ENTITY MANAGEMENT TRAINING

Transcription

1 ENTITY MANAGEMENT TRAINING

2 COURSE INSTRUCTIONS To Complete Training Navigate through each slide by pressing the right arrow (>) key on your keyboard or clicking your mouse You can pause the training at any time and resume when ready This training will take approximately 30min to complete For technical support 2

3 DEFINITION Definition Certified Entities includes the following Program: * Navigator (NAV), * Certified Application Counselor (CAC) * Plan Based Enroller (PBE) * Medi-Cal Managed Care Plan Program (MMCP) Certified Counselor includes: * Individuals affiliated to any of the entities Enrollment Assistance Programs include: * Navigator (NAV) * Certified Application Counselor (CAC), * Plan Based Enroller (PBE) * Medi-Cal Managed Care Plan Program (MMCP) CC= Cov.CA 3

4 TABLE OF CONTENTS 1. Introduction a. Enrollment Assistance Program Overview 2. Phase 1: Becoming an Active Certified Entity with Certified Counselors a. Steps to Becoming an Active Certified Entity b. Steps to Becoming a Counselor, including: Training Fingerprinting and Background Check c. Roles and Responsibilities 3. Phase 2: Understanding Consumer Service and Enrollment Assistance Support a. Consumer Service and Enrollment Assistance Support b. Systems and Resources As part of this training process, the Primary Contact of the Entity will be required to attest that they clearly understand the requirements associated with becoming an Entity. 4

5 PROGRAMS OVERVIEW 1. CERTIFIED APPLICATION COUNSELOR (CAC) 2. MEDI-CAL MANAGED CARE PLAN (MMCP) 3. NAVIGATOR PROGRAM (NAV) 4. PLAN BASED ENROLLER (PBE)

6 WHAT IS THE CERTIFIED APPLICATION COUNSELOR PROGRAM Certified Application Counselor (CAC) Program The CAC program is for entities interested in assisting consumers to enroll in Covered California s Health Plans and other insurance affordability programs. CAE: An entity or individual registered by Covered California to oversee CACs who provide one-on-one consumer assistance. A CAE is not eligible to receive compensation for enrollments. CAC: An individual who is certified by Covered California and affiliated with a CAE, to provide face-to-face, one-on-one consumer assistance. Certified Application Counselor Program Certified Application Entity Certified Application Counselor 6

7 WHAT IS THE MEDI-CAL MANAGED CARE PLAN ENROLLMENT ASSISTANCE PROGRAM Medi-Cal Managed Care Plan (MMCP) Program The MMCP Program is for entities contracting with the Department of Health Services (DHCS) to provide health care services to those enrolled in Medi-Cal MMCP: An entity contracting with the DHCS to provide health care services to enrolled Medi-Cal beneficiaries. Medi-Cal Managed Care Plan Program Medi-Cal Managed Care Plan MMCPE: An individual that is an employee or contractor of a Medi-Cal Managed Care Plan who provides enrollment assistance pursuant to this agreement. Medi-Cal Managed Care Plan Enroller 7

8 WHAT IS THE NAVIGATOR PROGRAM Navigator Program The Navigator (NAV) program engages trusted Certified Enrollment Entities (CEE) to conduct outreach, education, enrollment assistance, renewal assistance and post enrollment services on behalf of Covered California. Navigator Program NAV Grantees: A Grantee will provide Outreach & Education, Enrollment, Renewal and Post Enrollment activities as well as Enrollment Assistance. Navigator Grantees Navigator: A Certified Enrollment Counselor (CEC) who is affiliated with a Certified Enrollment Entity that is registered in the Navigator Program. Navigator 8

9 PROGRAM REGULATIONS It is your duty to carefully review and understand all contents within the program regulations and the Entity Agreement, independent of this training. The California Health Benefit Exchange established the Certified Application Counselor Program within Title 10 of the California Code of Regulations. The regulations that govern your organization s relationship with Covered California are available using the following web link: CAC: 20Application% 20Counselors%20- % 20Approved%20by%20OAL.pdf Navigator: 20Assistance% 20Emergency%20Readoption%20Reg % 20Package%20%20Approved% pdf Entity Agreement A copy of your fully executed agreement will be available for download on the online system, In-Person Assistance System (IPAS): Any updates to the Agreement will be published and communicated by Covered California to you and your Entity. 9

10 PHASE 1: BECOMING AN ACTIVE ENTITY WITH COUNSELORS

11 OVERVIEW OF THE PROCESS TO BECOME ACTIVE This section of the training will focus on steps needed to prepare your organization to perform enrollment assistance on behalf of Covered California. The following process shows the steps needed for Entities to become Active: Entities can build a Counselor team roster by adding individuals names to the application in the IPAS application If you have questions about adding Counselors to your roster, uploading the Counselor agreement or their photograph into IPAS, please contact: IPAsupport@ccgrantsandassisters.org The Entities Primary Contact (you) must complete this Entity Management Training prior to any of your affiliated Counselors carrying out any consumer assistance functions. 11

12 NOTIFICATION ONCE AN ORGANIZATION IS ACTIVE An Entity becomes Active when following requirements are met: 1. The Primary Contact has completed the Entity Management Training AND uploaded the Entity Management Completion Form to their My Files in IPAS 2. The Entity has at least one fully certified Counselor Once the Entity training is completed, the Primary Contact for the Entity will receive an from with the subject: Your Entity CoveredCA.com login credentials Expect to receive this within 3-5 business days after your entity has become Active. 12

13 STEPS FOR COUNSELORS TO BECOME CERTIFIED

14 OVERVIEW OF THE STEPS TO BECOME CERTIFIED The following graphic outlines how individuals affiliated to your Entity will become a Certified Counselor: Note: the background check/fingerprinting process may happen concurrently with training, individuals do not need to complete these steps in sequence. Individuals should begin both steps as soon as possible. 14

15 COUNSELOR TRAINING REQUIREMENTS

16 CERTIFICATION TRAINING OVERVIEW Counselors will receive login credentials to the Learning Management System (LMS) once their application is submitted and approved in IPAS. All training components are located in the LMS at Counselor logs in to the LMS and accesses the appropriate Counselor Certification Training Completes the seven (7) Computer-Based Training courses online (approximately 10 hours to complete) Passes the CAC exam 50 multiple choice/true or false questions 3 opportunities to pass the exam with 80% or better score 16

17 TRAINING CURRICULUM The seven courses for Counselor Certification Training are: 1. Introduction to the Affordable Care Act 2. Introduction to Health Insurance 3. Understanding Your CEC Role 4. Eligibility for Individuals and Families 5. Covered California Plan Options 6. Privacy 7. The Application *You and your Counselors will receive notification to complete the required annual recertification training You are encouraged, but not required, to take the Counselor certification training. Please contact the training department at to register. Counselors will have access to download and print Participant Guides for the first seven 7 courses. These documents provide detailed, text-book like reading material to help them study for the exam and reference while assisting consumers. Participant Guides are available in IPAS and in the LMS. 17

18 FINGERPRINTING AND BACKGROUND CHECK PROCESS FOR INDIVIDUALS

19 CRIMINAL BACKGROUND CHECK AND FINGERPRINTING OVERVIEW Remember that the background check is not dependent on training completion. Counselors should begin background check and complete training as soon as possible. The Entity Primary Contact (PC) downloads the forms: The background check requires Counselors to complete two forms provided by the PC, and available in IPAS: 1. (2 copies) Request for LiveScan Service (fingerprinting) 2. Criminal Disclosure Form Forms are available in IPAS. PC s click the Download Forms link next to each Counselor applicant s name. The link will only appear when the Counselors application has been fully completed. 19

20 COMPLETING THE LIVESCAN FORM You will print TWO pre-populated Request for Live Scan Service forms and provide to the Counselor. The Counselor will complete the remaining blank fields. Counselors must use Covered California approved service locations. Live Scan sites for the Covered California approved vendor can be located at: work.html 1. Covered California pays the fingerprinting fees for individuals applying to become Navigator or CAC Enrollment Counselors up to December 31, For MMCP Counselors. The entity shall pay fingerprinting fees for individuals applying to become enrollment counselors. 3. The Counselor schedules an appointment at his/her chosen Covered California approved fingerprinting location and brings two completed prepopulated Live Scan Forms. MMCP and PBE Counselor applicants shall pay for fingerprinting service when rendered. 20

21 COMPLETING CRIMINAL DISCLOSURE FORM 1. An individual applying to become a Counselor must also complete the Criminal Disclosure Form. The form is available for download in IPAS using the download forms link in your Counselor roster. This form is to be completed by the individual applying to become a Counselor. **The Entity may not assist in this process. 2. Entity personnel are NOT allowed to process, view, collect, or mail this disclosure form for the individual. ONLY the individual completing the Criminal Disclosure Form may view, mail, or fax the form. 3. Faxed to: (916) (preferred submission method) Or, 4. Mailed to: Covered CA CONFIDENTIAL Attn: Enrollment Assistance Program Unit 1601 Exposition Blvd Sacramento, CA

22 FINAL STEPS FOR COUNSELORS Receiving the Delegation Code A Counselor applicant becomes Certified when the following requirements are met: 1. Cleared background check 2. Completed all training requirements 3. Passed certification exam 4. Entity completes management training Within 3 5 business days after becoming Certified, the Counselor will receive an from IPAsupport@ccgrantsandassisters.org with a delegation code and additional information to create an account on the web-based enrollment portal, CoveredCA.com. 22

23 IDENTIFICATION BADGES Counselors will receive an ID badge 5-7 business days after they are certified. Before a badge can be issued, Entities must upload a headshot photo in the Counselors application in IPAS. The photo must be taken from the shoulders up and have a plain background. The following images are appropriate badge photos: The Entity will guarantee that its affiliated Counselors wear ID badges issued by Covered California at all times when providing consumer assistance. Counselors are required to show the ID badge to consumers before they provide enrollment assistance. 23

24 ROLES AND RESPONSIBILITIES

25 MEETING PROGRAM EXPECTATIONS Roles and responsibilities covered in this section apply to both Entities and Counselors. Under the guidance of the Entities, Counselors are expected to: Provide information about available Covered California Health Plans and financial help in the form of premium assistance and cost-sharing reductions. Explain the enrollment options available on CoveredCA.com. Educate consumers about the value of health insurance and answer their questions. Inform consumers about premium costs and the benefits of obtaining health insurance coverage. Provide consumers with support and access to tools and resources that assist in comparing costs, benefits and coverage options. Assist eligible consumers with enrollment into Covered California Health Plans and/or other Insurance Affordability Programs, to include Medi-Cal. Provide information about consumer assistance hotlines and resources, such as the Medi-Cal ombudsman, and the Office of Patient Advocate. 25

26 PROHIBITED ACTIVITIES The Entity will ensure that affiliated Counselors NEVER: Fail to disclose conflicts of interest Mail the paper application for the consumer Coach the consumer to provide inaccurate information on the application Coach or recommend one plan or provider over another Accept premium payments from the consumer Pay any or part of the premium or any other type of consideration to or on behalf of the consumer Induce or accept any type of direct or indirect remuneration from the consumer Intentionally create multiple applications from the same household Invite, influence, or arrange an individual to separate from employer-sponsored plan 26

27 COMPLIANCE STANDARDS The Entity is accountable for and must comply with Covered California s fraud prevention policies The Entity and any of its affiliated Counselors must not have had a criminal case filed or a legal pleading issued, or have been convicted of a felony or been implicated in a complaint, related to the business of insurance or to issues of fraud or moral turpitude The Entity must report to Covered California, within 30 days, any incidence of fraud or any new criminal case filed or legal pleading issue related to the business of insurance, or to issues of fraud or moral turpitude Failure to report a known instance of fraud may result in PERMANENT termination of the Entity 27

28 PRIVACY AND SECURITY STANDARDS California, Title 10, Article (a) (4) requires compliance with federal law pertaining to handling and safeguarding a consumer s personally identifiable information. What information must be protected? Personally Identifiable Information (PII) Protected Health Information (PHI) Federal Tax Information (FTI) Elements of protected information are required as part of the enrollment process. Entities and Counselors who assist consumers will discuss, view and, if necessary, input this information into a Covered California enrollment application. PII is information that can be used to distinguish or trace an individual s identity, either alone or when combined with other personal or identifying information. The following are examples of PII: Name Birthplace Date of Birth Age Social Security Number Address 28

29 PROTECTED HEALTH INFORMATION AND FEDERAL TAX INFORMATION PHI whether verbal or written: 1. Is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearing house (e.g., a 3 rd party medical biller); and 2. Relates to the past, present or future physical or mental health or condition of an individual; or past, present or future payment for the provision of health care to an individual FTI is information from the Internal Revenue Service (IRS), contained in federal tax returns, including: any tax information declaration of estimated tax claim for refund a taxpayers identity the nature, source or amount of income, payments, receipts; deductions, exemptions, credits, assets, liabilities, net worth, tax liability, tax withheld, deficiencies, over-assessments, or tax payments Other information related to a tax return 29

30 PRIVACY AND SECURITY SAFEGUARDS Key Safeguarding Practices: Establish policies related to appropriate/prohibited access, use and disclosure of PII, PHI and FTI Communicate the policies to Counselors, staff and colleagues Monitor Counselor compliance with policies Reinforce Covered California training on protecting information Counselors shall never: Disclose or transmit PII/PHI/FTI over unsecure medium (e.g., , phone) or in a public venue Discuss PII/PHI/FTI with anyone other than the person who is the subject of the information Ask for, or use, a consumer s Covered California account log-in information without their authorized consent Unnecessarily retain any PII/PHI/FTI Directly access the Consumer s Covered California account rather than through the designated Counselors account 30

31 USING COVERED CALIFORNIA MARKETING AND COLLATERAL MATERIAL CAC AND MMCP Utilizing collateral material will help your Entity enrollment services. It is important to use consistent, branded materials and messages to maintain the integrity of the Covered California program. The Entity must use approved materials with Covered California branding (e.g., tablecloths, banners and signs) when conducting Counselor activities The Entity must maintain adequate supplies of collateral materials and compliance with established policies with Covered California marketing/branding guidelines available on CoveredCA.com at: Entities can order materials via the online Print Store which will be discussed later in this course 31

32 PHASE 2: UNDERSTANDING CONSUMER SERVICE AND ENROLLMENT SUPPORT

33 OVERVIEW OF PHASE 2 In this section the training will focus on what to do AFTER your organization is Active and your counselors are Certified. The topics we will review in this phase include: Understanding how to support and provide enrollment assistance services to consumers How to utilize Covered California websites, systems and resources so you and your team can be successful 33

34 DELIVERING ENROLLMENT ASSISTANCE SERVICES Under the oversight of the Entity, Counselors are expected to: Utilize the CoveredCA.com web-based portal to assist consumers with completing and submitting their application for health care coverage in Covered California health plans and Medi-Cal Educate consumers regarding first payment requirement to enroll in a Covered California health plan Refer, when appropriate to consumer assistance hotlines, such as ombudsman, Department of Mental Health Care, Office of Patient Advocate, Plans, Department of Social Services, and the Covered California Service Center Assist consumers with annual renewal applications during open enrollment periods and special enrollment applications utilizing the CoveredCA.com web-based enrollment portal. * Consumers may enroll outside of the open-enrollment period through a special enrollment due to a qualifying life event, such as: birth or adoption, marriage, change in residence, loss of a job. 34

35 HOW TO HELP YOUR TEAM BE SUCCESSFUL Use these helpful hints to ensure your Counselors are empowered and effective: Develop and train Counselors on internal processes Provide Counselors with the necessary resources to be effective in their role Participate in identifying and building local partnerships for collaborative enrollment efforts Develop a list of resources in your community Determine networking contacts that could support outreach and education efforts Identify already scheduled events in the community that may be leveraged and brainstorm underserved populations that may be eligible 35

36 NON-DISCRIMINATION Entities and affiliated Counselors should never act in a manner that discriminates on the basis of: Race, ethnicity, gender, age, national origin, or religion Mental or physical disability High or low-income areas Health status Newly eligible beneficiaries over other beneficiaries Claims experience, genetic information, or evidence of insurability To ensure that consumer assistance is accessible to people with disabilities: Provide enrollment resources, websites and tools that are accessible to individuals with disabilities Provide assistance in a location and manner that is physically and otherwise accessible Maintain knowledge to refer people with disabilities to long term services and support programs when appropriate 36

37 BUILDING CULTURAL COMPETENT ASSISTANCE PROGRAMS Supporting consumers with culturally and linguistically appropriate services is a fundamental requirement of Covered California. As you build your enrollment assistance population, make sure you and your Counselors are: Identifying community organizations that the entity may be able to partner with for community outreach Developing and maintaining general knowledge about racial, ethnic and cultural groups Providing consumers with information and assistance in the consumer s preferred language when appropriate Receiving ongoing education and training in culturally and linguistically appropriate service delivery Implementing strategies to recruit, support and promote a staff that is representative of the demographics of the target communities Maintaining an inventory of printed materials from Covered California in the languages necessary to support target markets (ordering printed materials will be discussed later in this course) 37

38 SYSTEMS AND RESOURCES

39 UNDERSTANDING THE SYSTEMS USED FOR COVERED CALIFORNIA There are four (4) systems that will be important for Entities to become familiar and utilize for their work with Covered California. These systems include: 1. In-Person Administrative System (IPAS) 2. CoveredCA.com (CalHEERS) 3. Learning Management System (LMS) 4. Covered California Print Shop 39

40 IN-PERSON ADMINISTRATIVE SYSTEM (IPAS) The IPAS homepage also houses additional information and resources for Entities and their affiliated Counselors. The IPAS homepage is: Frequent this page regularly as new information is uploaded to the IPAS homepage often. Entity Status Board The Entity status board is available in IPAS and allows the entity to track the certification process of all individuals in their counselor roster as well as report changes. To view your Entity Status board, simply login to your IPAS account and click on the speedometer icon as shown: *Questions related to IPAS should be directed to: 40

41 COVEREDCA.COM CoveredCA.com, also known as the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS). This system is the online portal that allows individuals and small businesses to sign up for health care coverage through Covered California or Medi-Cal. The Counselors affiliated with your Entity will use this system to enroll consumers in Covered California. Entities will use this system to monitor Counselor enrollment activities. Questions on CoveredCA.com should be directed to the Certified Representative Help Line at:

42 LEARNING MANAGEMENT SYSTEM (LMS) This system is an online training site used to administer and track Counselors training and examination progress. The LMS can be accessed at: As the Primary Contact you will not have access to this system unless requested. However, it is important that you understand its purpose to help you better manage your Counselors certification progress. Questions regarding LMS should be directed to: 42

43 PRINT SHOP RESOURCES For CAC and NAV Covered California provides printed and other collateral materials available for purchase through: Once a Entity becomes active on CoveredCA.com, the Primary Contact (or IPAS user) will receive Print Shop credentials from Covered California. Entities are allotted a quarterly budget to purchase collateral materials. Budget amounts are evaluated and allotted quarterly based on funding availability. Amounts allotted to each Entity can be founds online in the Entity Print Shop account. Questions related to the Print Shop should be directed to: m360support2@kpcorp.com For Print Shop User ID/Login assistance Rosa.Keophimane@covered.ca.gov ***The Print Shop Resources are not available for the MMCP. 43

44 ADDITIONAL INFORMATION AND RESOURCES PRIMARY POINTS OF CONTACT: ENTITY/COUNSELOR HELP LINE at :00 a.m. 6 p.m. General CoveredCA.com questions and system errors CoveredCA.com login issues Call center line dedicated to CoveredCA.com Entity dashboard Entity payment inquiries and Reconciliation Form Entities and Counselors. Provides Interpreting CoveredCA eligibility results support related to: Troubleshooting all issues with CoveredCA new applications, change requests for current applications, and renewals of applications CoveredCA Counselor PIN resets COVERED CALIFORNIA SERVICE CENTER: Covered California operated call center, supporting activities related to: All Counselor Helpline issues that arise outside of the business hours of the Counselor Helpline SUPPORT FOR IPAS: IPAsupport@ccgrantsandassisters.org Adding or withdrawing Counselors from an entity To assist Entities/Counselors in Reporting changes to an entity s contacts or sites activities related to: Updating the Find Help Near You information on CoveredCA.com Counselor certification status COUNSELOR TRAINING HELP DESK: CCULearning@covered.ca.gov dedicated to assist Learning Management System (LMS) access Counselors in activities related to: Training requirements, status and progress PRINT SHOP RESOURCES: m360support2@kpcorp.com Active Entities can purchase marketing material to support enrollment assistance services. Access the print shop at: ***The Print Shop Resources are not available for the MMCP. 44

45 ADDITIONAL INFORMATION AND RESOURCES (CONT.) KEY PROGRAM RESOURCES AVAILABLE ON IPAS Program Resource Page Program Webinars Index of all program webinars Community Partner Communications Index Community Partner Communications Index Program home page that list a wealth of program resources, including: Job Aids, FAQs, Welcome to Answers and other important information Index of all program webinar and topic areas covered, includes links to webinar recording and presentation slides These newsletters are equipped with the latest program updates, resources and announcements related to Entities and Counselors and their role with Covered California. COUNSELOR INFORMATION Certified Application Counselor Application/Agreement Criminal Disclosure Form Live Scan Request Form Live Scan Locations Contact Live Scan at (877) or coveredca@capitallivescan.com Required form, Counselors must submit Required form, Counselors must submit. Required to use prepopulated form in IPAS exported from Entity application by primary contact Official Counselor Live Scan Request Form. Required to use prepopulated form in IPAS exported from Entity application by primary contact Locate nearest Covered California approved location for Live Scan processing with questions regarding fingerprinting or background check 45

46 ADDITIONAL INFORMATION AND RESOURCES (CONT.) OTHER RESOURCES Federal health care reform Office of the Patient Advocate The Centers for Medicare and Medicaid Services Center for Consumer Information and Insurance Oversight California Health Benefit Exchange Department of Managed Health Care (DMHC) and its programs California Department of Insurance 46

47 RECEIVING CREDIT FOR COMPLETING THIS TRAINING

48 NEXT STEP Next Step: Click on the underlined text to download and complete the Entity Management Training Completion Form Upload the completed form to My Files in IPAS (see screen shot below) 48

49 THANK YOU This concludes the Entity Management Training. Thank you for your participation! 49