FY 2015 Health Center Outreach and Enrollment Assistance

Supplemental Funding Post-Award Call HRSA-15-126

Health Resources and Services AdministrationDepartment of Health and Human Services

Technical Assistance Website: http://bphc.hrsa.gov/outreachandenrollment/index.html

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Agenda

Purpose and Background Summary of Funding Funding Requirements and Expectations Use of Funds O/E Quarterly Progress Reporting (QPR) Technical Assistance Resources Questions & Answers

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Purpose

These funds have been invested in health centers that did not receive O/E funding in FY 2013 and beyond to expand O/E assistance activities and facilitate enrollment of eligible health center patients and service area residents into affordable health insurance coverage through:―Health Insurance Marketplaces;―Medicaid; and―The Children’s Health Insurance Program.

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Summary of Funding

HRSA has awarded approximately $6.4 million under the FY 2015 O/E assistance funding opportunity through formula-based supplemental awards to 91 Health Center Program grantees, across 36 states and the District of Columbia, that did not receive FY 2013 O/E Assistance Supplemental Funding.

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Funding Requirements & Expectations

Health centers that received FY15 O/E supplemental funding must:1. Increase the health center’s current outreach and

enrollment capacity. A minimum of at least 1.0 full-time equivalent (FTE) must be added to the health center’s current O/E assistance capacity.

2. Ensure all health center O/E assisters (i.e., current and newly supported) comply with and successfully complete all required and applicable federal and/or state assister training and comply with all associated regulations and requirements, as are required for personnel carrying out consumer assistance functions.

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Funding Requirements & Expectations

3. Conduct “in reach” with currently uninsured health center patients and “outreach” to non-health center patients in their approved service area.

4. Collaborate with other health centers, PCAs and providers in their service area to ensure that O/E assistance activities are coordinated with other local, regional, and/or state-wide O/E assistance efforts and training requirements.

5. Comply with all applicable Health Center Program requirements.

6. Submit Quarterly Progress Reports (QPRs) to HRSA starting in January 2015.

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Allowable Uses of O/E Funds

Personnel, including at least one FTE O/E assister who will be trained as a certified application counselor or equivalent to facilitate enrollment in new affordable insurance options available through the Marketplace, Medicaid and CHIP on behalf of the health center.

Fringe benefits for O/E assisters Moveable equipment and supplies to support outreach and enrollment

assistance individually valued at less than $5,000 Leasing of temporary space for the sole purpose of O/E assistance

activities (e.g., leasing space in a community center) Paid media, mailers, and other broad-based strategies to promote the

availability of health center O/E assistance to non-health center patients Training in support of the grant Local travel in support of the grant

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Unallowable Uses of O/E Supplemental Funds

Fringe benefits other than those to support O/E assisters; Incentives (e.g., gift cards, food, free services); Moveable equipment and supplies individually valued at

$5,000 or greater; Vehicles; Primary health care services; Construction costs (including minor alterations and

renovation and fixed/installed equipment); and Facility or land purchases.

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O/E QPR

O/E Quarterly Progress Reporting(QPR)

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O/E Quarterly Progress Reporting (QPR) Timeline

O/E QPR Reporting Periods for 2015 open enrollment period ―October 1, 2014 - December 31, 2014 (due January 2015)― January 1, 2015 - March 31, 2015 (due April 2015)―April 1, 2015 - June 30, 2015 (due July 2015)― July 1, 2015 - September 30, 2015 (due October 2015)

Failure to submit the OE QPR by the identified deadlines will result in the H80 grant being place on draw restriction.

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O/E QPR Metrics

Number trained Assists provided Applications submitted Estimated enrolled Issues/barriers Key strategies and lessons learned

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Definition of “Trained” Assister

Number of assisters working on behalf of the health center who have successfully completed all required federal and/or state training (certified application counselor (CAC) or equivalent, at a minimum) to assist individuals with enrollment through Federal, state-based, or state partnership marketplaces for the 2015 open enrollment period.

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Reporting the Number of Trained Assisters

For the October 1, 2014 - December 31, 2014 reporting period, health centers should report all individuals who have successfully completed all required federal and/or state training to assist individuals with enrollment through Federal, state-based, or state partnership marketplaces for the 2015 open enrollment period, even if the individual was trained prior to October 1, 2014.

Every health center that has HRSA O/E funds should have a minimum of one FTE trained to assist with enrollment through the Marketplace.

HRSA encourages health centers to ensure that staff who may assist only with Medicaid enrollment complete CAC or equivalent training.

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Reporting the Number of Trained Assisters

Can health centers report assists provided by individuals trained exclusively to assist with Medicaid and CHIP enrollment?―Yes, they can count the assists provided, applications

submitted, and estimated enrollments by individuals trained exclusively to assist with Medicaid and CHIP enrollment.

―Health centers must not include these individuals in the “number trained,” as this is intended to capture only those health centers assisters that are trained to facilitate enrollment through the Marketplace, Medicaid, and CHIP.

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Definition of an “Assist Provided”

Number of assists provided by trained assisters working on behalf of the health center to support individuals with actual or potential enrollment or reenrollment in health insurance available through Marketplace qualified health plans and/or through Medicaid or CHIP

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What should be reported as assists provided?

DO report as an “assist provided” assistance with

DO NOT report as an “assist provided”

Understanding health insurance options through one-on-one or other customizable education

• Mailings• Brochure distribution• Conference calls• Large group presentations• Public Service Announcements• Other education and outreach that do

not allow for customizable messages to consumers

Creating a user account in the Marketplace

Updating an account profile and/or income information

Filing an exemption or appeal

Understanding Marketplace auto-enrollment notices

Submitting an application to/through the Marketplace or directly to the state Medicaid agency (also include as an application submitted)

Understanding an eligibility determination

Selecting a new or different Marketplace plan

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Definition of “Applications Submitted”

Number of applications submitted to the Marketplace and/or directly to state Medicaid agency for coverage in Marketplace qualified health plans and/or Medicaid or CHIP with the help of a trained assister working on behalf of the health center This includes:

―Applications submitted for enrollment in a new or different Marketplace plan, even by individuals previously enrolled, and

―Medicaid/CHIP renewals/re-enrollments. Note: All applications submitted should also be counted as

assists provided.

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Definition of “Estimated Enrollment”

Report the number of individuals determined or presumed to be eligible for coverage and for whom the assister has confirmation or reasonable confidence of an intent on the part of the consumer to complete the enrollment process (e.g., the consumer has selected a Marketplace plan and has been informed about how to pay the premium or has submitted a complete application to the state Medicaid agency).

HRSA does not expect health center assisters to make significant efforts (e.g., follow up calls) to determine whether an assisted individual has enrolled.

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Issues/Barriers Narrative

Issues/Barriers―For the current reporting period, describe up to three

major issues/barriers that you experienced while conducting outreach and enrollment activities.

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Key Strategies and Lessons Learned Narrative

Key Strategies and Lessons Learned―For the current reporting period, describe up to three

strategies that contributed most to the success of your outreach and enrollment efforts.

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O/E QPR Resources

OE QPR resources available at http://bphc.hrsa.gov/outreachandenrollment/ include:―Health Center O/E QPR sample• Provides a breakdown of what is required for each data

element ―Quick Reference Guide• Provides a technical walk-through of the process to

submit the O/E QPR through the EHB―QPR FAQs• Responses to common questions related to how to

report on health center O/E activities

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Contact Information

ASSISTANCE NEEDED PLEASE CONTACT

Technical assistance specific to FY 2015 O/E supplemental funding applications

FY 2015 O/E Supplemental Funding WebsiteTechnical assistance resources including the funding opportunity guidance, sample forms, work plan template, and EHB User Guide to support application submission for the FY 2015 O/E supplemental funding opportunity.http://bphc.hrsa.gov/outreachandenrollment/FY15Supplement

General O/E technical assistance Ongoing O/E Technical Assistance WebsiteTechnical assistance for health centers conducting ongoing O/E assistance activities initially funded in FY 2013. http://bphc.hrsa.gov/outreachandenrollment/

Program and budget issues Outreach and Enrollment TeamBureau of Primary Health CareOffice of Policy and Program Development bphc-oe@hrsa.gov

Electronic submission issues BPHC HelplineFor questions on navigating and completing forms in EHBbphchelpline@hrsa.gov or 1-877-974-2742

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Questions