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In-person Assistance

Program

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February 7th, 2014

JULIE WEIGAND, DEPUTY DIRECTOR, RHA

TOPICS COVERED IN THIS PRESENTATION

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• Covered California

• In-Person Assistance (IPA) Program

• Certified Enrollment Entity and Certified Enrollment

Counselor Roles

• IPA Program Eligibility

• Becoming a Certified Enrollment Entity

• Becoming a Certified Enrollment Counselor

• Fingerprinting and Criminal Background Checks

• Overview of CEC Training

PRIMARY TARGET POPULATION

COVERED CALIFORNIA’S PRIMARY TARGET POPULATION IS 5.3 MILLION CALIFORNIA RESIDENTS WHO STAND TO BENEFIT FROM EXPANDED COVERAGE OPTIONS:

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PRIMARY TARGET POPULATION (CONT.)

California’s vast

geographically diverse

mix of rural and urban

communities is unique

and present outreach

challenges.

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Source: CalSIM model, Version 1.8

Covered California’s target population by region

IN-PERSON ASSISTANCE

PROGRAM

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IPA PROGRAM OVERVIEW

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In-Person Assistance

(IPA) Program: The program whereby

entities and individuals are

registered and certified by

Covered California to

provide in-person

assistance to consumers to

enroll in a Covered

California Health Plan.


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Certified Enrollment

Entity (CEE):

An entity certified by Covered

California to participate in the

In-Person Assistance Program

by overseeing Certified

Enrollment Counselors who

provide one-on-one consumer

assistance. This entity may be

compensated for each

successful, effectuated

application completed by their

Counselors.


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Certified Enrollment Counselor (CEC): An individual who is trained and certified by Covered California pursuant to Section 6654, Title 10, of the California Code of Regulations to provide face-to-face, one-on-one consumer enrollment assistance.

CEE AND CEC ROLES

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CEES AND CECS RESPONSIBILITIES

• Certified Enrollment Entities (CEEs)

• Certified Enrollment Counselors (CECs) conduct the

following activities on behalf of Covered California:

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ELIGIBILITY

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CEE ELIGIBLE ENTITIES

American Indian Tribes or Tribal Organizations Licensed health care clinics*

Chambers of Commerce Licensed health care institutions*

City Government Agencies Licensed health care providers*

Commercial fishing industry organizations Non-Profit Community Organizations

Community Colleges or Universities Ranching and farming organizations

County departments of public health, city health

departments, or county departments that deliver

health services*

Resources Partners of the Small Business

Administration

Faith-Based Organizations School Districts

Indian Health Services and Facilities Tax preparers as defined in section 2225 (a) (1) (A)

of the Business and Professions Code

Labor Unions Trade, industry, and professional organizations

Licensed attorneys (i.e. family law attorneys who

have clients that are experiencing life transitions

Other public or private entities or individuals who

meet the requirements of this Article except for

entities and individuals who are license by the

Department of Insurance)

13 *Entities not eligible for compensation (with the exception of: Community Clinics, free clinics, federally

qualified health center (FQHC), FQHC look-alikes, and urban health centers).

Entities eligible to participate and may be compensated include:

ENTITIES NOT ELIGIBLE FOR

COMPENSATION

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County departments of public health or city health departments that deliver

health care services

Licensed health care clinics* (with an exceptions of certain types of clinics)

Licensed health care institutions

Licensed health care providers

Other public or private entities or individuals determined by Covered California

to have a conflict of interest or who received direct or indirect consideration for

consumer assistance

*With the exception of: Community Clinics, free clinics, federally qualified

health center (FQHC), FQHC look-alikes, and urban health centers.

The following Entities are eligible to participate, but will NOT be

Compensated by Covered California:

ELIGIBLE ENTITIES AS CEEs

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WHY PARTICIPATE IN COVERED

CALIFORNIA?

Eligible entities are in a unique position to help consumers for the following reasons:

• Great understanding of your community and its needs

• Established relationships with consumers and are in a position to provide advice about the Affordable Care Act

• Well positioned to help consumers enroll in Covered California Health Plans and Medi-Cal

• Considered to be critical resource in building a “culture of coverage” and helping millions of Californians enroll in health insurance

• Have experience in reaching out and assisting individuals throughout our state

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BENEFITS OF BECOMING A CEE

• Helping consumers enroll in qualified

health care plans

• Assisting local communities by providing

up-to-date Covered California information

• Providing a new service that generates

new customers

• Tapping into an additional source of

income (if eligible)

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BECOMING A CERTIFIED

ENROLLMENT ENTITY

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ONLINE APPLICATION PROCESS

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ONLINE APPLICATION PROCESS

CEE Application Landing Page https://ipas.ccgrantsandassisters.org/

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https://ipas.ccgrantsandassisters.org/



ONLINE APPLICATION PROCESS -

WORKSHEET

The CEE Application

Worksheet provides a

way to collect all

necessary information

to complete required

application fields. It

also lists the required

documents to gather.

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4 STEPS TO BECOMING A CERTIFIED

ENROLLMENT ENTITY

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1. COMPLETE THE CERTIFIED ENROLLMENT ENTITY

(CEE) APPLICATION ONLINE

• Access CEE Application online

• Download and review CEE Application Worksheet

• Gather necessary information and documentation

• Login or create username and password

• Complete ALL required application fields

• Download and complete Certified Enrollment Entity Agreement


ENROLLMENT ENTITY

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1. COMPLETE THE CERTIFIED ENROLLMENT ENTITY (CEE)

APPLICATION ONLINE (CONT.)

• Add your Certified Enrollment Counselors (CECs)

information, including CEC agreement

• Add Covered California as an additional insured to General

Liability Insurance policy

• Upload Required Documents:

o Certified Enrollment Entity Agreement

o Proof of business status documentation

o Proof of Insurance - general liability and workers compensation

o State of California Payee Data Record Form

o Proof of current or valid business license

• Submit CEE Application


ENROLLMENT ENTITY

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2. REVIEW OF CEE APPLICATION BY COVERED

CALIFORNIA

• Application is reviewed for completeness and

program eligibility

• Organization receives notification by email or

phone regarding missing application information

needed for approval (if applicable)

• Review process takes 3-5 business days


ENROLLMENT ENTITY

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3. RECEIVE APPROVAL OF SUBMITTED CEE

APPLICATION

• Receive notification by email, detailing:

o Status of application approval

o Next steps to follow to complete the required

Certified Enrollment Entity Management

Training


ENROLLMENT ENTITY

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4. MEET CERTIFIED ENROLLMENT ENTITY

TRAINING REQUIREMENTS

• Receive email with link to the training

• Individual designated as the Primary Contact

must complete CEE Management Training

• Webinar is approximately 2.5 hours

• At any time a CEE may add additional

Certified Enrollment Counselors to their

application

CEE TRAINING OBJECTIVES

CEE TRAINING WILL COVER • Covered California Overview

• In-Person Assistance Program Overview

• Certified Enrollment Entities Roles and Responsibilities

• Certified Enrollment Counselor Recruitment, Role, Services, and Support

• Compensation

• Expectations for Monitoring, Reporting and Quality Assurance

• Collateral Materials Management

• Certified Enrollment Entity Agreement

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FINGERPRINTING AND

BACKGROUND CHECK

PROCESS FOR INDIVIDUALS

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CEE ROLE

• The Certified Enrollment Entity is required to facilitate a

fingerprint-based criminal background check on all its

affiliated personnel who plan to become Certified

Enrollment Counselors, as CECs will have access to

CoveredCA.com and confidential consumer information.

• Confidential consumer information includes personal

identifying information, personal health information,

federal tax information, or any other information as

required by federal law or guidance applicable to

Covered California.

• Must use an approved Covered California Live Scan

site

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ENROLLMENT COUNSELOR

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1. AFFILIATE WITH A CERTIFIED ENROLLMENT ENTITY

• CEE provides individuals with a Certified Enrollment

Counselor (CEC) Application (from the worksheet)

and CEC Agreement

• Individual completes and returns the one-page CEC

Application and the signed Agreement to the CEE

• CEE reviews information and completes CEC section

of the CEE application online and uploads signed

CEC Agreement

o CEE has the ability to add additional counselors in the

online CEE application at anytime



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2. COMPLETE FINGERPRINTING-BASED CRIMINAL

BACKGROUND CHECK

• Receive a pre-filled Criminal Disclosure Form from the CEE

(generated from IPAS)

• Mail Completed Criminal Record Disclosure form to:

Covered California

Attn: Disclosure Unit

PO Box 1199

Sacramento, CA 95812

• NOTE: Any communication in connection with the Criminal

Disclosure Form is between the individual applicant and Covered

California. The CEE will not be involved in the collection or review

of the content of this document.



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2. COMPLETE FINGERPRINTING-BASED CRIMINAL

BACKGROUND CHECK

• Receive a pre-populated Live Scan Fingerprinting

Form from CEE (generated from IPAS)

• Find the nearest approved Live Scan location to

schedule your appointment by visiting:

www.cpaitallivescan.com/covered_ca_home.htlm

• Must bring TWO completed Request for Live Scan

Service Forms to your appointment

• Fingerprinting will be provided on-site at the

training locations as well

http://www.cpaitallivescan.com/covered_ca_home.htlm



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3. COMPLETE CERTIFIED ENROLLMENT COUNSELOR TRAINING

• Complete training modules o Complete a 3-Day CEC Training (must attend ALL three days) OR

o Complete Self Guided Training (online modules)

• Complete Covered California Certification Exam

• Score 80% or better on the exam o The systems allows three attempts to score 80% or better

• Receive email notification including login information

to create profile in CoveredCA.com

4 Steps to Becoming a Certified

Enrollment Counselor

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4. CREATE USER PROFILE IN COVEREDCA.COM

• Login to CoveredCA.com to create CEC

profile

o Receive your Certified Enrollment Counselor

identification badge

o *CEE must upload headshot picture of each

CEC in CEE application

o Begin assisting consumers!

CEES AND CECS RESPONSIBILITIES

TWO KEY POINTS ABOUT SERVING CONSUMERS:

1. CEEs/CECs MAY NOT handle payments and

CANNOT make payments on behalf of consumers

(see agreement for exact language)

2. CEEs/CECs MAY NOT steer consumers towards

health plans

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CEC TRAINING

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CERTIFIED ENROLLMENT COUNSELOR

TRAINING MODULES

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• For each course, participants will receive a comprehensive Participant

Guide and the instructor’s PowerPoint slides

• In order to achieve certification, attendees must achieve a score of

80%

• Must attend annual recertification

Introduction to the Affordable

Care Act Covered California Plan Options

Introduction to Covered

California

Enrollment Support for

Individuals and Families

Introduction to Health Insurance Compliance Standards

Certified Enrollment Counselor

Role Privacy and Security

Eligibility for Individuals and

Families Providing Consumer Assistance

Training Topics Include:

TO SIGN UP AND SCHEDULE TRAINING

• Once approved for certification process,

individual will receive email from Learning

Management System (LMS) with login and

password information for training

• Training will be offered weekly, statewide

• Login to LMS to access schedule of Certified

Enrollment Counselor Training sessions and

register for a suitable session

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FOR MORE INFORMATION

• To complete the CEE Application, go to: http://www.healthexchange.ca.gov/Pages/EnrollmentAssistanceProgram.aspx

• For questions or assistance, please call the Covered California Enrollment Assistance Help Desk

(888) 402-0737 Monday – Friday, 8:00 AM to 5:00 PM

• Email support is available at:

[email protected]

• Enrollment Assistance Specialists are available in your area to provide support

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http://www.healthexchange.ca.gov/Pages/EnrollmentAssistanceProgram.aspx



mailto:[email protected]

QUESTIONS & ANSWERS

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