Embed Size (px)
Citation preview
Health Center Outreach and Enrollment (O/E) Quarterly
Progress Report (QPR) Training
1
Agenda
– Introduction– Timeline – Reporting Expectations– O/E QPR Definitions– Reporting Scenarios– EHB Considerations– Resources
2
Timeline
• Revised Health Center O/E QPR sample available at http://bphc.hrsa.gov/outreachandenrollment/
• O/E QPR Reporting Periods – 7/1/2013 – 9/30/2013– 10/1/2013 – 12/31/2013 – 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
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
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
How the Marketplace Works
6
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
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 Marketplaceo Include all trained health center staff, contractors, and
volunteerso 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
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 needso Assessing consumer knowledgeo Education about basic insurance topicso Creating an accounto Updating an account profileo Submitting a Marketplace applicationo Understanding eligibility determinations for the Marketplace, Medicaid,
or CHIPo Selecting a plan
9
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
What to Report as an “Assist”
11
Ass
ista
nce
•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
Ass
ista
nce
*Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state)
What to Report as “Applications Submitted”
12
Ass
ista
nce
• 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
Ass
ista
nce
*Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state)
What to Report as “Applications Submitted”
• Number of Applications Submitted– Report number of applications submitted by the number
of individuals represented in the applicationo 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
What to Report as an “Estimated Number Enrolled”
14
Ass
ista
nce
•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
Ass
ista
nce
*Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state)
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
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
Summary
17
Ass
ista
nce
• 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
Ass
ista
nce
*Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state)
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
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
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
Scenarios—One Session
2121
Ass
ist
Ass
ist
• 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
Ass
ista
nce
*Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state)
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
Scenarios
2323
Ass
ist
• 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
Ass
ista
nce
*Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state)
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
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
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
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: https://help.hrsa.gov/display/public/EHBSKBFG/Grants+Access+and+Registration+FAQs
27
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 formso 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
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
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
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 re-enrollment/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
Resources
• PCA Contact List– http://bphc.hrsa.gov/technicalassistance/partnerlinks/associations.html
• BPHC O/E Team Inbox– [email protected]
• BPHC O/E supplemental funding technical assistance website– http://bphc.hrsa.gov/outreachandenrollment/
• BPHC Helpline – EHB or other technical issues– 1-877-974-2742– [email protected]
32
