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Colorado Health Benefits Exchange

IT and Implementation Committee Strategic IT Decisions

January 4, 2012

RFP Discussion Topics1. Summary of Last Meeting

2. Overview of RFP Sections and Attachments

3. RFP Review Process and Release Timeline• COHBE• CMS/CCIIO

4. RFP Discussion Topics• Feasibility of 1-Year contract duration• Contractor facilities in metro-Denver during implementation

5. Master Services Agreement

6. Activities and Timelines• Pre-release of RFP• Post-release of RFP

7. Discussion Topics for 01/07 Board Meeting

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Summary of Last Meeting (12/21)

1. Decision to maintain minimum interoperability alternative rather than considering additional interoperability between Exchange and State system(s) and business processes

2. Option for COHBE to own CRM application

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Overview of RFP and Attachments

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Overview of RFP

• Section 1 Purpose, Points of Emphasis, Background and Concept of Operations: Contains an explanation of the RFP purpose, the project background, information on existing State of Colorado medical eligibility and a brief description of the vision of how COHBE will operate to fulfill its mission. Information on customers and key stakeholders is included in this section.

• Section 2 General and Administrative Information and Timeline: Contains mandatory Proposer qualifications, the Exchange Procurement Schedule, various Proposer instructions, implementation timeline and other items of interest to the Proposer.

• Section 3 Exchange Contact Center and Technology Project Scope: Contains information about the project goals, contract and term information, and a summary of the solution scope, including core functional scope, implementation and integration services scope, ongoing operations scope, organizational scope, and other scope considerations. Resources, facilities, and equipment to be provided by the Proposer are also discussed.

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Overview of RFP

• Section 4 Proposal Response: Contains proposal submission information, and instructions concerning how Proposers are to structure and format their proposals. Detailed preparation instructions are given for each section of both the Technical Proposal and the Cost Proposal. In this section instructions and guidance on describing the proposed solution component(s) including solution gaps, implementation services, operational capabilities, implementation and operational organizations, and other proposal requirements and considerations. Requested information on Proposer resources, facilities and required equipment are also discussed.

• Section 5 Proposed Master Services Agreement (MSA): Contains key terms and conditions to be incorporated into an MSA under which the Contractor shall perform the contract.

• Section 6 Contains the various forms that support the procurement process and the submission of a proposal.

• Appendices 1 – 19 (see RFP TOC)

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Overview of RFP

Section 4 – Proposal ResponseSection 3 – Services & Technology Scope

3.4.2.1 SHOP Exchange Technology Application, Implementation, Maintenance and Support and Hosting – Solution Components 2.A and 2.B

3.4.2.1.1 SHOP Exchange Application

3.4.2.1.2 SHOP Exchange Implementation (Appendices 1, 2, 4, 5, 6, 9, 10, 11, 17)

3.4.2.1.3 SHOP Exchange Maintenance and Support and Hosting

3.4.2.1.4 SHOP Business Development, Contact Center and Other Services

4.2.10.4 SHOP Exchange Application response

4.2.10.5 SHOP Exchange Implementation response

4.2.10.6 SHOP Exchange Maintenance and Support and Hosting response

4.2.10.7 SHOP Business Development, Contact Center and Other Services response

Sections 3 and 4 are closely related. Section 3 defines the scope (narrative and requirements) for specific solution components. Section 4 describes how the response (to the specific section) should be structured and what it should contain.

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RFP Review Process and Release Timeline

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RFP Review Process and Release Timeline

• 01/04 – 01/11 – 1st Review including CMS

• 01/12 – 01/16 – 1st Round Revisions

• 01/17 – 01/20 – 2nd Review including CMS

• 01/21 – 01/22 – 2nd Round Revisions

• 01/23 Release RFP

• 01/23 Begin acquisition “quite period”

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1. “Because of the work that we do (low-income advocacy), we are particularly concerned about the people who are on the cusp of Medicaid and Exchange eligibility and that people will be properly screened and directed both at initial application and during the year as their circumstances change. We have a lot of concern about people “ping-ponging” back and forth between Medicaid and the Exchange either due to changing life circumstances or due to an inability to determine eligibility for either. It is not only important that the vendor is knowledgeable about Medicaid, but also that the vendor have a workable plan for managing the space and activity between Exchange and Medicaid. In the interest of continuity, the vendor should be able to articulate a plan for managing life and income changes through the year that provides simplicity for clients and minimal disruption in coverage.

Will incorporated into points of emphasis and in Section 4 response re interoperability and incorporated into Requirement EL032

2. Among other Medicaid related concerns is the need for the Exchange to do a cursory screen for disability so that people who are more appropriately served through a Medicaid disability category rather than a MAGI (Medicaid or premium credit) category will be appropriately placed.

Incorporated into Requirement EL020

3. We understand that you are considering the experience of mixed households that have family members who would be potentially eligible for several affordability programs. But, it is also important to consider other types of mixed households that contain non-applicants (such as mixed immigration status families where the children are citizens and the parents are either legal permanent residents or undocumented). In these cases, there must be a way for non-applicants to apply for benefits on behalf of family members without having to provide social security numbers.

Incorporated into Requirement EL031

RFP Review Process includes Opportunities for Stakeholders to Provide Input, e.g.

- Colorado Center on Law and Policy

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RFP Discussion Topics

RFP Discussion Topics

1. Feasibility of 1-Year contract duration• Eventus (subcontractor) recommends eliminating one-year

duration option• Use strong performance, penalties and termination language

and measures to address underperformance• Leading vendor in Exchange marketspace indicates that cost

for a one-year contract will be unrealistically high

2. Requirement for Contractor(s) to establish some presence in Denver metro area primarily during implementation

3. Referenced UX 2014 design elements but no requirements to use

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Master Services Agreement

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Master Services Agreement (MSA)

• Drafted by attorney (Lise Hamilton) with Eventus (COHBE subcontractor)

• Approximately 75 pages

• Covers customer service and technology solution components

• May require multiple MSAs depending on contracting arrangements

• Needs input from COHBE in several areas, e.g. retention, performance, security, insurance, contingencies

• Statement of work (negotiated prior to award) will provide specifics re contract scope, resources, milestones, etc.

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Activities and Timelines

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Timeline – Pre-RFP Release

• Complete remaining RFP items:• Cost worksheets• Forms• Proposal preparation checklist• HCPF background section (comments from HCPF)

• Incorporate comments from multiple sources

• Prepare 2nd release 01/17

• Continue working with HCPF to coordinate Exchange and HCPF system and business process changes

• Develop RFP for additional PM & IT support services

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Timeline – Post-RFP Release

• Establish PMO

• Prepare for Pre-bid conference – 01/31/12 @ 10am

• Develop proposal evaluation process, evaluation worksheets, (generic) demo, orals and discovery scripts

• Respond to written vendor questions

• Begin preparing for CCIIO Architectural and Project Baseline reviews

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Background Material

COHBE Implementation and Start-up Timeline

19Note: Accompanying timeline for required enhancements to PEAK

& CBMS not shown

Analysis/Confirmation of Current Approach & Prel

RFP

High-Level Timeline – COHBE Policy & Business Decisions and IT

Procure IT Systems & Services for HIX

COHBE Certificationby HHS

11/11 01/12 03/12 05/12 07/12 09/12 11/12 01/13 03/13 05/13 07/13

2011 2012

HIXIntegration Testing

Design/Build/Test HIX Systems (Eligibility/Enrollment/Plan Mgmt and Associated Services Interface w/ Federal Data Hub, Other Data Sources, MMIS, PEAK/CBMS)

2013

Policy & BusinessDecisions and Activities

HIX - IndividualPilot Phase06/13 – 10/13

HIX Deployment

Policy & Business Decisions

Impacting IT

Supreme CourtRuling on Mandate

Evolving Policy and Business Decisions based on CCIIO/CMS/Board/Executive Director/Legislative Oversight/etc.

Start-up and Operational Decisions

Start-up Activities

Operational Activities

Analysis/Confirmation of Current Approach & Prel

RFP

IT/Systems

Procure IT Systems & Services for HIX

HIX SHOPIntegration TestingDesign/Build/Test HIX Systems for SHOP

HIX - SHOPPilot Phase04/13 – 10/13

HIX Deployment

Establish PMO

Draft COHBE Guiding Principles for Systems and Implementation

Category Guiding Principle

Exchange Functions, Features and Business Processes

Meet the minimal requirements of federal regulations; enhanced functions, features and integration will be considered in the future. New business processes to execute Exchange business processes shall minimize the impact to other State agencies’ business processes or systems.

Exchange Customers and Business Lines

Customers of the Exchange are individuals and small business owners and their employees.There will be a single Exchange. The Exchange will have two business lines: 1) the SHOP Exchange and 2) the Individual Exchange

Market Competition Encourage competition in the market whether it is inside or outside the Exchange.

Continuity of Care Ensuring continuity of care is a personal responsibility; the Exchange will not pro-actively enroll or change enrollments of consumers (i.e. individuals and small employers and their employees).

Integration with Medicaid

Minimize integration with Medicaid eligibility in the near-term; consider tight integration (and possible upgrade of State’s eligibility system) in long-term (i.e. 3-5 years); make investments based on this strategy. Send consumers to the “right” door first but enable cross (MAGI) eligibility determination.

Federal Deadlines Work with State Medicaid agency but do not jeopardize meeting federal and state deadlines.

Solution Acquisition Leverage existing solutions and solution components from other states and federal partners to the maximum extent possible.

Inter-agency Partnerships

Work in concert with all State agencies, e.g. HCPF, DHS, OIT and Insurance Department.

Regulatory Authority Maintain the Colorado Insurance Department as the single regulator.

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Role of IT and Implementation Committee

• Role is to provide guidance to COHBE executive leadership and early input into major strategic decisions such as IT investments, acquisition of services and Acquisition strategy

• These initial acquisition decision(s) will likely be in the order of tens of millions of dollars over the first 3 – 5 years

• Acquisitions will be structured to be competitive, fair and transparent

• Due to the political sensitivities and visibility surrounding the COHBE, it is important that there be no real or apparent conflicts of interest in Acquisitions activities and operational decisions

• Meet weekly leading up to the start of the formal acquisition process

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