ENTITY MANAGEMENT TRAINING COURSE INSTRUCTIONS

To Complete Training

• This training will take approximately 30min to complete

• For questions email: [email protected]

2 DEFINITIONS

Definitions • Certified Entities includes entities affiliated with any of these Enrollment Assistance Programs: * Navigator Program (NAV) * Certified Application Counselor Program (CAC) * Medi-Cal Managed Care Plan Program (MMCP)

• Certified Counselor includes: * Individuals affiliated to any of the entities

• CC: Covered California

3 TABLE OF CONTENTS

1. Introduction a. Enrollment Assistance Program Overview 2. Phase 1: Becoming an Active Certified Entity with Certified Counselors a. Steps to Becoming an Active Certified Entity b. Steps to Becoming a Counselor, including: • Training • Fingerprinting and Background Check c. Roles and Responsibilities 3. Phase 2: Understanding Consumer Service and Enrollment Assistance Support a. Consumer Service and Enrollment Assistance Support b. Systems and Resources

As part of this training process, the Primary Contact of the Entity will be required to attest that they clearly understand the requirements associated with becoming an Entity.

4 PROGRAMS OVERVIEW 1. CERTIFIED APPLICATION COUNSELOR (CAC) 2. NAVIGATOR PROGRAM (NAV) 3. MEDI-CAL MANAGED CARE PLAN (MMCP) WHAT IS THE CERTIFIED APPLICATION COUNSELOR PROGRAM Certified Application Certified Counselor (CAC) Program Application Counselor The CAC program is for entities interested in Program assisting consumers to enroll in Covered California’s Health Plans and other insurance affordability programs.

CAE: An entity or individual registered by Certified Covered California to oversee CACs who provide Application Entity one-on-one consumer assistance. A CAE is not eligible to receive compensation for enrollments.

CAC: An individual who is certified by Covered California and affiliated with a CAE, to provide Certified face-to-face, one-on-one consumer assistance. Application Counselor

6 WHAT IS THE NAVIGATOR PROGRAM

Navigator Program

The Navigator (NAV) program engages trusted Certified Enrollment Entities (CEE) to conduct Navigator Program outreach, education, enrollment assistance, renewal assistance and post enrollment services on behalf of Covered California.

NAV Grantees: A Grantee will provide Outreach & Education, Enrollment, Renewal and Post Navigator Grantees Enrollment activities as well as Enrollment Assistance.

Navigator: A Certified Enrollment Counselor (CEC) who is affiliated with a Certified Enrollment Entity that is registered in the Navigator Program. Navigator

7 WHAT IS THE MEDI-CAL MANAGED CARE PLAN ENROLLMENT ASSISTANCE PROGRAM Medi-Cal Managed Care Plan (MMCP) Program Medi-Cal Managed Care Plan Program The MMCP Program is for entities contracting with the Department of Health Services (DHCS) to provide health care services to those enrolled in Medi-Cal Medi-Cal Managed Care MMCP: An entity contracting with the DHCS to provide health care services to enrolled Medi-Cal Plan beneficiaries.

MMCPE: An individual that is an employee or contractor of a Medi-Cal Managed Care Plan who Medi-Cal provides enrollment assistance pursuant to this Managed Care agreement. Plan Enroller

8 PROGRAM REGULATIONS

It is your duty to carefully review and understand all contents within the program regulations and the Entity Agreement, independent of this training.

The California Health Benefit Exchange established the Certified Application Counselor Program within Title 10 of the California Code of Regulations. The regulations that govern your organization’s relationship with Covered California are available using the following web links: • CAC: http://hbex.coveredca.com/regulations/index%20-%20Certified%20Application%20Counselors.shtml • Navigator: http://hbex.coveredca.com/regulations/index%20-%20Enrollment%20Assistance.shtml • MMCP: http://hbex.coveredca.com/regulations/index%20-%20Medi-Cal%20Managed%20Care.shtml

Entity Agreement A copy of your fully executed agreement will be available for download on the online system, In-Person Assistance System (IPAS): https://ipas.ccgrantsandassisters.org. Any updates to the Agreement will be published and communicated by Covered California to you and your Entity.

9 PHASE 1: BECOMING AN ACTIVE ENTITY WITH COUNSELORS OVERVIEW OF THE PROCESS TO BECOME ACTIVE

This section of the training will focus on steps needed to prepare your organization to perform enrollment assistance on behalf of Covered California. The following process shows the steps needed for Entities to become Active:

Entities can build a Counselor team roster by adding individuals’ names to the application in the IPAS application If you have questions about adding Counselors to your roster, uploading the Counselor agreement or their photograph into IPAS, please contact: [email protected] The Entities Primary Contact (you) must complete this Entity Management Training prior to any of your affiliated Counselors carrying out any consumer assistance functions.

11 NOTIFICATION ONCE AN ORGANIZATION IS ACTIVE

An Entity becomes Active when the following (3) requirements are met:

1. The Primary Contact has completed the Entity Management Training

2. The Entity has uploaded the Entity Management Completion Form and Conflict of Interest Prevention Plan to their “My Files” in IPAS:

3. The Entity has at least one fully certified Counselor

Once, these requirements have been met, the Primary Contact for the Entity will receive an email from [email protected] with the subject: “Your Entity CoveredCA.com login credentials” Expect to receive this email within 3-5 business days after your entity has

become Active. 12 STEPS FOR COUNSELORS TO BECOME CERTIFIED OVERVIEW OF THE STEPS TO BECOME CERTIFIED

The following graphic outlines how individuals affiliated to your Entity will become a Certified Counselor:

Note: the background check/fingerprinting process may happen concurrently with training, individuals do not need to complete these steps in sequence.

Individuals should begin both steps as soon as possible.

Individuals who are currently active and certified with another Entity will not need to complete the training and background clearance process again.

14 COUNSELOR TRAINING REQUIREMENTS CERTIFICATION TRAINING OVERVIEW

Counselors will receive login credentials to the Learning Management System (LMS) once their application is submitted and approved in IPAS. All training components are located in the LMS at https://learning.coveredca.com.

Counselor logs in to the LMS and accesses the appropriate Counselor Certification Training

Completes the Computer- Based Training courses online

Passes the Counselor exam

16 TRAINING CURRICULUM

Courses for Counselor Certification Training:

1. Introduction to the Affordable Care Act 2. Introduction to Health Insurance 3. Covered California for Small Business 4. Understanding Your Role 5. Eligibility for Individuals and Families 6. Covered California Plan Options 7. Privacy, Security and Compliance 8. The Application Process 9. Application Updates

*Recertification Training is required annually.

17 FINGERPRINTING AND BACKGROUND CHECK PROCESS FOR INDIVIDUALS CRIMINAL BACKGROUND CHECK AND FINGERPRINTING OVERVIEW

Remember that the background check is not dependent on training completion. Counselors should begin background check and complete training as soon as possible.

The Entity Primary Contact (PC) downloads the forms: The background check requires Counselors to complete two forms provided by the PC, and available in IPAS: 1. (2 copies) Request for LiveScan Service (fingerprinting) 2. Criminal Disclosure Form

Forms are available in IPAS. PCs click the “Download Forms” link next to each Counselor applicant’s name. The link will only appear when the Counselor’s application has been fully completed.

19 COMPLETING THE LIVESCAN FORM

You will print TWO pre-populated Request for Live Scan Service forms and provide to the Counselor. The Counselor will complete the remaining blank fields.

Counselors must use Covered California approved service locations. Live Scan sites for the Covered California approved vendor can be located at: https://www.applicantservices.com/CapitalLiveScan/Liv eScan_Locations

Covered California pays the fingerprinting fees for individuals applying to become Navigator or CAC Enrollment Counselors.

1. For MMCP Counselors. The entity shall pay fingerprinting fees for individuals applying to become enrollment counselors.

2. The Counselor schedules an appointment at his/her chosen Covered California approved fingerprinting location and brings two completed prepopulated Live Scan Forms. MMCP Counselor applicants shall pay for fingerprinting service when rendered. 20 COMPLETING CRIMINAL DISCLOSURE FORM

1. An individual applying to become a Counselor must also complete the Criminal Disclosure Form. The form is available for download in IPAS using the download forms link in your Counselor roster. This form is to be completed by the individual applying to become a Counselor. **The Entity may not assist in this process.

2. Entity personnel are NOT allowed to process, view, collect, or mail this disclosure form for the individual. ONLY the individual completing the Criminal Disclosure Form may view, mail, or fax the form.

3. Faxed to: (916) 228-8905 (preferred)

Or

4. Mailed to: HBEX/California Health Benefit Exchange CONFIDENTIAL – BACKGROUND CHECKS Office of Legal Affairs 1601 Exposition Blvd. Sacramento, CA 95815

21 FINAL STEPS FOR COUNSELORS

Receiving the Delegation Code Once an entity has completed all requirements (see slides 11 and 12), a Counselor applicant becomes Certified when the following requirements are met: 1. Cleared background check 2. Completed all training requirements 3. Passed certification exam 4. Badge photo uploaded to counselor profile

Within 3 – 5 business days after becoming Certified, the Counselor will receive an email from [email protected] with a delegation code and additional information to create an account on the web-based enrollment portal, CoveredCA.com.

22 IDENTIFICATION BADGES

Counselors will receive an ID badge 5-7 business days after they are certified. Before a badge can be issued, Entities must upload a headshot photo in the Counselor’s application in IPAS. The photo must be taken from the shoulders up and have a plain background. The following images are appropriate badge photos:

The Entity will guarantee that its affiliated Counselors wear ID badges issued by Covered California at all times when providing consumer assistance. Counselors are required to show the ID badge to consumers before they provide enrollment assistance.

23 ROLES AND RESPONSIBILITIES MEETING PROGRAM EXPECTATIONS

Roles and responsibilities covered in this section apply to both Entities and Counselors. Under the guidance of the Entities, Counselors are expected to: • Provide information about available Covered California Health Plans and financial help in the form of premium assistance and cost-sharing reductions. • Explain the enrollment options available on CoveredCA.com. • Educate consumers about the value of health insurance and answer their questions. • Inform consumers about premium costs and the benefits of obtaining health insurance coverage. • Provide consumers with support and access to tools and resources that assist in comparing costs, benefits and coverage options. • Assist eligible consumers with enrollment into Covered California Health Plans and/or other Insurance Affordability Programs, to include Medi-Cal. • Provide information about consumer assistance hotlines and resources, such as the Medi-Cal ombudsman, and the Office of Patient Advocate.

25 PROHIBITED ACTIVITIES

The Entity will ensure that affiliated Counselors NEVER: • Fail to disclose conflicts of interest • Coach the consumer to provide inaccurate information on the application • Coach or recommend one plan or provider over another • Accept premium payments from the consumer • Pay any or part of the premium or any other type of consideration to or on behalf of the consumer • Induce or accept any type of direct or indirect remuneration from the consumer • Intentionally create multiple applications from the same household • Invite, influence, or arrange an individual to separate from employer- sponsored plan

26 COMPLIANCE STANDARDS

 The Entity is accountable for and must comply with Covered California’s fraud prevention policies  The Entity and any of its affiliated Counselors must not have had a criminal case filed or a legal pleading issued, or have been convicted of a felony or been implicated in a complaint, related to the business of insurance or to issues of fraud or moral turpitude  The Entity must report to Covered California, within 30 days, any incidence of fraud or any new criminal case filed or legal pleading issue related to the business of insurance, or to issues of fraud or moral turpitude

Failure to report a known instance of fraud may result in PERMANENT termination of the Entity

27 PRIVACY AND SECURITY STANDARDS

California, Title 10, Article 11 §6864 (a) (4) requires compliance with federal law pertaining to handling and safeguarding a consumer’s personally identifiable information. What information must be protected? • Personally Identifiable Information (PII) • Protected Health Information (PHI) • Federal Tax Information (FTI) Elements of protected information are required as part of the enrollment process. Entities and Counselors who assist consumers will discuss, view and, if necessary, input this information into a Covered California enrollment application. PII is information that can be used to distinguish or trace an individual’s identity, either alone or when combined with other personal or identifying information. The following are examples of PII: • Name • Age • Birthplace • Social Security Number • Date of Birth • E-mail Address

28 PROTECTED HEALTH INFORMATION AND FEDERAL TAX INFORMATION PHI whether verbal or written: 1. Is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearing house (e.g., a 3rd party medical biller); and 2. Relates to the past, present or future physical or mental health or condition of an individual; or past, present or future payment for the provision of health care to an individual FTI is information from the Internal Revenue Service (IRS), contained in federal tax returns, including: – any tax information – declaration of estimated tax – claim for refund – a taxpayers’ identity – the nature, source or amount of income, payments, receipts; deductions, exemptions, credits, assets, liabilities, net worth, tax liability, tax withheld, deficiencies, over-assessments, or tax payments – Other information related to a tax return 29 PRIVACY AND SECURITY SAFEGUARDS

Key Safeguarding Practices: • Establish policies related to appropriate/prohibited access, use and disclosure of PII, PHI and FTI • Communicate the policies to Counselors, staff and colleagues • Monitor Counselor compliance with policies • Reinforce Covered California training on protecting information

Counselors shall never: • Disclose or transmit PII/PHI/FTI over unsecure medium (e.g., email, phone) or in a public venue • Discuss PII/PHI/FTI with anyone other than the person who is the subject of the information • Ask for, or use, a consumer’s Covered California account log-in information without their authorized consent • Unnecessarily retain any PII/PHI/FTI • Directly access the Consumer’s Covered California account rather than through the designated Counselors account

30 USING COVERED CALIFORNIA MARKETING AND COLLATERAL MATERIAL – CAC AND NAVIGATOR

Utilizing collateral material will help your Entity enrollment services. It is important to use consistent, branded materials and messages to maintain the integrity of the Covered California program.

 The Entity must use approved materials with Covered California branding (e.g., tablecloths, banners and signs) when conducting Counselor activities  The Entity must maintain adequate supplies of collateral materials and compliance with established policies with Covered California marketing/branding guidelines available on CoveredCA.com at: http://hbex.coveredca.com/toolkit/  Entities can order materials via the online Print Store which will be discussed later in this course

31 PHASE 2: UNDERSTANDING CONSUMER SERVICE AND ENROLLMENT SUPPORT OVERVIEW OF PHASE 2

In this section the training will focus on what to do AFTER your organization is Active and your counselors are Certified.

The topics we will review in this phase include:  Understanding how to support and provide enrollment assistance services to consumers  How to utilize Covered California websites, systems and resources so you and your team can be successful

33 DELIVERING ENROLLMENT ASSISTANCE SERVICES

Under the oversight of the Entity, Counselors are expected to:

• Utilize the CoveredCA.com web-based portal to assist consumers with completing and submitting their application for health care coverage in Covered California health plans and Medi-Cal • Educate consumers regarding first payment requirement to enroll in a Covered California health plan • Refer, when appropriate to consumer assistance hotlines, such as ombudsman, Department of Mental Health Care, Office of Patient Advocate, Plans, Department of Social Services, and the Covered California Service Center • Assist consumers with annual renewal applications during open enrollment periods and special enrollment applications utilizing the CoveredCA.com web-based enrollment portal.

* Consumers may enroll outside of the open-enrollment period through a special enrollment due to a qualifying life event, such as: birth or adoption, marriage, change in residence, loss of a job.

34 HOW TO HELP YOUR TEAM BE SUCCESSFUL

Use these helpful hints to ensure your Counselors are empowered and effective: • Develop and train Counselors on internal processes • Provide Counselors with the necessary resources to be effective in their role • Participate in identifying and building local partnerships for collaborative enrollment efforts • Develop a list of resources in your community • Determine networking contacts that could support outreach and education efforts • Identify already scheduled events in the community that may be leveraged and brainstorm underserved populations that may be eligible

35 NON-DISCRIMINATION

Entities and affiliated Counselors should never act in a manner that discriminates on the basis of:

• Race, ethnicity, gender, age, national origin, or religion • Mental or physical disability • High or low-income areas • Health status • Newly eligible beneficiaries over other beneficiaries • Claims experience, genetic information, or evidence of insurability To ensure that consumer assistance is accessible to people with disabilities:

• Provide enrollment resources, websites and tools that are accessible to individuals with disabilities • Provide assistance in a location and manner that is physically and otherwise accessible • Maintain knowledge to refer people with disabilities to long term services and support programs when appropriate 36 BUILDING CULTURAL COMPETENT ASSISTANCE PROGRAMS Supporting consumers with culturally and linguistically appropriate services is a fundamental requirement of Covered California. As you build your enrollment assistance population, make sure you and your Counselors are:  Identifying community organizations that the entity may be able to partner with for community outreach  Developing and maintaining general knowledge about racial, ethnic and cultural groups  Providing consumers with information and assistance in the consumer’s preferred language when appropriate  Receiving ongoing education and training in culturally and linguistically appropriate service delivery  Implementing strategies to recruit, support and promote a staff that is representative of the demographics of the target communities  Maintaining an inventory of printed materials from Covered California in the languages necessary to support target markets (ordering printed materials will be discussed later in this course)

37 SYSTEMS AND RESOURCES UNDERSTANDING THE SYSTEMS USED FOR COVERED CALIFORNIA

There are four (4) systems that will be important for Entities to become familiar and utilize for their work with Covered California.

These systems include: 1. In-Person Administrative System (IPAS) 2. CoveredCA.com (CalHEERS) 3. Learning Management System (LMS) 4. Covered California Print Store

39 IN-PERSON ADMINISTRATIVE SYSTEM (IPAS)

The IPAS homepage also houses additional information and resources for Entities and their affiliated Counselors. The IPAS homepage is: https://ipas.ccgrantsandassisters.org/ Frequent this page regularly as new information is uploaded to the IPAS homepage often. Entity Status Board The Entity status board is available in IPAS and allows the entity to track the certification process of all individuals in their counselor roster as well as report changes. To view your Entity Status board, simply login to your IPAS account and click on the speedometer icon as shown:

*Questions related to IPAS should be sent to: [email protected] 40 COVEREDCA.COM

CoveredCA.com, also known as the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS).

This system is the online portal that allows individuals and small businesses to sign up for health care coverage through Covered California or Medi-Cal. The Counselors affiliated with your Entity will use this system to enroll consumers in Covered California. Entities will use this system to monitor Counselor enrollment activities. Questions on CoveredCA.com should be directed to the Certified Representative Help Line at: 1-855-324-3147

41 LEARNING MANAGEMENT SYSTEM (LMS)

This system is an online training site used to administer and track Counselors training and examination progress. The LMS can be accessed at: https://learning.coveredca.com As the Primary Contact you will not have access to this system unless requested. However, it is important that you understand its purpose to help you better manage your Counselors certification progress. Questions regarding LMS should be directed to: [email protected]

42 PRINT STORE RESOURCES

For CAC and NAV Covered California provides printed and other collateral materials available for purchase through: http://360.kpcorp.com/coveredca/Login.aspx Once a Entity becomes active on CoveredCA.com, the Primary Contact (or IPAS user) will receive Print Store credentials from Covered California. Entities are allotted an annual budget to purchase collateral materials. Budget amounts are based on funding availability. Amounts allotted to each Entity can be found online in the Entity Print Shop account.

Questions related to the Print Shop should be directed to: [email protected]

For Print Shop User ID/Login assistance e-mail: [email protected]

***The Print Store Resources are not available for the MMCP. 43 ADDITIONAL INFORMATION AND RESOURCES

PRIMARY POINTS OF CONTACT:

ENTITY/COUNSELOR HELP LINE at 1-855-324-3147 8:00 a.m. – 6 p.m.  General CoveredCA.com questions and system errors  CoveredCA.com login issues Call center line dedicated to  CoveredCA.com Entity dashboard Entities and Counselors. Provides  Interpreting CoveredCA eligibility results support related to:  Troubleshooting all issues with CoveredCA new applications, change requests for current applications, and renewals of applications  CoveredCA Counselor PIN resets COVERED CALIFORNIA SERVICE CENTER: 1-800-300-1506 Covered California operated call  All Counselor Helpline issues that arise outside of the business hours center, supporting activities of the Counselor Helpline related to: E-MAIL SUPPORT FOR CERTIFICATION: [email protected]  Adding or withdrawing Counselors from an entity To assist Entities/Counselors in  Reporting changes to an entity’s contacts or sites activities related to:  Updating the “Find Help Near You” information on CoveredCA.com  Counselor certification status COUNSELOR TRAINING HELP DESK: [email protected] Email dedicated to assist  Learning Management System (LMS) access Counselors in activities related to:  Training requirements, status and progress PRINT STORE RESOURCES HELP DESK: [email protected] Active Entities can purchase Access the print shop at: http://360.kpcorp.com/coveredca/Login.aspx marketing material to support enrollment assistance services.

44 ADDITIONAL INFORMATION AND RESOURCES (CONT.)

KEY PROGRAM RESOURCES AVAILABLE ON IPAS

Program Resource Page Program home page that list a wealth of program resources, including: Job Aids, FAQs, Welcome to Answers and other important https://ipas.ccgrantsandassisters.org/ information Program Webinars Index of all program webinar and topic areas covered, includes links Index of all program webinars to webinar recording and presentation slides Community Partner Communications Index These newsletters are equipped with the latest program updates, resources and announcements related to Entities and Counselors Community Partner Communications and their role with Covered California. Index

COUNSELOR INFORMATION Certified Application Counselor Required form, Counselors must submit Application/Agreement Counselors MUST submit completed pre-populated form to Covered Criminal Disclosure Form California. The Primary Contact of the affiliated entity retrieves and provides this pre-populated form to the counselor. Counselors MUST submit copies of the pre-populated Official Live Scan Request Form to a Covered California approved Live Scan Live Scan Request Form location. The. Primary Contact of the affiliated entity retrieves and provides these pre-populated Official Live Scan Forms to the counselor. Locate nearest Covered California approved location for Live Scan Live Scan Locations processing

Contact Live Scan at (877) 888-8802 or Email or call with questions re: fingerprinting or background check Email by Clicking Here 45 ADDITIONAL INFORMATION AND RESOURCES (CONT.)

OTHER RESOURCES

Federal health care reform www.healthcare.gov

Office of the Patient Advocate www.opa.ca.gov

The Centers for Medicare and Medicaid Services’ Center for Consumer Information and Insurance http://cciio.cms.gov/ Oversight

California Health Benefit Exchange www.healthexchange.ca.gov

Department of Managed Health Care (DMHC) and www.dmhc.ca.gov its programs

California Department of Insurance www.insurance.ca.gov

46 RECEIVING CREDIT FOR COMPLETING THIS TRAINING NEXT STEP

Next Steps (1 of 2): Click on the underlined text to download and complete the Entity Management Training Completion Form

Upload the completed form to My Files in IPAS (see screen shot below)

48 NEXT STEPS

Next Steps (2 of 2): Click on the underlined text to download: • Conflict of Interest Prevention Plan Instructions • Conflict of Interest Prevention Plan Template

Upload the completed template to My Files in IPAS (see screen shot below)

49 THANK YOU

This concludes the Entity Management Training.

Thank you for your participation!

For additional questions, please email: [email protected]

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