Home » Blog » Exchange Releases Draft IT RFP

Exchange Releases Draft IT RFP

California’s new eligibility and enrollment information technology (IT) system has been dubbed the “California Healthcare Eligibility, Enrollment, and Retention System” (CalHEERS). The IT system will serve as the Exchange’s infrastructure by storing eligibility information for the Exchange and other public programs and allowing people to receive real-time determinations. The project is a partnership between the Exchange, the Department of Health Care Services, and the Managed Risk Medical Insurance Board.

A few months ago, the Exchange Board contracted with the firm “ClearBest” to develop a Request For Proposals (RFP) for an IT vendor. Last night, the draft RFP was posted to their website. The RFP provides applicants with a basic framework, a scope of work, and a list of requirements related to creating this complex system. It reflected many of the comments previously submitted by stakeholders. Stakeholders will have until December 30 to submit comments and a final RFP will be released on January 18, 2012. With the help of ClearBest, the Exchange Board will select a final vendor by April 17, 2012.

The draft includes 6 sections and 19 attachments. Because of the short comment period that extends through the holidays, the Board suggested stakeholders focus on Section 1 (Introduction and Background), Section 4 (Vendor Scope of Work) and Attachment 3 (Requirements). In order to comment, visit the Exchange’s solicitation page, fill out the comment matrix, and submit one set of comments per organization to hbexsolicitation@hbex.ca.gov. Comments are due by December 30, 2011 at 5:00pm.

At yesterday’s Exchange Board meeting, Yolanda Richardson (Exchange Staff) and Dianne Koelzer (CalHEERS Acting Project Director) provided an overview of the draft RFP and emphasized how they addressed stakeholder input.

“No Wrong Door” Approach

Applicants may apply by phone, in person, online, or by mail. Applicants will be able to compare health plans in the Exchange, Medi-Cal, and Healthy Families and be able to select a plan that best meets their situation. Based on verified applicant information, CalHEERS will be able to do online, real-time eligibility determination for Modified Adjusted Gross Income (MAGI) Medi-Cal, Healthy Families, Access for Infants and Mothers (AIM), tax credits and cost sharing reductions through the Exchange, and the Basic Health Program (if enacted). The system will have role-based security that will allow self-service consumers, assisters, and program eligibility administrators to gain access to information.

Cultural and Linguistic Appropriateness

All modes of communication will be designated to meet the needs of the full range of customers, including non-English speakers and persons with disabilities. The system will conform to state and federal laws regarding accessibility.

First Class User Experience

Vendors will have to demonstrate their evaluations for user experience solutions, including the UX 2014 project.

Real-Time Eligibility Determinations

CalHEERS will have the technical capabilities to do online, real-time eligibility determination for Modified Adjusted Gross Income (MAGI) Medi-Cal, Healthy Families, Access for Infants and Mothers (AIM), tax credits and cost sharing reductions through the Exchange, and the Basic Health Program (if enacted).

Consistent Rules

CalHEERS will provide consistent eligibility determinations based on verified applicant information. The determinations will be provided to applicants with simple language explaining the results. Results will also be shared with the Exchange’s interface partners, if needed.

Reduce Consumer Burden

CalHEERS will to automatic re-determinations of annual eligibility based on current applicant data. This will require interfacing with federal and/or state systems.

Ensure Transparency and Accountability

CalHEERS will produce data, reports and performance information for program evaluation in order to ensure continuous improvement in business operations, transparency and accountability. There will also be a single rules engine to determine eligibility.

Minimize Administrative Tasks for Employers

Employers must be able to create and update an employee roster through an online application process. CalHEERS will ensure employers can update their accounts.

We at ITUP look forward to sharing our own comments with you within the next few days.

Tags: ,