 through March 31, This represents a six month permissible extension of our original contract, which was awarded during the first quarter of calendar At the same time, I am submitting two other scopes of work that fit within the broad scope of the PMO contract but were not itemized in last year s amendment. The first is a Plan Management scope that represents a transfer of Marketplace consulting work that has been performed by PCG under a contract with the Arkansas Insurance Department. The transfer of this scope aligns with the conversion of the Insurance Department s grants to AHIM effective July 1. It is the only part of this request that has a July- September 2015 component due to continuity with the current Insurance Department grant. The second scope relates to establishment of an Agent/Broker/Navigator program intended to assist potential Marketplace customers. PCG has national experience in this area and has performed successfully in this role in New Hampshire and Delaware. We understand Arkansas focus on an agent and broker solution and are prepared to deliver training materials and other technical assistance. Notably, our baseline PMO funding request reflects no increase from the current annualized funding rate. The Plan Management scope price is consistent with the amount of funding the Insurance Department has traditionally provided to PCG for this support. The Agent/Broker/Navigator assistance is a new item and provided for funding consideration at the option of the Board. All of us at PCG recognize that it a privilege to be working with AHIM, and we appreciate your consideration of these proposals. Please don t hesitate to contact me at (608) or ralbertoni@pcgus.com if you have any questions. Sincerely, Richard Albertoni Manager 148 State Street, 10 th Floor, Boston, Massachusetts Telephone: (617)

2 Marketplace PMO Consulting Services For the Period of October 1, 2015 March 31, 2016 For the period of October 1 through March 31, 2016, Public Consulting Group will commence the following Program Management Office (PMO) scopes of work for the Arkansas Health Insurance Marketplace: Deliverable: Joint Application Design (JAD) Session Requirements Eligibility and Enrollment Cost: 785 hours at $237/hr = $186,045 PCG will facilitate the individual market JAD sessions necessary to define system business requirements related to Eligibility and Enrollment. This core function will require complex design sessions aimed at establishing new functionality for Advance Premium Tax Credit (APTC) and Cost Sharing Reduction (CSR) eligibility. This may require integration with existing functionality for Modified Adjusted Gross Income (MAGI) income measuring and verifications through the Federal Data Services Hub (FDSH). Deliverable: Joint Application Design (JAD) Session Requirements Financial Management Cost: 510 hours at $237/hr = $120,870 Financial management is a key program integrity area for the Marketplace. AHIM will be tasked with effectively managing premium assessment funds, accurately tracking and reporting consumer tax liability through 1095 forms and sending key financial information to the CMS and the IRS to accurately measure tax credits and other subsidies. PCG will facilitate the JAD sessions to develop the system business requirements for the individual market in this major functional area. Deliverable: Joint Application Design (JAD) Session Requirements for Plan Management Cost: 200 hours at $237/hr = $47,400 Comparing, shopping for and enrolling in a health plan will be a key business function of the Marketplace. PCG will facilitate the JAD sessions for Plan Management. Assuring the accuracy of business requirements will be critical to making sure health plans have accurate enrollment reports and that customers receive medical cards and premium billing statements on a timely basis. Across state based marketplaces, this has consistently been one of the most troublesome areas of system design. PCG s experience with PMO processes and Qualified Health Plan subject areas will assure the success of this process. Deliverable: Joint Application Design (JAD) Session Requirements for Privacy and Security Cost: 120 hours at $237/hr = $28,440 (5 sets/meetings at $5,688 per set/meeting) One of the most important responsibilities AHIM will encounter is safeguarding personal information stored in the Marketplace IT system. PCG will facilitate JAD sessions related to system business requirements for privacy and security. Deliverable: Call Center Design/Procurement and Request for Proposal Document Cost: 550 hours at $237/hr = $130,350

3 Marketplace PMO Consulting Services For the Period of October 1, 2015 March 31, 2016 The Call Center is anticipated to be a core element of the overall Marketplace design and implementation. PCG will work with AHIM staff to design a call center business solution and then to build a procurement strategy around this, including a full Request for Proposal document. Deliverable: Marketplace Policy and Regulatory Guidance/Options Papers Cost: 575 hours at $237/hr = $136,275 Policy and regulatory consulting related to federal and state laws, regulations and guidance has been and will continue to be a primary role for the PCG PMO effort. PCG s subject matter experts continuously monitor developments in state and federal policy changes that directly and indirectly impact the Marketplace. This pool of funds will support a variety of policy and options papers at the direction of the Board and the Executive Director. Deliverable: CMS Design Review Artifacts Cost: Two Design Reviews at $55,695 per Design Review (235 PCG has supported a variety of states through CMS design reviews and is familiar with the set of artifacts that must be prepared and submitted in advance to federal staff. PCG will prepare artifacts and assist in transmitting them through the appropriate federal databases for submission. Deliverable: Monthly PMO Project Status Reports Cost: Six Monthly Reports at $59,250 per report (250 PMO Status reports are a physical representation of an ongoing effort at enterprise-wide coordination of all Marketplace design, development and implementation efforts. Maintaining this single point of coordination is key to a successful launch. The reports will serve as the payment deliverable but will be backed by ongoing daily efforts to assure all development is synchronized. Total October 1, 2015-March 31, 2016 PMO Scope of Work: $1,403,040

4 For the Period of July 1 through September 30, 2015 For the period of July 1 through September 30, 2015, Public Consulting Group will commence the following plan management scopes of work for the Arkansas Health Insurance Marketplace: Deliverable: Comprehensive AHIM Plan Management Policies and Procedures Manual Cost: 240 hours at $237/hr = $56,880 Development of a comprehensive Policies and Procedures manual is an investment in assuring AHIM staff have a long -term document that establishes Plan Management protocols for the organization. This deliverable will be actively developed in collaboration with AHIM staff. The development process provides the opportunity for PCG to work with AHIM staff to identify and end-to-end Plan Management business process for the organization. Through this process, AHIM staff become immersed in the business requirements for certifying and monitoring health plans in conjunction with the Insurance Department regulatory work. The manual will also become an exhibit for CMS review to demonstrate readiness for AHIM to be certified as a state-based marketplace. Deliverables: Briefing Materials for Stakeholder Engagement Meetings Cost: 80 hours at $237/hr = $18,960 (3 meetings/sets of materials at $6,320 per meeting/set) Since early 2012, a wide variety of Arkansas providers, agents, brokers, carriers, consumer advocates and state agency personnel have participated as Plan Management stakeholders. They have attended advisory meetings to provide input on establishing certification criteria for Marketplace plans. As subject matter experts in state and federal Qualified Health Plan regulations, PCG has staffed and facilitated these meetings. PCG proposes to continue that work at AHIM to develop background materials, conduct research and provide policy options. Deliverable: 2016 SHOP QHP Certification Guidance for Issuers Cost: 200 hours at $237/hr = $47,400 As Arkansas launches its Small Business Health Options Program (SHOP) for plan year 2016, AHIM will be the party legally required to certify small group plans. This transition from the federal SHOP, if not managed correctly, will cause confusion on the part of carriers, who have been thus far following 2016 plan year certification procedures outlined in the CMS annual letter to issuers. PCG will provide guidance for AHIM to author its own letter to issuers that identifies transitional issues and speaks to the process AHIM will use to certify small group QHPs for This letter will be a critical step in developing operational clarity for health plans The following outline provides a starting reference for guidance to be provided to issuers, ensuring clear communications regarding the Marketplace plan submittal, review, and approval process: 1. Certification Process & Timeline a. Issuer registration with SBM; b. Issuer data submittal and collection;

5 For the Period of July 1 through September 30, 2015 c. SBM & State Review of QHP application; d. Data changes 2. Plan Certification Standards a. State Certification Standards b. State-to-SBM MOU c. Data transmission / sharing policy between SBM and State 3. Qualified Health Plan Monitoring & Oversight a. Issuer Account management b. Issuer compliance monitoring and compliance reviews c. Oversight of agents & brokers 4. Consumer Support a. Consumer appeals, case tracking & resolution PCG recognizes from experience in several states that a Marketplace must maintain an ongoing capacity to respond to issuer requests or inquiries, and will maintain a support presence capable of ramping up quickly to address issuer questions or concerns. Deliverables: Materials to Support Issuer Technical Advisory Workgroup Cost: 120 hours at $237/hr = $28,440 (5 sets/meetings at $5,688 per set/meeting) Technical assistance meetings with carriers during conversion to the SHOP will be a key piece of a successful transition. Based upon experience gained through three successful QHP review periods, providing information relating to timelines, required documents, and applicable policy considerations prior to the application window considerably reduces the effort required to fully review and correct applications. PCG has facilitated several interactions with issuers, either through in-person sessions or through online webinars, to walk through state and federal plan submittal and review requirements, leading to better coordination and adherence to plan specifications. PCG will work with the Marketplace to coordinate with issuers to organize and prepare checklists, tools, and other documentation to assist the plan application and certification process. During the most recent QHP application review cycle, PCG created or facilitated development of the following list of documentation relating to QHP certification: 1. QHP Certification Bulletin; 2. QHP Health Plan Submission Requirements Listing (Situational); 3. QHP Review Checklists; a. Binder & Template Review b. Form Filing Review c. EHB Compliance Review 4. Federal Regulation Release Summary (both Proposed and Final rules); and 5. QHP Issuer Workshop Presentations.

6 For the Period of July 1 through September 30, 2015 Deliverable: Quality Assurance Inventory Document for Accuracy of Plan Upload Process Cost: 120 hours at $237/hr = $28,440 As an operational authority on plan review, frequently embedded within the offices overseeing review of plan information, PCG possesses an unparalleled understanding each year of the makeup of the Marketplace and the plans within each market. This knowledge is valuable in that it allows PCG to, at a glance, identify any potential errors that may occur through plan submission or transfer across organizational lines. For this scope and in past engagements, PCG proposes to provide information relating to the quality of health plan submissions, including: 1. Confirmation of plan counts by issuer and market; In past years, confirming this basic information can provide assurance that all plans intended for transfer to the Marketplace have successfully made that transfer. Additionally, PCG proposes to provide high-level validation of plan contents to ensure that plan IDs are correctly linked with the appropriate plan information, both within and across plan data templates. 2. Managing the issuer plan preview window; After the State transfers plan applications to the Marketplace, issuers will have the opportunity to review the plan information and confirm that the template contents accurately reflect the design of the plan. While the data transfer process rarely causes any misalignment of plan information, issuers frequently notice issues in plan data through a final review of template contents. Most often, these issues result from incongruences between plan policy documentation and the cost sharing input within the plan data templates. Upon noticing such an error, the issuers must file a change request with the appropriate entity (in this case AHIM) to request a re-opening of the plan application to make the required corrections. PCG proposes through this scope to manage this plan correction process, including evaluation of the validity of suggested change requests, and implementing those changes uniformly across all affected documents and files. 3. Plan Data Sharing / Broker Support Tools Producer engagement, particularly in the small group market, is vital for distributing Marketplace information to employers and encouraging enrollment through the SHOP portal. The Marketplace must providing information to these producers in a manner that facilitates the efficient and accurate sharing of plan premiums, cost-sharing, and additional components of plan design. PCG has internally developed a platform (using Tableau) to share this necessary information in a manner that aligns with the needs of producers, produces situation-specific information for plan availability and premiums, and can be rapidly adapted according to user priorities. Providing this tool proactively to producers, as well as training about this offering and additional capabilities, will reduce plan data requests and the demands on Marketplace resources to respond to requests that can be resolved independently.

7 For the Period of July 1 through September 30, 2015 Within this scope, PCG proposes the development and application of this broker support tool to Marketplace small group plans, as well as regular sharing of plan data for cases in which information is not readily available. The billing deliverable for this work will be submission of an inventory document attesting to completion of plan preview and accuracy of plan upload. Deliverable: Summary Document of Final 2016 Plans and Associated Rates by Region Cost: 60 hours at $237/hr = $14,220 Annually, PCG has completed and provided a post-qhp certification summary document to reflect plan and associated rate information by region. Specific information provided will include: 1. Premium rates available across issuers, metal levels, regions, and enrollee age; 2. Advance Premium Tax Credit scenarios; 3. Plan counts by issuer, market, and plan type; 4. Issuer provider network reports and comparisons; and 5. Trending in rates, plan cost sharing, and network coverage. All of the above-named plan information can be gleaned from templates provided to the Marketplace by issuers, and will provide valuable management reporting and policy considerations for AHIM in both the near- and long term. Total July-September 2015 Plan Management Scope of Work: $194,340

8 Agent/Broker/Navigator Consulting Services For the Period of October 1, 2015 through March 31, 2016 For the period of October 1, 2015 through March 31, 2016, Public Consulting Group will commence the following agent/broker/navigator establishment program (ABN) scopes of work for the Arkansas Health Insurance Marketplace: Deliverable: AHIM ABN Program Operations Manual Cost: 350 hours at $237/hr = $82,950 Development of a comprehensive Policies and Procedures manual is an investment in assuring AHIM staff have a long -term document that establishes the agent/broker/navigator (ABM) program. This deliverable will be actively developed in collaboration with AHIM staff. The development process provides the opportunity for PCG to work with AHIM staff to identify the most efficient way to organize the ABN program. Through this process, AHIM staff become immersed in the requirements for establishing an ACA compliant program that meets AHIM s specific goals needs. Deliverables: Training Modules for ABN Program Cost: 425 hours at $237/hr = $100,725 Training for agents/brokers/navigators will be required. Participants in the ABM program will be a front line of AHIM s face to the general public and interact with perspective enrollees into the AHIM marketplace. The trainings will contain multiple modules that ensure all state and federal regulations are met and be designed with the goal of increasing enrollment in the marketplace in order to achieve sustainability. Deliverable: Navigator Selection Process Cost: 300 hours at $237/hr = $71,100 As a State Based Marketplace (SBM), AHIM will be required to contract with a minimum of two different organizations to provide ACA compliant Navigator services. Through this deliverable, PCG will assist AHIM in determining the most efficient way to identify and contract with Navigators. Deliverables: Agent/Broker/Navigator Program Organizational Structure Cost: 175 hours at $237/hr = $41,475 AHIM will require staff, internal organization, and on-going internal structures to run the ABN program. PCG will provide information on how other SBMs have organized their programs and recommendations on how AHIM may want to structure its program. PCG will work with AHIM to organize its ABN program as part of this deliverable. 1

9 Agent/Broker/Navigator Consulting Services For the Period of October 1, 2015 through March 31, 2016 Deliverable: Navigator Program Funding Model Cost: 150 hours at $237/hr = $35,550 Navigator programs are barred from being funded via Federal grant dollars at any point in time. Thus, ACA required Navigators represent an upfront cost that AHIM will face even while grants funds can be used to develop nearly all other aspects of the marketplace. In addition, Navigators represent an ongoing cost that AHIM will face in future years. Via this deliverable, PCG will work with AHIM to find the best method to fund this ACA mandate. Deliverable: ABN Program Contracts Cost: 150 hours at $237/hour = $35,550 Agents, Brokers, and Navigators who are selected to be part of this program may require contracts with AHIM. While agents and brokers likely will not universally need contracts to work with AHIM, some may if they choose to play a double role as a navigator group or perhaps have special status with AHIM. (A policy decision on entering into special relationships with certain agents/brokers has not yet been made.) Navigators will definitely require contracts with AHIM. PCG will work with AHIM to create contracts that can be used for the ABN program so when organizations are selected contracting can happen as soon as AHIM desires. Deliverable: ABN Program Support Cost: 200 hours at $237/hour = $47,400 As the ABN program is yet to be developed unforeseen needs are likely to arise. PCG has created this budget line item to cover any work requirements that may arise but are not included in this current scope. If additional work is not required by AHIM this money will not be allocated to any project work. Total October 2015 March 2016 Agent/Broker/Navigator Establishment Program Scope: $426,600 2

10 For the Period of July 1, 2015 through March 31, 2016 For the period of July 1, 2015 through March 31, 2016, Public Consulting Group will commence the following plan management scopes of work for the Arkansas Health Insurance Marketplace: Deliverable: Comprehensive AHIM Plan Management Policies and Procedures Manual Cost: 240 hours at $237/hr = $56,880 Development of a comprehensive Policies and Procedures manual is an investment in assuring AHIM staff have a long -term document that establishes Plan Management protocols for the organization. This deliverable will be actively developed in collaboration with AHIM staff. The development process provides the opportunity for PCG to work with AHIM staff to identify and end-to-end Plan Management business process for the organization. Through this process, AHIM staff become immersed in the business requirements for certifying and monitoring health plans in conjunction with the Insurance Department regulatory work. The manual will also become an exhibit for CMS review to demonstrate readiness for AHIM to be certified as a state-based marketplace. Deliverables: Briefing Materials for Stakeholder Engagement Meetings Cost: 160 hours at $237/hr = $37,920 (6 meetings/sets of materials at $6,320 per meeting/set) Since early 2012, a wide variety of Arkansas providers, agents, brokers, carriers, consumer advocates and state agency personnel have participated as Plan Management stakeholders. They have attended advisory meetings to provide input on establishing certification criteria for Marketplace plans. As subject matter experts in state and federal Qualified Health Plan regulations, PCG has staffed and facilitated these meetings. PCG proposes to continue that work at AHIM to develop background materials, conduct research and provide policy options. Deliverable: 2016 SHOP QHP Certification Guidance Letter to Issuers Cost: 120 hours at $237/hr = $28,440 As Arkansas launches its Small Business Health Options Program (SHOP) for plan year 2016, AHIM will be the party legally required to certify small group plans. This transition from the federal SHOP, if not managed correctly, will cause confusion on the part of carriers, who have been thus far following 2016 plan year certification procedures outlined in the CMS annual letter to issuers. PCG will provide guidance for AHIM to author its own letter to issuers that identifies transitional issues and speaks to the process AHIM will use to certify small group QHPs for This letter will be a critical step in developing operational clarity for health plans The following outline provides a starting reference for guidance to be provided to issuers, ensuring clear communications regarding the Marketplace plan submittal, review, and approval process: 1. Certification Process & Timeline a. Issuer registration with SBM; b. Issuer data submittal and collection;

11 For the Period of July 1, 2015 through March 31, 2016 c. SBM & State Review of QHP application; d. Data changes 2. Plan Certification Standards a. State Certification Standards b. State-to-SBM MOU c. Data transmission / sharing policy between SBM and State 3. Qualified Health Plan Monitoring & Oversight a. Issuer Account management b. Issuer compliance monitoring and compliance reviews c. Oversight of agents & brokers 4. Consumer Support a. Consumer appeals, case tracking & resolution PCG recognizes from experience in several states that a Marketplace must maintain an ongoing capacity to respond to issuer requests or inquiries, and will maintain a support presence capable of ramping up quickly to address issuer questions or concerns. Deliverables: Materials to Support Issuer Technical Advisory Workgroup Cost: 192 hours at $237/hr = $45,504 (8 sets/meetings at $5,688 per set/meeting) Technical assistance meetings with carriers during conversion to the SHOP will be a key piece of a successful transition. Based upon experience gained through three successful QHP review periods, providing information relating to timelines, required documents, and applicable policy considerations prior to the application window considerably reduces the effort required to fully review and correct applications. PCG has facilitated several interactions with issuers, either through in-person sessions or through online webinars, to walk through state and federal plan submittal and review requirements, leading to better coordination and adherence to plan specifications. PCG will work with the Marketplace to coordinate with issuers to organize and prepare checklists, tools, and other documentation to assist the plan application and certification process. During the most recent QHP application review cycle, PCG created or facilitated development of the following list of documentation relating to QHP certification: 1. QHP Certification Bulletin; 2. QHP Health Plan Submission Requirements Listing (Situational); 3. QHP Review Checklists; a. Binder & Template Review b. Form Filing Review c. EHB Compliance Review 4. Federal Regulation Release Summary (both Proposed and Final rules); and 5. QHP Issuer Workshop Presentations.

12 For the Period of July 1, 2015 through March 31, 2016 Deliverable: Quality Assurance Inventory Document for Accuracy of Plan Upload Process Cost: 120 hours at $237/hr = $28,440 As an operational authority on plan review, frequently embedded within the offices overseeing review of plan information, PCG possesses an unparalleled understanding each year of the makeup of the Marketplace and the plans within each market. This knowledge is valuable in that it allows PCG to, at a glance, identify any potential errors that may occur through plan submission or transfer across organizational lines. For this scope and in past engagements, PCG proposes to provide information relating to the quality of health plan submissions, including: 1. Confirmation of plan counts by issuer and market; In past years, confirming this basic information can provide assurance that all plans intended for transfer to the Marketplace have successfully made that transfer. Additionally, PCG proposes to provide high-level validation of plan contents to ensure that plan IDs are correctly linked with the appropriate plan information, both within and across plan data templates. 2. Managing the issuer plan preview window; After the State transfers plan applications to the Marketplace, issuers will have the opportunity to review the plan information and confirm that the template contents accurately reflect the design of the plan. While the data transfer process rarely causes any misalignment of plan information, issuers frequently notice issues in plan data through a final review of template contents. Most often, these issues result from incongruences between plan policy documentation and the cost sharing input within the plan data templates. Upon noticing such an error, the issuers must file a change request with the appropriate entity (in this case AHIM) to request a re-opening of the plan application to make the required corrections. PCG proposes through this scope to manage this plan correction process, including evaluation of the validity of suggested change requests, and implementing those changes uniformly across all affected documents and files. 3. Plan Data Sharing / Broker Support Tools Producer engagement, particularly in the small group market, is vital for distributing Marketplace information to employers and encouraging enrollment through the SHOP portal. The Marketplace must providing information to these producers in a manner that facilitates the efficient and accurate sharing of plan premiums, cost-sharing, and additional components of plan design. PCG has internally developed a platform (using Tableau) to share this necessary information in a manner that aligns with the needs of producers, produces situation-specific information for plan availability and premiums, and can be rapidly adapted according to user priorities. Providing this tool proactively to producers, as well as training about this offering and additional capabilities, will reduce plan data requests and the demands on Marketplace resources to respond to requests that can be resolved independently.

13 For the Period of July 1, 2015 through March 31, 2016 Within this scope, PCG proposes the development and application of this broker support tool to Marketplace small group plans, as well as regular sharing of plan data for cases in which information is not readily available. The billing deliverable for this work will be submission of an inventory document attesting to completion of plan preview and accuracy of plan upload. Deliverable: Summary Document of Final 2016 Plans and Associated Rates by Region Cost: 60 hours at $237/hr = $14,220 Annually, PCG has completed and provided a post-qhp certification summary document to reflect plan and associated rate information by region. Specific information provided will include: 1. Premium rates available across issuers, metal levels, regions, and enrollee age; 2. Advance Premium Tax Credit scenarios; 3. Plan counts by issuer, market, and plan type; 4. Issuer provider network reports and comparisons; and 5. Trending in rates, plan cost sharing, and network coverage. All of the above-named plan information can be gleaned from templates provided to the Marketplace by issuers, and will provide valuable management reporting and policy considerations for AHIM in both the near- and long term. Deliverable: 2017 Federal and State Regulatory Impact Review Document Cost: 160 hours at $237/hr = $37,920 Preceding the 2017 Plan Management cycle, PCG will assess the state and federal regulatory landscape for impacts on QHP requirements. This involves review of any changes to the CMS code of federal regulations or other changes to federal guidance. State regulatory changes will also be assessed, notably any changes to the Private Option for 2017 that will be expected to have an impact on QHP rules and filings for Deliverable: Draft QHP Certification Bulletin for Plan Year 2017 Cost: 400 hours at $237/hour = $94,800 PCG annually assists the Arkansas Insurance Department with drafting of the comprehensive bulletin that sets the regulatory parameters for QHP certification for the coming plan year. This bulletin draft is reflective of any and all changes to certification criteria recommended by AID and/or AHIM and incorporates changes to state and federal law. This deliverable reflects months of pre-planning of certification policy setting to complete. Deliverable: QHP Review Checklist for Compliance Examinations Cost: 240 hours at $237/hour = $56,880

14 For the Period of July 1, 2015 through March 31, 2016 PCG annually translates state and federal regulations, guidance, bulletin contents, rate and review tools requirements into an operational checklist to be used by compliance staff to conduct the compliance review process. Given the tight timelines for compliance reviews, this checklist is key to timely submissions and approval of plan filings. Deliverable: 2017 Individual Market and SHOP QHP Certification Guidance Letter to Issuers Cost: 240 hours at $237/hr = $56,880 Similar to the 2016 SHOP Letter to Issuers this 2017 version will include guidance for both the Individual and Small Group markets. Component parts will include: 1. Certification Process & Timeline a. Issuer registration with SBM; b. Issuer data submittal and collection; c. SBM & State Review of QHP application; d. Data changes 2. Plan Certification Standards a. State Certification Standards b. State-to-SBM MOU c. Data transmission / sharing policy between SBM and State 3. Qualified Health Plan Monitoring & Oversight a. Issuer Account management b. Issuer compliance monitoring and compliance reviews c. Oversight of agents & brokers 4. Consumer Support a. Consumer appeals, case tracking & resolution Deliverable: Materials for 2017 Plan Year Staff and Issuer Trainings Cost: 160 hours at $237/hour = $37,920 As we have done in previous years, PCG will provide training sessions to AHIM, AID, DHS and Issuer staff on the QHP review and certification process for plan year This will include hands on demonstrations of new submission templates and review tools as well as guidance on changes to rules and processes for the new year. Total July 2015 March 2016 Plan Management Scope: $495,804

15 6/10/2015 Arkansas Health Insurance Marketplace PCG Scope of Work Task ID Task Description Start Date Finish Date Estimated Consulting Hours Fully Loaded Hrly Rate Total Cost 1.0 Project Management Office 1.1 Requirements and Design support for Individual Market Review IM vendor requirements documentation for Eligibility and Enrollment Participate in all E&E JAD sessions Manage resolution of E&E JAD action items and decision points Provide feedback on post-jad E&E documentation DELIVERABLE: REQUIREMENT AND DESIGN SUPPORT ELIGIBLITY AND ENROLLMENT 2/15/2015 2/15/ $ 237 $ 186, Review IM vendor requirements documentation FOR Plan Management prior to JAD sessions Participate in all PM JAD sessions Manage resolution of JAD action items and decision points for Plan Management Provide feedback on post-jad PM documentation DELIVERABLE: REQUIREMENT AND DESIGN SUPPORT FOR PLAN MANAGEMENT 2/15/2015 2/15/ $ 237 $ 120, Review Financial Management vendor requirements documentation prior to JAD sessions for technical requirements Participate in all FM JAD sessions Manage resolution of JAD action items and decision points for Financial Management Provide feedback on post-jad documentation for FM DELIVERABLE: REQUIREMENT AND DESIGN SUPPORT FOR INDIVIDUAL MARKET FOR FINANCIAL MANAGEMENT 2/15/2015 2/15/ $ 237 $ 120,870

16 Review IM vendor requirements documentation prior to JAD sessions for technical requirements Participate in all IM JAD sessions for TR Manage resolution of JAD action items and decision points for technical requirements Provide feedback on post-jad documentation on technical requirements DELIVERABLE: REQUIREMENT AND DESIGN SUPPORT FOR INDIVIDUAL MARKET FOR 2/15/2015 2/15/ $ 237 $ 120,870 TECHNICAL REQUIREMENTS Review IM vendor requirements documentation prior to JAD sessions for security Participate in all IM JAD sessions fore security Manage resolution of JAD action items and decision points for security Provide feedback on post-jad documentation for security DELIVERABLE: REQUIREMENT AND DESIGN SUPPORT FOR INDIVIDUAL MARKET FOR PRIVACY AND SECURITY 2/15/2015 2/15/ $ 237 $ 120, Call Center RFP 10/1/ /30/ Determine RFP format and parameters 10/1/ /15/ Draft supporting language for RFP 10/1/ /15/ Draft Call Center Vendor requirements 10/1/ /31/ Draft Call Center Vendor scope of work and service level agreements 10/1/ /31/ Support review and approval of RFP document 11/1/ /15/ Support release of RFP 11/15/ /30/ DELIVERARBLE: RFP RELEASED 11/30/ /30/ $ 237 $ 130, Policy and Regulatory Support 11/1/2015 1/31/ Ongoing guidance/reports on federal Marketplace policies 11/1/2015 1/31/ Impact analysis of state policy changes impacting health insurance and the Marketplace 11/1/ /30/ Impact of integration with other coverage sources 11/1/2015 1/31/2016

17 1.3.4 DELIVERABLE: Individual Market Policy and Regulatory Guidance/Options Papers 1.4 CMS Gate Review Support DELIVERABLE: MATERIALS FOR START-UP REVIEW DELIVERABLE: MATERIALS FOR DESIGN REVIEW 1/31/2016 1/31/ $ 237 $ 136,275 11/15/ /15/ $ 237 $ 55,695 2/15/2016 3/15/ $ 237 $ 55, Perform ongoing IT vendor oversight and reporting 10/1/2015 3/31/ PMO Cycle 9 - October DELIVERABLE: MONTHLY STATUS REPORT 10/1/ /31/ $ 237 $ 59, PMO Cycle 10 - November DELIVERABLE: MONTHLY STATUS REPORT 11/1/ /30/ $ 237 $ 59, PMO Cycle 11 - December DELIVERABLE: MONTHLY STATUS REPORT 12/1/ /31/ $ 237 $ 59, PMO Cycle 12 - January DELIVERABLE: MONTHLY STATUS REPORT 1/1/2016 1/31/ $ 237 $ 59, PMO Cycle 13 - February DELIVERABLE: MONTHLY STATUS REPORT 2/1/2016 2/28/ $ 237 $ 59, PMO Cycle 14 - March DELIVERABLE: MONTHLY STATUS REPORT 3/1/2016 3/31/ $ 237 $ 59,250 Total Costs: Project Management Office 5,920 $ 237 $ 1,403,040