Health Center Outreach and Enrollment (O/E) Quarterly Progress Report (QPR) Training

Transcription

1 Health Center Outreach and Enrollment (O/E) Quarterly Progress Report (QPR) Training 1

2 Agenda Introduction Timeline Reporting Expectations O/E QPR Definitions Reporting Scenarios EHB Considerations Resources 2

3 Timeline Revised Health Center O/E QPR sample available at O/E QPR Reporting Periods 7/1/2013 9/30/ /1/ /31/2013 1/1/2014 3/31/2014 4/1/2014 6/30/2014 O/E QPR will continue beyond the 6/30/2014 reporting period additional reporting periods will be identified in future updates 3

4 Expectations O/E QPR is required for all heath centers that received the O/E supplemental funding (regardless of progress made with O/E activities during the reporting period) Failure to submit the O/E QPR will result in the entire H80 grant being placed on draw restriction HRSA does not expect health center O/E assistance workers to make significant efforts (e.g., follow-up calls) to determine whether an assisted individual has enrolled. The narrative section of the report provides the opportunity to describe issues that have created barriers to or have facilitated O/E activities. 4

5 Expectations HRSA does not require health center O/E assistance workers to track assistance by name or any other personal identifier. Duplicate reporting (e.g., counting assistance with the same individual on different days) is appropriate. If health center O/E assistance workers want to record information in order to facilitate follow-up with an individual assisted who plans to return, they should follow the health center s policies and procedures for protecting personally identifiable information and any guidelines provided in the training process or required by law. 5

6 How the Marketplace Works 6

7 Health Center O/E QPR The Health Center O/E QPR consists of the following items that must be reported to HRSA: Number of O/E assistance workers trained Assists provided Applications submitted Estimated number of individuals enrolled Issues/Barriers narrative section Key Strategies and Lessons Learned narrative section 7

8 O/E QPR Definitions: Number Trained Who to Report as Number Trained Number of health center O/E assistance workers that have successfully completed all required federal and/or state training to assist with enrollment in the Marketplace o Include all trained health center staff, contractors, and volunteers o Include all appropriate assister types, e.g., Certified Application Counselor (CAC), Navigator, in-person assister. If there are barriers in your state have prevented staff from getting training, note that in the issues/barriers section of the O/E QPR. 8

9 What to Report as an Assist What to Report as Number of Assists Provided Report assistance by session for the number of individuals who will benefit from O/E assistance Report sessions in which assistance is provided for any part of the enrollment process, e.g.,: o Assessing consumer needs o Assessing consumer knowledge o Education about basic insurance topics o Creating an account o Updating an account profile o Submitting a Marketplace application o Understanding eligibility determinations for the Marketplace, Medicaid, or CHIP o Selecting a plan 9

10 What to Report as an Assist Number of Assists Provided (continued) Do not report mass mailings, conference calls, group presentations, or other education and outreach that do not allow for customizable messages. 10

11 Assistance Assistance What to Report as an Assist Understanding benefits of and process for submitting a health coverage (i.e., QHP, Medicaid/CHIP) application Creating an account Applications Submitted Submitting application to the Marketplace Understanding Marketplace verification information and/or eligibility determination* Estimated Number Enrolled Selecting a QHP Submitting information for enrollment in Medicaid or CHIP Confirming enrollment in the Marketplace, Medicaid or CHIP *Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state) 11

12 Assistance Assistance What to Report as Applications Submitted Understanding benefits of and process for submitting a health coverage (i.e., QHP, Medicaid/CHIP) application Creating an account Applications Submitted Submitting application to the Marketplace Understanding Marketplace verification information and/or eligibility determination* Estimated Number Enrolled Selecting a QHP Submitting information for enrollment in Medicaid or CHIP Confirming enrollment in the Marketplace, Medicaid or CHIP *Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state) 12

13 What to Report as Applications Submitted Number of Applications Submitted Report number of applications submitted by the number of individuals represented in the application o Include all applications submitted to the Marketplace with the assistance of a trained O/E assistance worker. o Report in the number of applications submitted the total number of individuals included in the application submission. o Count both paper and electronic applications. 13

14 Assistance Assistance What to Report as an Estimated Number Enrolled Understanding benefits of and process for submitting a health coverage (i.e., QHP, Medicaid/CHIP) application Creating an account Applications Submitted Submitting application to the Marketplace Understanding Marketplace verification information and/or eligibility determination* Estimated Number Enrolled Selecting a QHP Submitting information for enrollment in Medicaid or CHIP Confirming enrollment in the Marketplace, Medicaid or CHIP *Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state) 14

15 What to Report as Estimated Number Enrolled Estimated Number of Individuals Enrolled Report estimated number of individuals enrolled for the number of individuals who will be covered by the enrollment Include individuals that are assisted with any of the following: o Selecting a Qualified Health Plan (QHP). o Submitting enrollment information for Medicaid or CHIP. o Confirming enrollment in the Marketplace, Medicaid or CHIP. 15

16 What to Report as Estimated Number Enrolled Estimated Number of Individuals Enrolled (continued) Health centers in states with systems that allow health center O/E assistance workers to track their facilitation of enrollment, report enrollment as captured by that state system. In states that restrict or prohibit health center facilitation of enrollment: o Health centers should report to HRSA only those activities that are permitted (e.g., number trained, assists, and/or applications submitted). o Please explain the state limitations in the narrative portion of the O/E QPR. 16

17 Assistance Assistance Summary Understanding benefits of and process for submitting a health coverage (i.e., QHP, Medicaid/CHIP) application Creating an account Applications Submitted Submitting application to the Marketplace Understanding Marketplace verification information and/or eligibility determination* Estimated Number Enrolled Selecting a QHP Submitting information for enrollment in Medicaid or CHIP Confirming enrollment in the Marketplace, Medicaid or CHIP *Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state) 17

18 O/E QPR Definitions Issues/Barriers Provide clear and specific issues/barriers, such as: o Difficulties in hiring and/or retaining health center O/E assistance workers. o Challenges in organizational certified application counselor designation and/or training staff o General issues with the implementation of the health center s O/E activities/efforts 18

19 O/E QPR Definitions Key Strategies and Lessons Learned Provide clear and specific key strategies and lessons learned, such as: o Health center educational events that attracted lots of people. o Successful collaboration with other health centers and providers in the service area. o Lessons learned that will inform activities in the next reporting period and/or potentially assist other health centers nationwide. 19

20 Scenarios One Session In one session an individual : Sets up an account, Submits an application, and Selects a qualified health plan with the assistance of a trained health center O/E assistance worker. The health center should report: 1 assist (one assist since there is only one session) 1 application submission (assistance resulted in an application submission in the same session) 1 estimated enrollment (assistance resulted in an estimated enrollment in the same session) 20

21 Assistance Assist Scenarios One Session Understanding benefits of and process for submitting a health coverage (i.e., QHP, Medicaid/CHIP) application Creates an account on 10/15/2013 Applications Submitted Submits an application to the Marketplace on 10/15/2013 Understanding Marketplace verification information and/or eligibility determination* Estimated Number Enrolled Selects a QHP on 10/15/2013 *Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state) 21

22 Scenarios Multiple Sessions An individual receives assistance from a trained health center O/E assistance worker in three separate sessions. In session 1, the individual sets up an account. In session 2, the individual submits an application In session 3, the individual selects a qualified health plan. The health center should report: 3 assists (one assist for each session) 1 application submission (session 2 = 1 assist + 1 application submission) 1 estimated enrollment (session 3 = 1 assist + 1 estimated enrollment) 22

23 Assist Assistance Scenarios Understanding benefits of and process for submitting a health coverage (i.e., QHP, Medicaid/CHIP) application Creates an account on 10/15/2013 Applications Submitted Submits an application to the Marketplace on 10/17/2013 Understanding Marketplace verification information and/or eligibility determination* Estimated Number Enrolled Selects a QHP on 10/21/2013 *Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state) 23

24 Scenarios One Consumer Represents Multiple Family Members An individual is assisted in a single session to set up an account, submit an application and enroll her family (herself and two children) in affordable insurance. Health centers should report assistance, application submission, and estimated enrollment by the number of individuals who will benefit from O/E assistance. The health center should report: 3 assists (to represent all family members assisted in the session) 3 application submissions (to represent all family members included in the application) 3 estimated enrollments (to represent all newly covered family members) 24

25 Scenarios Medicaid-Only Enrollment Assistance An individual is assisted to submit a Medicaid application by a health center staff person that has been trained to facilitate Medicaid enrollment, but has not yet completed all required federal and/or state training for assisting with enrollment through the Marketplace. Individuals who have assisted with Medicaid/CHIP eligibility and enrollment can continue to do so and report accordingly. These individuals should NOT be included in the total number O/E assistance workers trained. The health center should report: 1 assist 1 application submission 25

26 O/E QPR EHB Process Accessing the O/E QPR in EHB You must have a user account in the HRSA Electronic Handbook (EHB). Your user account must be associated with your organization. You must have the health center H80 grant in your portfolio. You must have the Edit or Submit access permission (as appropriate) for Progress Reports from the project director (PD) for the grant. 26

27 O/E QPR EHB Process Submitting the O/E QPR You must have the Submit access permission from the project director (PD) for the grant to submit the QPR. For help with grant registration and access permissions, see Grants Access and Registration FAQs at: Access+and+Registration+FAQs 27

28 O/E QPR EHB Process O/E QPR The O/E QPR will be listed as an incomplete submission in the Pending Tasks List in the Tasks section of the health center s H80 grant folder The submission will be entitled O/E Quarterly Progress Report The O/E QPR consists of two forms o Contact Information - Health centers should identify the person who will be best positioned to respond to any HRSA questions about the O/E QPR submission. o O/E form 28

29 O/E QPR EHB Process O/E QPR Complete both the Contact Information and O/E Form portions of the O/E QPR Review the QPR information before submitting to HRSA Once all sections of the O/E QPR are marked as complete, you will click the Submit button to open the confirmation page 29

30 O/E QPR EHB Process HRSA may request changes to the O/E QPR if: the data provided do not have sufficient narrative information to describe the situation (e.g., 0 trained staff but the issues/barriers narrative does not identify why) the narrative portions do not provide sufficient details to provide a reasonable understanding of the issues/barriers or strategies/lessons learned for the reporting period 30

31 Q4 (4/1/14 6/30/14) Quarterly Progress Reporting (QPR) Considerations Activity Report assist provided Report application submitted Report estimated enrollment Include in issues/barriers or successes narrative section of QPR Assistance with Medicaid/CHIP reenrollment/renewals X - - X Assistance with filing an exemption X - - X Assistance with filing an appeal X - - X Assistance with ongoing Medicaid/CHIP enrollment X X X X Assistance with Marketplace enrollment associated with a Special Enrollment Period (SEP) X X X X 31

32 Resources PCA Contact List BPHC O/E Team Inbox BPHC O/E supplemental funding technical assistance website BPHC Helpline EHB or other technical issues