Oversight and Program Integrity. Also required by Section 1313, each Exchange will need to ensure program integrity related to Federal and State funds utilized to start-up and operate the Exchange. Exchanges will need to ensure that they take steps to prevent waste, fraud, and abuse. The Financial Management core area includes the infrastructure the Exchange must establish for financial management while this core area includes the oversight and program integrity activities the Exchange undertakes to ensure compliance with Federal and State requirements, including annual audits.
Oversight and Program Integrity. It will be necessary for the exchange to combat waste, fraud and abuse within its financial management system, as well as within the processing of data, information and funds that flow through the exchange. Thus, setting up oversight and program integrity functions will be critical for a properly functioning exchange. Ensure the prevention of waste, fraud and abuse: As previously mentioned, the state financial policies already in place ensure the proper use of state and federal funds. The federal grants and budget specialist in HCA is currently developing agency policies specific to bridging the differences between state requirements of funds and those requirements laid out by the federal government. As a part of those requirements, the state will also develop appropriate procedures to meet HHS’ audit requirements.
Oversight and Program Integrity. During the Level I grant period, the Exchange will be able to build staff capacity to ensure its ability to comply with annual auditing requirements imposed under state and federal law. The Exchange will engage external consultants to develop a comprehensive plan to prevent waste, fraud and abuse in Exchange programs with specific milestones for staff implementation of the plan.
Oversight and Program Integrity. The California Exchange is committed to implementing an effective program to prevent waste, fraud and abuse with funds used to start up and operate the California Exchange. The California Exchange Board adopted integrity as one of its core values, defined as earning the public’s trust through its commitment to accountability, responsiveness, transparency, speed, agility, reliability, and cooperation. Strategies include getting outside expertise to review planning processes and decisions and building checks and oversight into major contracts. Further, the Board adopted conflict of interest standards and policies for designated personnel, consultants and new hires. The California Exchange regularly uses outside expertise in its contracting processes to build an additional level of oversight and monitoring. The California Exchange hired retired annuitants with extensive procurement expertise to set up contracting processes. Major solicitations are reviewed prior to release by partner organizations including the DHCS, MRMIB and the California Health and Human Services Agency. Consumer Assistance -- Providing Assistance to Individuals and Small Businesses, Coverage Appeals, and Complaints In order to deliver on the Affordable Care Act goal of a “no wrong door” service system that provides for a consistent and quality consumer experience at all entry points, the California Exchange is investing resources to develop culturally and linguistically appropriate oral and written communications and targeted strategies for populations with limited access such as persons with disabilities. The CalHEERS design will facilitate eligibility determinations and enrollment through multiple access points including the web, mail, phone and in-person applications. In addition to CalHEERS functionality, during the Level I grant (1.1) period, California has been exploring the most effective strategies to assist Exchange enrollees and potential enrollees, including: (1) Development of a robust Assisters Program, including Navigators, who will provide individualized services to persons who require help navigating the eligibility and enrollment process, and (2) Establishment of a consumer assistance function that supports consumers from the point of enrollment inquiry to post-enrollment problem resolution. During the grant period, the California Exchange released a communications solicitation for development of a marketing, outreach and education campaign and plan, including a propose...
