Common use of Proposal to Meet Program Requirements Clause in Contracts

Proposal to Meet Program Requirements. California anticipates that the Level I Exchange Establishment grant funding requested in this application will support the state in moving to the next level of planning, development, and implementation for the California Exchange. During the Level I grant period California will begin developing core staff capacity and ensure sufficient talent and skills to support development and implementation of Exchange programs going forward. With an eye toward realistic long-term sustainability for the California Exchange, this application proposes to supplement Exchange staff with a complement of time-limited and issue-focused consultants and experts to research, analyze and make recommendations to the Exchange Board in critical core areas. One of the main consultant supported activities early in the grant period will be development of a detailed and comprehensive business and operational plan. Over the one-year period of the grant the state will move to initial implementation in those areas with longer lead times, such as IT capacity and infrastructure development, and other core areas with time sensitivity identified through the business and operational planning process, to ensure that the state can meet federal goals and timelines for Exchange certification and operation. California Health Benefit Exchange Level I Grant Objectives ➢ Refine the vision and goals for the California Exchange consistent with state and federal law; ➢ Secure staff, consultant and expert resources, and actively engage stakeholders, to inform and support Exchange planning and implementation activities; ➢ Develop and initiate implementation of a three-year business and operational plan outlining the key tasks, milestones and timeline, including information technology(IT) infrastructure and functionality, necessary to achieve successful operation of the Exchange; ➢ Identify and begin to establish the systems and program capacity in core areas, such as IT development, to secure federal certification of the California Exchange by January 1, 2013; and, ➢ Prepare and submit a Level II Exchange grant application Spring 2012 to support full implementation and operation of the Exchange by 2014. Strategic Visioning One of the first tasks for the California Exchange during the Level I grant period will be to engage the Board, staff, and stakeholders in a strategic visioning process. CA-ACA establishes the California Exchange as an active purchaser by requiring that it selectively contract with carriers, set specific participation criteria “in the best interests of qualified individuals and small employers,” and contract with carriers to provide health coverage choices that offer the “optimal combination of choice, value, quality and service.” The next step will be to identify the policy objectives for the Exchange and consider the wide range of activities and approaches the Exchange could use to leverage higher-quality, more affordable insurance for individuals and small businesses.7 The California Exchange has enormous potential to have an impact on coverage and delivery systems in the state given the large numbers of people likely to be served by Exchange programs. By way of illustration, as part of the visioning process, the Exchange might explore to what extent the following activities identified by Georgetown University Health Policy Institute as choices and considerations for an “active purchaser” exchange, alone or in some combination, might serve as guideposts and core principles during development and implementation of California’s Exchange: ▪ Setting carrier certification criteria that reflect state goals for population health, plan quality, delivery system reform, transparency or [strengthening the state’s health care safety net]; ▪ Using the selective contracting process to negotiate better prices and higher-quality from carriers; ▪ Leveraging quality improvement and delivery system reforms by encouraging and authorizing participating health plans to implement specific reform strategies and efficiencies;

Proposal to Meet Program Requirements. ‌ The California anticipates that the Exchange is seeking funding for a second Level I Exchange Establishment grant funding requested in this application will support the state in moving (1.2) to implement the next level of planningplanning and development activities. As described in detail below and in the work plan attached as Attachment A, development, and implementation for during this proposed period of the California Exchange. During the second Level I grant period California will begin developing core staff capacity and ensure sufficient talent and skills to support development and implementation of Exchange programs going forward. With an eye toward realistic long(August 15, 2012-term sustainability for the California ExchangeJune 30, this application proposes to supplement Exchange staff with a complement of time-limited and issue-focused consultants and experts to research, analyze and make recommendations to the Exchange Board in critical core areas. One of the main consultant supported activities early in the grant period will be development of a detailed and comprehensive business and operational plan. Over the one-year period of the grant the state will move to initial implementation in those areas with longer lead times, such as IT capacity and infrastructure development, and other core areas with time sensitivity identified through the business and operational planning process, to ensure that the state can meet federal goals and timelines for Exchange certification and operation. California Health Benefit Exchange Level I Grant Objectives ➢ Refine the vision and goals for 2013) the California Exchange consistent will: ▪ Engage in ongoing planning, research and stakeholder consultation; ▪ Actively collaborate with state partner agencies administering public coverage programs and federal lawregulating health insurance markets to maximize coordination and integration of existing and newly developing health coverage programs, consumer services and oversight functions; ➢ Secure staff▪ Design and refine program and operational elements, consultant including advancing the development of CalHEERS and expert resourcesinternal operational policies to support a seamless and coordinated enrollment and eligibility function and effective consumer assistance and support; ▪ Refine and implement an aggressive marketing, outreach, and actively engage stakeholderspublic education program to set the stage for 2014 in the public arena and among targeted, potentially eligible constituencies; ▪ Finalize and execute a procurement and certification process for qualified health plans to inform be offered in the individual and support SHOP Exchange planning and implementation activitiesstarting in 2014; ➢ Develop and initiate implementation ▪ Submit the Exchange Blueprint, secure federal approval for the operation of a threestate-year business and operational plan outlining the key tasks, milestones and timeline, including information technology(IT) infrastructure and functionality, necessary to achieve successful operation of the Exchange; ➢ Identify and begin to establish the systems and program capacity in core areas, such as IT development, to secure federal certification of the California based Exchange by January 1, 2013; and, ➢ Prepare and submit a Level II multi-year establishment grant proposal, budget and timeline; ▪ Develop and execute a multi-year plan for evaluation and monitoring of California Exchange grant application Spring 2012 to programs and implementation of federal health reforms in the state; and, ▪ Maintain and enhance operational coordination, financial management support full implementation and operation business operations in service of the Exchange by 2014. Strategic Visioning One mission and functions of the first tasks for the Exchange. The California Exchange will continue to make progress in most of the federal core areas during the Level I grant period will be to engage (1.2) period. Figure 5 identifies and compares the Board, staff, and stakeholders in a strategic visioning process. CA-ACA establishes federal core areas with the work plan core areas used by the California Exchange as an active purchaser by requiring that it selectively contract with carriersin developing this grant proposal. Background Research and Evaluation‌ The California Exchange will continue to emphasize evidence-based decision making through collection of existing research and supporting or engaging in original research necessary to inform its planning and implementation activities. During the time period for the proposed Level I grant (1.2), set specific participation criteria “the Exchange expects to engage in the best interests following research and evaluation activities: ▪ Continue to work with UC Berkeley and UCLA to refine CalSIM estimates of qualified individuals potential enrollment in the Exchange and small employers,” other public coverage programs, as well as distill demographic and contract profile information that will be critical to the development of effective, California-specific programs and services. Having a robust data set with carriers so much detail, including information on health-seeking behaviors, chronic diseases, and regional variation, will help the Exchange in its effort to plan for and provide health coverage choices services and programs that offer can really work for the “optimal combination sheer size and ethnic and cultural diversity of choiceCalifornia communities anticipated to be the customers of the Exchange. The Exchange will also engage UC Berkeley and UCLA in helping to define data elements in CalSIM and the California Health Interview Survey, valueand support related data collection, quality that can provide the information needed for state evaluation of the impacts of the Affordable Care Act and service.” the implementation of Exchange programs. ▪ The next step Exchange will engage actuarial services and supports to help in modeling benefit design options, including consideration of standardized benefit plan designs with heavy emphasis on changes to cost- sharing structures. The goal of the analysis will be to identify the policy objectives benefit plan design options consistent with the coverage tiers established in the Affordable Care Act, Exchange principles and the overall goal of offering consumers choice and the opportunity to compare options that provide the best value for their dollar. Further, well designed cost-sharing structures should draw consumers to the Exchange as well as encourage appropriate utilization of covered health care services, especially preventive services. Having actuarial expertise will be essential for the Exchange to evaluate QHP benefit proposals and consider to estimate the wide range of activities potential costs and approaches utilization for Exchange coverage offerings under multiple scenarios; ▪ During the Exchange could use to leverage higher-quality, more affordable insurance for individuals and small businesses.7 The California Exchange has enormous potential to have an impact on coverage and delivery systems in the state given the large numbers of people likely to be served by Exchange programs. By way of illustration, as part period of the visioning processproposed Level I grant (1.2) , the Exchange might explore will engage in extensive internal evaluation planning engaging health care and health insurance experts and researchers, diverse stakeholders and state partner agencies to what extent the following activities identified by Georgetown University Health Policy Institute as choices develop and considerations begin to collect essential baseline data for an “active purchaser” exchange, alone or in some combination, might serve as guideposts and core principles during development and implementation of California’s a long-term evaluation plan. To develop the plan, the Exchange will need to catalogue and reconcile the multiple existing data and research sources in the state, conduct a gap analysis and develop rigorous quality and success indicators and measures to meet federal requirements and ensure a continuous quality improvement process for all activities of the Exchange: ▪ Setting carrier certification criteria . The evaluation plan will be driven by the Board-adopted vision, mission, and values, including the value of “results” which holds that reflect state goals for population healththe impact of the Exchange will be measured by its contributions to expanding coverage and access, plan improving health care quality, delivery system reformpromoting better health and health equity, transparency or [strengthening and lowering costs for all Californians. The Exchange hopes to build on the state’s 2011 CHCF-funded report by the State Health Access Data Assistance Center entitled, “A Framework for Tracking the Impacts of the Affordable Care Act in California,” which identified potential metrics, available state data sources and data gaps to measure the effects of health care safety net]; ▪ Using reform in the selective contracting process to negotiate better prices and higher-quality from carriers; ▪ Leveraging quality improvement and delivery system reforms by encouraging and authorizing participating health plans to implement specific reform strategies and efficiencies;state.‌

Proposal to Meet Program Requirements. California anticipates that the Level I Exchange Establishment grant funding requested in this application will support the state in moving to the next level of planning, development, and implementation for the California Exchange. During the Level I grant period California will begin developing core staff capacity and ensure sufficient talent and skills to support development and implementation of Exchange programs going forward. With an eye toward realistic long-term sustainability for the California Exchange, this application proposes to supplement Exchange staff with a complement of time-limited and issue-focused consultants and experts to research, analyze and make recommendations to the Exchange Board in critical core areas. One of the main consultant supported activities early in the grant period will be development of a detailed and comprehensive business and operational plan. Over the one-year period of the grant the state will move to initial implementation in those areas with longer lead times, such as IT capacity and infrastructure development, and other core areas with time sensitivity identified through the business and operational planning process, to ensure that the state can meet federal goals and timelines for Exchange certification and operation. California Health Benefit Exchange Level I Grant Objectives ➢ Refine the vision and goals for the California Exchange consistent with state and federal law; ➢ Secure staff, consultant and expert resources, and actively engage stakeholders, to inform and support Exchange planning and implementation activities; ➢ Develop and initiate implementation of a three-year business and operational plan outlining the key tasks, milestones and timeline, including information technology(IT) infrastructure and functionality, necessary to achieve successful operation of the Exchange; ➢ Identify and begin to establish the systems and program capacity in core areas, such as IT development, to secure federal certification of the California Exchange by January 1, 2013; and, ➢ Prepare and submit a Level II Exchange grant application Spring 2012 to support full implementation and operation of the Exchange by 2014. Strategic Visioning One of the first tasks for the California Exchange during the Level I grant period will be to engage the Board, staff, and stakeholders in a strategic visioning process. CA-ACA establishes the California Exchange as an active purchaser by requiring that it selectively contract with carriers, set specific participation criteria “in the best interests of qualified individuals and small employers,” and contract with carriers to provide health coverage choices that offer the “optimal combination of choice, value, quality and service.” The next step will be to identify the policy objectives for the Exchange and consider the wide range of activities and approaches the Exchange could use to leverage higher-quality, more affordable insurance for individuals and small businesses.7 The California Exchange has enormous potential to have an impact on coverage and delivery systems in the state given the large numbers of people likely to be served by Exchange programs. By way of illustration, as part of the visioning process, the Exchange might explore to what extent the following activities identified by Georgetown University Health Policy Institute as choices and considerations for an “active purchaser” exchange, alone or in some combination, might serve as guideposts and core principles during development and implementation of California’s Exchange: ▪ Setting carrier certification criteria that reflect state goals for population health, plan quality, delivery system reform, transparency or [strengthening the state’s health care safety net]; ▪ Using the selective contracting process to negotiate better prices and higher-quality from carriers; ▪ Leveraging quality improvement and delivery system reforms by encouraging and authorizing participating health plans to implement specific reform strategies and efficiencies;

Proposal to Meet Program Requirements. ‌ The California anticipates that the Exchange is seeking funding for a second Level I Exchange Establishment grant funding requested in this application will support the state in moving (1.2) to implement the next level of planningplanning and development activities. As described in detail below and in the work plan attached as Attachment A, development, and implementation for during this proposed period of the California Exchange. During the second Level I grant period California will begin developing core staff capacity and ensure sufficient talent and skills to support development and implementation of Exchange programs going forward. With an eye toward realistic long(August 15, 2012-term sustainability for the California ExchangeJune 30, this application proposes to supplement Exchange staff with a complement of time-limited and issue-focused consultants and experts to research, analyze and make recommendations to the Exchange Board in critical core areas. One of the main consultant supported activities early in the grant period will be development of a detailed and comprehensive business and operational plan. Over the one-year period of the grant the state will move to initial implementation in those areas with longer lead times, such as IT capacity and infrastructure development, and other core areas with time sensitivity identified through the business and operational planning process, to ensure that the state can meet federal goals and timelines for Exchange certification and operation. California Health Benefit Exchange Level I Grant Objectives ➢ Refine the vision and goals for 2013) the California Exchange consistent will:  Engage in ongoing planning, research and stakeholder consultation;  Actively collaborate with state partner agencies administering public coverage programs and federal lawregulating health insurance markets to maximize coordination and integration of existing and newly developing health coverage programs, consumer services and oversight functions; ➢ Secure staff Design and refine program and operational elements, consultant including advancing the development of CalHEERS and expert resourcesinternal operational policies to support a seamless and coordinated enrollment and eligibility function and effective consumer assistance and support;  Refine and implement an aggressive marketing, outreach, and actively engage stakeholderspublic education program to set the stage for 2014 in the public arena and among targeted, potentially eligible constituencies;  Finalize and execute a procurement and certification process for qualified health plans to inform be offered in the individual and support SHOP Exchange planning and implementation activitiesstarting in 2014; ➢ Develop and initiate implementation  Submit the Exchange Blueprint, secure federal approval for the operation of a threestate-year business and operational plan outlining the key tasks, milestones and timeline, including information technology(IT) infrastructure and functionality, necessary to achieve successful operation of the Exchange; ➢ Identify and begin to establish the systems and program capacity in core areas, such as IT development, to secure federal certification of the California based Exchange by January 1, 2013; and, ➢ Prepare and submit a Level II multi-year establishment grant proposal, budget and timeline;  Develop and execute a multi-year plan for evaluation and monitoring of California Exchange grant application Spring 2012 to programs and implementation of federal health reforms in the state; and,  Maintain and enhance operational coordination, financial management support full implementation and operation business operations in service of the Exchange by 2014. Strategic Visioning One mission and functions of the first tasks for the Exchange. The California Exchange will continue to make progress in most of the federal core areas during the Level I grant period will be to engage (1.2) period. Figure 5 identifies and compares the Board, staff, and stakeholders in a strategic visioning process. CA-ACA establishes federal core areas with the work plan core areas used by the California Exchange as an active purchaser by requiring that it selectively contract with carriersin developing this grant proposal. Background Research and Evaluation‌ The California Exchange will continue to emphasize evidence-based decision making through collection of existing research and supporting or engaging in original research necessary to inform its planning and implementation activities. During the time period for the proposed Level I grant (1.2), set specific participation criteria “the Exchange expects to engage in the best interests following research and evaluation activities:  Continue to work with UC Berkeley and UCLA to refine CalSIM estimates of qualified individuals potential enrollment in the Exchange and small employers,” other public coverage programs, as well as distill demographic and contract profile information that will be critical to the development of effective, California-specific programs and services. Having a robust data set with carriers so much detail, including information on health-seeking behaviors, chronic diseases, and regional variation, will help the Exchange in its effort to plan for and provide health coverage choices services and programs that offer can really work for the “optimal combination sheer size and ethnic and cultural diversity of choiceCalifornia communities anticipated to be the customers of the Exchange. The Exchange will also engage UC Berkeley and UCLA in helping to define data elements in CalSIM and the California Health Interview Survey, valueand support related data collection, quality that can provide the information needed for state evaluation of the impacts of the Affordable Care Act and service.” the implementation of Exchange programs.  The next step Exchange will engage actuarial services and supports to help in modeling benefit design options, including consideration of standardized benefit plan designs with heavy emphasis on changes to cost- sharing structures. The goal of the analysis will be to identify the policy objectives benefit plan design options consistent with the coverage tiers established in the Affordable Care Act, Exchange principles and the overall goal of offering consumers choice and the opportunity to compare options that provide the best value for their dollar. Further, well designed cost-sharing structures should draw consumers to the Exchange as well as encourage appropriate utilization of covered health care services, especially preventive services. Having actuarial expertise will be essential for the Exchange to evaluate QHP benefit proposals and consider to estimate the wide range of activities potential costs and approaches utilization for Exchange coverage offerings under multiple scenarios;  During the Exchange could use to leverage higher-quality, more affordable insurance for individuals and small businesses.7 The California Exchange has enormous potential to have an impact on coverage and delivery systems in the state given the large numbers of people likely to be served by Exchange programs. By way of illustration, as part period of the visioning processproposed Level I grant (1.2) , the Exchange might explore will engage in extensive internal evaluation planning engaging health care and health insurance experts and researchers, diverse stakeholders and state partner agencies to what extent the following activities identified by Georgetown University Health Policy Institute as choices develop and considerations begin to collect essential baseline data for an “active purchaser” exchange, alone or in some combination, might serve as guideposts and core principles during development and implementation of California’s a long-term evaluation plan. To develop the plan, the Exchange will need to catalogue and reconcile the multiple existing data and research sources in the state, conduct a gap analysis and develop rigorous quality and success indicators and measures to meet federal requirements and ensure a continuous quality improvement process for all activities of the Exchange: ▪ Setting carrier certification criteria . The evaluation plan will be driven by the Board-adopted vision, mission, and values, including the value of “results” which holds that reflect state goals for population healththe impact of the Exchange will be measured by its contributions to expanding coverage and access, plan improving health care quality, delivery system reformpromoting better health and health equity, transparency or [strengthening and lowering costs for all Californians. The Exchange hopes to build on the state’s 2011 CHCF-funded report by the State Health Access Data Assistance Center entitled, “A Framework for Tracking the Impacts of the Affordable Care Act in California,” which identified potential metrics, available state data sources and data gaps to measure the effects of health care safety net]; ▪ Using reform in the selective contracting process to negotiate better prices and higher-quality from carriers; ▪ Leveraging quality improvement and delivery system reforms by encouraging and authorizing participating health plans to implement specific reform strategies and efficiencies;state.‌