Post on 31-Dec-2015
description
Connecticut Health Insurance ExchangeConnecticut Health Insurance Exchange
Connecticut Health Insurance Exchange
Information Technology Project
OverviewApril 19, 2012
Prepared by CTHIX Management Team
Page 2Connecticut Health Insurance Exchange
Agenda
HIX Major Processes Program Integration IT Phasing MOU Department of Social Services HIX Technical Assistances HIX Solution Request for Information Questions and Answers
Page 4Connecticut Health Insurance Exchange Page Connecticut Health Insurance Exchange
Program Integration | Without Integrated Eligibility
Medicaid
Subsidy
Individual Purchase
Other
Multiple Front Doors
Multiple Eligibility Platforms
Multiple Eligibility Outcomes
Exchange
DSS
DDS
DCF
DMHAS
DPH
Eligibility Determination
Eligibility Determination
Eligibility Determination
Eligibility Determination
Eligibility Determination
Page 5Connecticut Health Insurance Exchange Page Connecticut Health Insurance Exchange
Program Integration | Integrated Eligibility
Single Front Door Unified Eligibility Platform
One Eligibility Determination Process for All HHS Programs
Single Front Door
Consumer Enters Info
Eligibility Determination
• HIX• DSS• DDS• DCF• DMHAS• DPH
Page 6Connecticut Health Insurance Exchange
IT Phasing
Priority Track
IT plan emphasizes the priorities of HIX and Medicaid (CT DSS):
Exchange operations MAGI and other eligibility
Other HHS
Strategy to achieve an integrated eligibility solution to serve all HHS agencies
Solution for HIX and DSS will become the core of an integrated eligibility platform
Phased implementation for HHS agencies will follow HIX and DSS roll out
2012 2013 2014
MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JULJAN FEB AUG SEP OCT NOV DEC Q1 Q2 Q1 Q2 Q3 Q4Q3 Q4
2015
Other HHS Integrated Eligibility & Non-Priority Modernization
Priority Track: HIX Operations, MAGI and other Eligibility
Go-Live New Eligibility Determination
CoverageBegins
Go-Live deadline for enhanced FFP
Now exploring phased implementations to facilitate key deadlines
2012 2013 2014 2015
Page 7Connecticut Health Insurance Exchange
Revised Approach Currently Consolidating Planning & Implementation
Consolidate Contractor/Procurement
TBD
IT Phasing
2012 2013 2014
A M J J A S O N D J F M A M J J A S O N D J F M A M J J
HIX
MITA 3.0 Self-Assessment
Integrated Eligibility
Medicaid-only Eligibility,E-APD & Certifications
Component Modernizations
Consolidated Approach
Planning, Design, Procurement coordinated across all Medicaid, HHS and HIX stakeholders
One Master Technical Assistance Contractor
Coordinate all CCIIO and CMS Gates & certifications
Developing expedited Procurement Strategy to accelerate Implementation and Collapse Time-to-Market
e.g. Leverage State’s List of Pre-Selected IT Firms
e.g. Potentially use Single Implementation PrimeOther
TBD
Multiple
Unified Agency Governance
Page 8Connecticut Health Insurance Exchange
MOU| Department of Social Services
MOU Between HIX and DSS (Medicaid)
2011 2012 2013
A M J J A S O N D J F M A M J J A S O N D J F M A M J J
Business ProcessRequirements
IT Requirements
PurchaseStrategyOptions
& Prelim Cost
Estimate
Specifications for Preferred Option
Implementation Plan
RFP Development &
ProcurementSupport
Opti
on S
elec
tion
Top-Level Phasing of Exchange Planning technical assistance contract
Business ProcessRequirements
IT Requirements
PurchaseStrategyOptions
& Prelim Cost
Estimate
Specifications for Preferred Option
Implementation Plan
RFP Development &
ProcurementSupport
Opti
on S
elec
tion
Top-Level Phasing of Exchange Planning technical assistance contract
HIX Development
Unified, Coordinated
CT Medicaid and HHS Modernizations
MOU betweenHIX and DSS:Coordinate
Plan/Procure cycleShare Technical
Resources and Vendors
Coordinate Federal approvals and Certifications
Lays groundwork for shared Operations
Page 9Connecticut Health Insurance Exchange
HIX Technical Assistance
Original Phasing of HIX Planning Basis of HIX Contractor SOW
2012 2013 2014
A M J J A S O N D J F M A M J J A S O N D J F M A M J J
Business ProcessRequirements
IT Requirements
PurchaseStrategyOptions
& Prelim Cost
Estimate
Specifications for Preferred Option
Implementation Plan
RFP Development &
ProcurementSupport
Opti
on S
elec
tion
HIX Technical Assistance Contractor
• Primarily HIX-focused• Soft Coordination with Medicaid Modernization
Concept ofOperations
Page 10Connecticut Health Insurance Exchange
HIX Operating Options Drive Functional Requirements and Define Exchange Logical Component Model
Business Process
Operating Model
Functional Requirement
Exchange Business Service
(Software)
Logical Component
Has one or more
Determines May require
Automates
May be included inMay
support one or more
Exchange Operating Model ‘”Options”
IT Solution Implementation
Options for Planning & Budgeting
Page 11Connecticut Health Insurance Exchange
Exchange Logical Component Model
Health Benefits Exchange – High Level Business Architecture
Business Management Components
Financial Management & Reporting
Core Business & Service Delivery Components
Marketing and Outreach Individual Customers
Account Management
Plan Certification & Risk Management
Plan Certification
Premium & Tax Credit Processing
Asset Management
Eligibility & Enrollment
Individual
Eligibility Assessment
Comparison Shopping
Enrollment Processing
Appeals Management
Human Resource Management
Procurement Management
Customer Service
Financial Services
Health Insurance Carriers
Federal Verification (IRS, SSA)
Health Care Providers
Broker/Navigators
Health Insurance Regulators
Human Service Programs (DSS, DOI,
DoITT)
IT Service Providers
Actuarial Services
Exchange Board
Small Business (SHOP)
Risk Management
SHOP
Eligibility Assessment
Comparison Shopping
Enrollment Processing
Appeals Management
IT Services
EligibilityRules
Enrollment Confirmation
Enrollment Request
Plan Rating & Risk Assessments
Insurance Coverage & Costs Advice
Commission Payment
Reports Policy
Identity Information
Regulation
Plans & PricingEnrollment
Confirmation
Quote
Health Insurance Benefits & Eligibility
Enrollment Request
Requirements
Premium Payments
Plan Certification
Enrollment Request
Premium Payment
Enrollment Confirmation
Plan Information
Coverage Quotation
Income, identity,
citizenship verification
Federal Oversight
(CMS/CCIIO)
Reports Policy
Broker/Navigator Relationship Management
Financial Services
Page 12Connecticut Health Insurance Exchange
HIX Solution Request for Information
RFI issued March 9, 2012 Review options available in the market for
information technology and business process solutions
12 responses received March 30 Responses will be reviewed and evaluated
during April