Common use of Proposal to Meet Program Requirements Clause in Contracts

Proposal to Meet Program Requirements. ‌ The California Exchange is seeking funding for a second Level I Exchange Establishment grant (1.2) to implement the next level of planning and development activities. As described in detail below and in the work plan attached as Attachment A, during this proposed period of the second Level I grant (August 15, 2012-June 30, 2013) the California Exchange will:  Engage in ongoing planning, research and stakeholder consultation;  Actively collaborate with state partner agencies administering public coverage programs and regulating health insurance markets to maximize coordination and integration of existing and newly developing health coverage programs, consumer services and oversight functions;  Design and refine program and operational elements, including advancing the development of CalHEERS and internal 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 public 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 be offered in the individual and SHOP Exchange starting in 2014;  Submit the Exchange Blueprint, secure federal approval for the operation of a state-based Exchange 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 programs and implementation of federal health reforms in the state; and,  Maintain and enhance operational coordination, financial management support and business operations in service of the mission and functions of the Exchange. The California Exchange will continue to make progress in most of the federal core areas during the Level I grant (1.2) period. Figure 5 identifies and compares the federal core areas with the work plan core areas used by the California Exchange in 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), the Exchange expects to engage in the following research and evaluation activities:  Continue to work with UC Berkeley and UCLA to refine CalSIM estimates of potential enrollment in the Exchange and other public coverage programs, as well as distill demographic and profile information that will be critical to the development of effective, California-specific programs and services. Having a robust data set with 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 services and programs that can really work for the sheer size and ethnic and cultural diversity of California 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, and support related data collection, that can provide the information needed for state evaluation of the impacts of the Affordable Care Act and the implementation of Exchange programs.  The 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 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 to estimate the potential costs and utilization for Exchange coverage offerings under multiple scenarios;  During the period of the proposed Level I grant (1.2) , the Exchange will engage in extensive internal evaluation planning engaging health care and health insurance experts and researchers, diverse stakeholders and state partner agencies to develop and begin to collect essential baseline data for implementation of 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. The evaluation plan will be driven by the Board-adopted vision, mission, and values, including the value of “results” which holds that the impact of the Exchange will be measured by its contributions to expanding coverage and access, improving health care quality, promoting better health and health equity, and lowering costs for all Californians. The Exchange hopes to build on the 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 reform in the state.‌

Proposal to Meet Program Requirements. ‌ The California Exchange is seeking funding for a second Level I Exchange Establishment grant (1.2) to implement the next level of planning and development activities. As described in detail below and in the work plan attached as Attachment A, during this proposed period of the second Level I grant (August 15, 2012-June 30, 2013) the California Exchange will:  ▪ Engage in ongoing planning, research and stakeholder consultation;  ▪ Actively collaborate with state partner agencies administering public coverage programs and regulating health insurance markets to maximize coordination and integration of existing and newly developing health coverage programs, consumer services and oversight functions;  ▪ Design and refine program and operational elements, including advancing the development of CalHEERS and internal 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 public 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 be offered in the individual and SHOP Exchange starting in 2014;  ▪ Submit the Exchange Blueprint, secure federal approval for the operation of a state-based Exchange 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 programs and implementation of federal health reforms in the state; and,  ▪ Maintain and enhance operational coordination, financial management support and business operations in service of the mission and functions of the Exchange. The California Exchange will continue to make progress in most of the federal core areas during the Level I grant (1.2) period. Figure 5 identifies and compares the federal core areas with the work plan core areas used by the California Exchange in 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), the Exchange expects to engage in the following research and evaluation activities:  ▪ Continue to work with UC Berkeley and UCLA to refine CalSIM estimates of potential enrollment in the Exchange and other public coverage programs, as well as distill demographic and profile information that will be critical to the development of effective, California-specific programs and services. Having a robust data set with 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 services and programs that can really work for the sheer size and ethnic and cultural diversity of California 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, and support related data collection, that can provide the information needed for state evaluation of the impacts of the Affordable Care Act and the implementation of Exchange programs.  ▪ The 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 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 to estimate the potential costs and utilization for Exchange coverage offerings under multiple scenarios;  ▪ During the period of the proposed Level I grant (1.2) , the Exchange will engage in extensive internal evaluation planning engaging health care and health insurance experts and researchers, diverse stakeholders and state partner agencies to develop and begin to collect essential baseline data for implementation of 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. The evaluation plan will be driven by the Board-adopted vision, mission, and values, including the value of “results” which holds that the impact of the Exchange will be measured by its contributions to expanding coverage and access, improving health care quality, promoting better health and health equity, and lowering costs for all Californians. The Exchange hopes to build on the 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 reform in the state.‌

Proposal to Meet Program Requirements. ‌ The California Exchange is seeking funding for a second anticipates that the Level I Exchange Establishment grant (1.2) funding requested in this application will support the state in moving to implement the next level of planning 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 activitiesand implementation of Exchange programs going forward. As described 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 detail below and critical core areas. One of the main consultant supported activities early in the work plan attached as Attachment A, during this proposed grant period will be development of a detailed and comprehensive business and operational plan. Over the one-year period of the second Level I grant (August 15the state will move to initial implementation in those areas with longer lead times, 2012-June 30such as IT capacity and infrastructure development, 2013) 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. ➢ Refine the vision and goals for the California Exchange will:  Engage in ongoing planning, research and stakeholder consultation;  Actively collaborate consistent with state partner agencies administering public coverage programs and regulating health insurance markets federal law; ➢ Secure staff, consultant and expert resources, and actively engage stakeholders, to maximize coordination inform and integration support Exchange planning and implementation activities; ➢ Develop and initiate implementation of existing and newly developing health coverage programs, consumer services and oversight functions;  Design and refine program a three-year business and operational elementsplan outlining the key tasks, milestones and timeline, including advancing information technology(IT) infrastructure and functionality, necessary to achieve successful operation of the development of CalHEERS Exchange; ➢ Identify and internal operational policies begin to support a seamless establish the systems and coordinated enrollment and eligibility function and effective consumer assistance and support;  Refine and implement an aggressive marketingprogram capacity in core areas, outreachsuch as IT development, and public 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 be offered in the individual and SHOP Exchange starting in 2014;  Submit the Exchange Blueprint, secure federal approval for certification of the operation of a state-based California Exchange by January 1, 2013; and, ➢ Prepare and submit a Level II multi-year establishment Exchange grant proposal, budget application Spring 2012 to support full implementation and timeline;  Develop and execute a multi-year plan for evaluation and monitoring of California Exchange programs and implementation of federal health reforms in the state; and,  Maintain and enhance operational coordination, financial management support and business operations in service of the mission and functions of the Exchange. The California Exchange will continue to make progress in most of the federal core areas during the Level I grant (1.2) period. Figure 5 identifies and compares the federal core areas with the work plan core areas used by the California Exchange in 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), the Exchange expects to engage in the following research and evaluation activities:  Continue to work with UC Berkeley and UCLA to refine CalSIM estimates of potential enrollment in the Exchange and other public coverage programs, as well as distill demographic and profile information that will be critical to the development of effective, California-specific programs and services. Having a robust data set with 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 services and programs that can really work for the sheer size and ethnic and cultural diversity of California 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, and support related data collection, that can provide the information needed for state evaluation of the impacts of the Affordable Care Act and the implementation of Exchange programs.  The 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 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 to estimate the potential costs and utilization for Exchange coverage offerings under multiple scenarios;  During the period of the proposed Level I grant (1.2) , the Exchange will engage in extensive internal evaluation planning engaging health care and health insurance experts and researchers, diverse stakeholders and state partner agencies to develop and begin to collect essential baseline data for implementation of 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. The evaluation plan will be driven by the Board-adopted vision, mission, and values, including the value of “results” which holds that the impact operation of the Exchange will be measured by its contributions to expanding coverage and access, improving health care quality, promoting better health and health equity, and lowering costs for all Californians. The Exchange hopes to build on the 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 reform in the state.‌2014.

Proposal to Meet Program Requirements. ‌ The California Exchange is seeking funding for a second anticipates that the Level I Exchange Establishment grant (1.2) funding requested in this application will support the state in moving to implement the next level of planning 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 activitiesand implementation of Exchange programs going forward. As described 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 detail below and critical core areas. One of the main consultant supported activities early in the work plan attached as Attachment A, during this proposed grant period will be development of a detailed and comprehensive business and operational plan. Over the one-year period of the second 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 (August 15, 2012-June 30, 2013) Grant Objectives ➢ Refine the vision and goals for the California Exchange will:  Engage in ongoing planning, research and stakeholder consultation;  Actively collaborate consistent with state partner agencies administering public coverage programs and regulating health insurance markets federal law; ➢ Secure staff, consultant and expert resources, and actively engage stakeholders, to maximize coordination inform and integration support Exchange planning and implementation activities; ➢ Develop and initiate implementation of existing and newly developing health coverage programs, consumer services and oversight functions;  Design and refine program a three-year business and operational elementsplan outlining the key tasks, milestones and timeline, including advancing information technology(IT) infrastructure and functionality, necessary to achieve successful operation of the development of CalHEERS Exchange; ➢ Identify and internal operational policies begin to support a seamless establish the systems and coordinated enrollment and eligibility function and effective consumer assistance and support;  Refine and implement an aggressive marketingprogram capacity in core areas, outreachsuch as IT development, and public 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 be offered in the individual and SHOP Exchange starting in 2014;  Submit the Exchange Blueprint, secure federal approval for certification of the operation of a state-based California Exchange by January 1, 2013; and, ➢ Prepare and submit a Level II multi-year establishment Exchange grant proposal, budget application Spring 2012 to support full implementation and timeline;  Develop and execute a multi-year plan operation of the Exchange by 2014. Strategic Visioning One of the first tasks for evaluation and monitoring of the California Exchange programs and implementation of federal health reforms in the state; and,  Maintain and enhance operational coordination, financial management support and business operations in service of the mission and functions of the Exchange. The California Exchange will continue to make progress in most of the federal core areas during the Level I grant (1.2) periodperiod will be to engage the Board, staff, and stakeholders in a strategic visioning process. Figure 5 identifies and compares the federal core areas with the work plan core areas used by CA-ACA establishes the California Exchange in 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)as an active purchaser by requiring that it selectively contract with carriers, the Exchange expects to engage set specific participation criteria “in the following research best interests of qualified individuals and evaluation activities:  Continue small employers,” and contract with carriers to work with UC Berkeley provide health coverage choices that offer the “optimal combination of choice, value, quality and UCLA to refine CalSIM estimates of potential enrollment in the Exchange and other public coverage programs, as well as distill demographic and profile information that will be critical to the development of effective, California-specific programs and services. Having a robust data set with 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 services and programs that can really work for the sheer size and ethnic and cultural diversity of California communities anticipated to be the customers of the Exchange. service.” The Exchange will also engage UC Berkeley and UCLA in helping to define data elements in CalSIM and the California Health Interview Survey, and support related data collection, that can provide the information needed for state evaluation of the impacts of the Affordable Care Act and the implementation of Exchange programs.  The 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 next step will be to identify the 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 policy objectives for the Exchange and consider the wide range of activities and approaches the Exchange could use to evaluate QHP benefit proposals leverage higher-quality, more affordable insurance for individuals and small businesses.7 The California Exchange has enormous potential to estimate have an impact on coverage and delivery systems in the potential costs and utilization for state given the large numbers of people likely to be served by Exchange coverage offerings under multiple scenarios;  During the period programs. By way of illustration, as part of the proposed Level I grant (1.2) visioning process, the Exchange will engage 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 extensive internal evaluation planning engaging 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 health insurance experts and researchers, diverse stakeholders and state partner agencies to develop and begin to collect essential baseline data for implementation of a longhigher-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 from carriers; ▪ Leveraging quality improvement process for all activities of the Exchange. The evaluation plan will be driven and delivery system reforms by the Board-adopted vision, mission, encouraging and values, including the value of “results” which holds that the impact of the Exchange will be measured by its contributions authorizing participating health plans to expanding coverage implement specific reform strategies and access, improving health care quality, promoting better health and health equity, and lowering costs for all Californians. The Exchange hopes to build on the 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 reform in the state.‌efficiencies;