Vendor Conference: Childrens Health Insurance Program CHIP RFI

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Vendor Conference Childrens Health Insurance
Program(CHIP)RFI 529-07-0154June 11, 2007
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Welcome and Introductions
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Integrated Eligibility History
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How is eligibility currently performed?

• The Health and Human Services Commission (HHSC)
  is responsible for determining eligibility for
  state services, including
• Childrens Health Insurance Program (CHIP)
• Medicaid
• Food stamps
• Temporary Assistance for Needy Families (TANF)
• Long-term care for the elderly and people with
  disabilities (financial eligibility)

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How is eligibility currently performed?

• CHIP
• Since the inception of the CHIP program, CHIP
  eligibility has been determined by a private
  contractor.
• HHSC transition to a new CHIP contractor in Dec.
  2005
• Childrens Medicaid and CHIP have a single
  application form.
• State workers must determine eligibility for
  Medicaid
• Eligibility information is submitted by
  telephone, fax and mail.

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How is eligibility currently performed?

• Adult Medicaid, TANF, Food Stamps
• A single application is used to apply for these
  programs.
• Requires contact with a designated eligibility
  office and state worker.
• Assigned to an office based on proximity
• Case files are paper based.

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Current Eligibility System

• There is a clear and compelling need to modernize
  the eligibility system.
• The current model is based on a service delivery
  framework designed in the 1970s and continues to
  reflect certain inherent limitations
• Outdated computer technology which is difficult
  and costly to maintain and update
• Inflexible office-based system that cannot easily
  respond to demographic or workload changes,
  consumer preferences, or other external factors

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Current Eligibility System

• Inconvenient for clients, who are tied to a
  specific office that is only accessible in person
  during business hours
• Client surveys demonstrate demand for change
• 80 percent said they would be likely to use the
  phone to apply for services
• 36 percent said they would be interested in
  applying online
• 28 percent rely on public transportation or
  someone else to take them to an office
• 82 percent wanted to be able to apply outside of
  normal work hours and not lose time on the job
• 81 percent wanted to be able to apply in private
  without others around

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Current Eligibility System

• Limited use of technological tools and modern
  business practices to support eligibility
  processing
• Staff and resource intensive process that cannot
  respond to caseload growth without substantial
  increases in appropriations
• In FY 1995 there were 12,487 annual average
  eligibility determination FTEs. In FY 2006 there
  were 5,975 annual average eligibility
  determination FTEs.
• If staffed at the FY 2002 level, the current
  eligibility model would require more than 13,000
  staff an increase of 7,000 over current
  staffing levels.
• This level of staffing would cost more than 250
  million per year in All Funds.

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New Eligibility System

• The 78th Legislature, 2003, enacted statutory
  provisions to achieve the cost savings and
  revenue necessary to finance certain health and
  human services. The legislation in part
• Directed HHSC to establish call centers, if
  cost-effective
• Required HHSC to outsource call centers unless
  HHSC determined that contracting for the
  operation of the call centers would not be
  cost-effective
• Business case completed in March 2004
  determined that the use of call centers would be
  cost-effective.
• Competitive procurement through an RFP
  determined that outsourcing was more
  cost-effective than state-operated call centers.

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Convenient Access

• Convenient access for consumers through multiple
  channels including phone, fax, Internet and mail.
  Texans will not have to take off work, pay for
  transportation or arrange child care to apply for
  services.
• Easier recertification process consumers will
  be able to complete most re-certifications and
  make basic changes, such as addresses, without an
  office visit.
• One application for many services clients will
  be able to access a variety of services even
  across agency lines.
• Field offices strategically located across the
  state providing in-person services.

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What is IE?

• Integrated Eligibility (IE) is an initiative to
  modernize the eligibility system by
• Replacing outdated technology
• Changing business processes
• Creating electronic case records which allows
• Additional channels of access for clients
• Benefits can be accessed through local offices,
  fax, Internet, telephone or mail.
• Clients are no longer tied to a particular
  eligibility office.
• More efficient use of state resources by
  balancing workload
• Workload can be distributed around the state.
• Provides additional flexibility during a
  disaster.

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What is IE?

• HHSC is redesigning programs around consumers,
  with extended hours and multiple ways Texans can
  apply for services at times and places that are
  convenient to them. Application options will
  include
• In person at a field office (8 am - 5 pm, Monday
  - Friday)
• By phone by dialing 2-1-1 (extended hours, 8 am -
  8 pm, Monday - Friday)
• Over the Internet (24 hours a day, 7 days a week)
• By fax or mail

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Implementing the New Eligibility System

• In June 2005, HHSC contracted with the Texas
  ACCESS Alliance (TAA) for multiple
  responsibilities
• Responsibilities assumed from previous vendors
• CHIP eligibility
• Medicaid and CHIP managed care enrollment broker
  services
• Maintenance of the Texas Integrated Eligibility
  Redesign System TIERS automated system
• New responsibilities
• Integrated eligibility services for Medicaid,
  Food Stamps, and TANF
• Piloted in 4 out of over 300 eligibility offices

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Functional Components of the TAA Contract

• Childrens Health Insurance (CHIP and Childrens
  Medicaid)
• Eligibility determination for CHIP
• Call center intake, operations and processing
• Document imaging and processing
• Data collection and case maintenance
• IE Call Center Intake Operations (TANF, Food
  Stamps, Adult and LTC Medicaid)
• Call center intake and operations
• Document imaging and basic data collection
• Basic inquiries about eligibility process
• IE Eligibility Processing (TANF, Food Stamps,
  Adult and LTC Medicaid)
• IEE Pilot Activities
• Application processing
• Case maintenance
• Screening, application and general case update
  activities

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Functional Components of the TAA Contract

• Enrollment Broker
• Enrollment into managed care plans for STAR,
  STARPLUS, NorthSTAR, and CHIP programs
• Education and Outreach Services to Managed Care
  Beneficiaries
• Texas Health Steps Outreach, Informing and
  Support Services
• Federal requirements stipulate that managed care
  enrollment must not be performed by an HMO
• TIERS Maintenance
• System Maintenance and Modification
• System Testing
• Conversion of data from SAVERR to TIERS
• Help Desk for support for eligibility staff using
  TIERS

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IE Pilot

• IE Pilot Conclusions
• The concept is sound and clients are eager for a
  more flexible eligibility system.
• The new system must efficiently support state
  workers and keep complex decision-making in the
  hands of trained, experienced state employees.
• The pilot has shown us that we needed to redraw
  the line between the state and private sector to
  clarify that the private sector is there to
  provide a support role to state staff.

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IE Contract Transition

• On March 13, 2007, HHSC announced it would begin
  winding down its contract with TAA.
• Responsibilities in the contract are
• Childrens Health Insurance Eligibility
  Processing
• Medicaid and CHIP enrollment into a health plan
  (managed care enrollment broker services)
• Maintenance of the new automation system -- Texas
  Integrated Eligibility Redesign System (TIERS)
• Integrated eligibility services for Medicaid,
  Food Stamps, and TANF

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IE Contract Transition

• HHSC is now responsible for direct management of
  some parts of the project and has entered into
  short-term contracts to ensure services continue
  without disruption.
• Timelines for transition will be different for
  each component.
• In the short term, work is continuing to be
  performed by existing subcontractors. HHSC will
  evaluate whether to hire state staff or use
  different contractors for those tasks.
• The State assumed management of Maximus CHIP
  contract.
• In the short term, Maximus is processing
  applications.
• Maintenance of TIERS will transition to state
  staff and contracted staff.
• Maximus will continue to enroll Medicaid and CHIP
  clients into managed care plans.
• The State assumed management of Maximus call
  center/ processing support contract.

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IE Contract Transition

• HHSC executed 3 short-term contracts for
• Childrens Health Insurance processing
• Call centers
• Enrollment broker
• The short-term contracts ensured no disruption
  
• to client services and access to benefits.
• During this period HHSC
• Completed a plan defining procurement strategies,
  goals and services to be procured
• Issued three Requests for Information (RFI) on
  May 31, 2007
• responses are due by June 29, 2007

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What is TIERS? How does it relate to IE?

• New Computer System -- TIERS
• Established by the 76th Legislature in 1999 to
  design and replace multiple client eligibility
  determination systems.
• TIERS is as modern as todays Internet technology
  and will integrate the application process for
  more than 50 HHS programs.
• A TIERS pilot began in June 2003 in eligibility
  offices in Travis and Hays counties and was
  expanded to Williamson county in November 2006.
• In February 2007, 51,468 foster care client
  records were converted and added to TIERS.
• At a cost of about 279 million, TIERS does more
  and costs less than similar systems in other
  large states.

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What is TIERS? How does it relate to IE?

• New Computer System -- TIERS
• TIERS is the new computer system that will allow
  the state to modernize the eligibility system and
  make access to services easier for clients.
• TIERS is a complex computer system designed to
  administer complex eligibility policies.
• Approximately 4.6 million lines of code
• 320 system interfaces
• 167 pieces of unique client correspondence
• 223 distinct reports State, Federal and
  Operational
• Eligibility and reporting requirements are
  always changing
• 977 application changes implemented in FY 2006
  impacting approximately 25 of TIERS
  application code.

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TIERS Deliverables

• TIERS will
• Replace multiple outdated existing automated
  systems with a single integrated automated system
  that uses state of the art technology to support
  eligibility determination process systems to be
  replaced include the 25 year old SAVERR mainframe
  system
• Ensure effective and efficient business processes
• Add process improvements to the face-to-face
  business model
• Improve client access to benefits and services
• Better coordinate service delivery for different
  HHS programs

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What is TIERS? How does it relate to IE?

• To date, TIERS
• Serves Texas Works and Long Term Care clients
  each month
• Texas Works Clients 220,993
• Long Term Care Clients 29,497
• Has successfully converted 678,296 clients from
  SAVERR to TIERS
• Has issued 415,670,421 in client benefits (Food
  Stamp and TANF)

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TentativeTimelines
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Timelines - CHIP

• Childrens Health Insurance Program (CHIP)
• Issue request for information May 31, 2007
• Issue final request for proposals December 2007
• Contract Award May 2008
• External review of contract June-August 2008
• Transition of services Completed by Jan. 2009

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Timelines - Enrollment Broker

• Enrollment Broker
• Issue request for information May 31, 2007
• Issue final request for proposals December 2008
• Contract Award December 2009
• Transition of services Completed by July 2010

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Timelines - Call center and Integrated
Eligibility Support

• Call Center and Integrated Eligibility Support
• Issue request for information May 31, 2007
• Issue final request for proposals December 2007
• Contract Award May 2008
• External review of contract June-August 2008
• Transition of services Completed by Jan. 2009

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Next Steps

• After defining tasks that will be contracted,
  HHSC
• will
• Develop an RFP
• Evaluate proposals
• Select appropriate vendors
• HHSC will continue to employ interim contracts to
  sustain client services during the
  procurement and
• transition period.

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Impact to State Employees

• The state workforce remains an essential part of
  the eligibility system.
• The statewide network of field offices will be
  maintained and staffed with state employees.
• HHSC continues to look for effective ways to
  manage the increasing workloads at local offices.
• The most effective workload management is to
  continue to modernize technology and to allow
  consumers to choose how to apply for services.

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Information Technology Process
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Federal Approval Guidelines

• Purpose of APD is to get Federal Funding for IT
  System Development.
• Written prior approval is required before
  releasing RFP, executing contracts or contract
  amendments that exceed thresholds.
• Feds have 60 days to review and respond.
• State must wait for approval before signing.

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Technology Solution
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Program OverviewChildrens Health Insurance
Program
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CHIP Overview

• The Health and Human Services Commission (HHSC)
  offer four separate children's health insurance
  programs
• Children's Medical Assistance (CMA)
• Childrens Health Insurance Program (CHIP)
• State Kids Insurance Program (SKIP)
• CHIP perinatal

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Program Descriptions

• CMA provides comprehensive health insurance for
  children under age 19. There are no enrollment
  fees or co-payments.
• CHIP provides health insurance for children under
  age 19 at a price that fits the budgets of Texas
  families.
• Recipients who work for a state agency and
  receive health insurance benefits from the
  Employee Retirement System (ERS) may qualify to
  receive SKIP. ERS provides a monthly SKIP
  supplement to eligible families to assist them in
  paying their insurance premium.
• CHIP perinatal provides health insurance to
  unborn children of non-Medicaid or non-CHIP
  eligible pregnant women. There are no enrollment
  fees or co-payments.

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CHIP Key Roles
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CHIP Key Roles
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Customer Care Center

• There are four Customer Care Center facilities,
  which can be accessed through a toll-free number
  where recipients obtain information on rules,
  application, or enrollment processes.

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Call Center Locations
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Customer Service

• Call centers include live assistance in English,
  Spanish, and Vietnamese.
• State field offices and call centers have access
  to a language line which provides telephone
  interpreters fluent in many languages.
• Call centers are equipped with Relay Texas or TDD
  lines.

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House Bill 109

• Makes the following changes to CHIP effective
  09/01/07
• Allows a child care deduction
• Requires a community outreach campaign
• Increases the asset limit and vehicle value
  exclusion amounts
• Requires eligibility to be determined based on
  net income

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House Bill 109

• Increases the enrollment period
• Requires an income check for certain households
• Redefines the 90 day wait period and who is
  subject to the wait
• Changes the cost share cap
• Changes to enrollment fee requirements

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Business Scope

• Summarize the approach and solution assuming a
  program operations and business audience.
• Describe the schedule and milestones required to
  implement your proposed business solution.
• Summarize your approach to implementing and
  operating effective
• call center operations
• document processing center, including
  inbound/outbound mail imaging of client
  documents creation and maintenance of electronic
  records
• CHIP eligibility determination with a full
  Medicaid screen
• printing operations as it relates to client
  correspondence and documents
• Describe process to identify and route case work
  appropriately.
• Identify trends in public policy in service
  delivery that may affect CHIP
• Identify best practices .
• Include options to eliminate barriers to
  eligibility or enrollment.

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DiscussionQ A