Health Center Outreach and
Enrollment (O/E) Quarterly
Progress Report (QPR) Training
October 9, 2013
1
Agenda
– Introduction
– Timeline
– Reporting Expectations
– O/E QPR Definitions
– Reporting Scenarios
– EHB Considerations
– Resources
2
Timeline
• Revised Health Center O/E QPR sample available at
http://bphc.hrsa.gov/outreachandenrollment/
• O/E QPR for Reporting Period 7/1/2013 – 9/30/2013
– UPDATED October 16, 2013 – Health Center O/E QPR is
available in the EHB
– October 24, 2013 (11:59 p.m. ET) – Due date for
submission of the Health Center O/E QPR
• Future O/E QPR Reporting Periods
– 10/1/2013 – 12/31/2013 (available in early January)
– 1/1/2014 – 3/31/2014
– 4/1/2014 –6/30/2014
3
Focus of Quarter 1 Reporting:
Number Trained, Issues and
Lessons
Health Center Outreach
and Enrollment (O/E)Learned
Quarterly Progress Report (QPR) – SAMPLE FORMAT
10/8/2013 10:05 AM
1. O/E Activities
1a.
Current
reporting
period
Cumulative
Total
Number of health center O/E assistance workers that have successfully
completed all required federal and/or state training.
1b. Number of assists provided by a trained health center O/E assistance
worker.
1c.
Number of applications submitted to the Marketplace with the
assistance of a trained health center O/E assistance worker.
1d. Estimated number of individuals enrolled with the assistance of a
trained health center O/E assistance worker.
2. Issues/Barriers (for the current reporting period only)
Describe any major outreach and enrollment issues/barriers you have encountered.
Required; up to 1500 characters (1/2 page)
3. Key Strategies and Lessons Learned (for the current reporting period only)
Describe key strategies and lessons learned that have contributed to the success of your outreach and
enrollment efforts.
Required; up to 1500 characters (1/2 page)
4
Expectations
• O/E QPR is required for all heath centers that received the
O/E supplemental funding (regardless of progress made
with O/E activities during the reporting period)
– Failure to submit the O/E QPR will result in the entire
H80 grant being placed on draw restriction
• HRSA does not expect health center O/E assistance
workers to make significant efforts (e.g., follow-up calls) to
determine whether an assisted individual has enrolled.
• The narrative section of the report provides the opportunity
to describe issues that have created barriers to or have
facilitated O/E activities.
5
Expectations
• HRSA does not require health center O/E assistance
workers to track assistance by name or any other personal
identifier.
• Duplicate reporting (e.g., counting assistance with the same
individual on different days) is appropriate.
– If health center O/E assistance workers want to record
information in order to facilitate follow-up with an
individual assisted who plans to return, they should
follow the health center’s policies and procedures for
protecting personally identifiable information and any
guidelines provided in the training process or required by
law.
6
How the Marketplace Works
7
Health Center O/E QPR
• The Health Center O/E QPR consists of the following items
that must be reported to HRSA:
– Number of O/E assistance workers trained
– Assists provided
– Applications submitted
– Estimated number of individuals enrolled
– Issues/Barriers – narrative section
– Key Strategies and Lessons Learned – narrative section
8
O/E QPR Definitions: Number
Trained
• Who to Report as Number Trained
– Number of health center O/E assistance workers that
have successfully completed all required federal and/or
state training to assist with enrollment in the Marketplace
o Include all trained health center staff, contractors, and
volunteers
o Include all appropriate assister types, e.g., Certified
Application Counselor (CAC), Navigator, in-person
assister.
– If there are barriers in your state have prevented staff
from getting training, note that in the issues/barriers
section of the O/E QPR.
9
What to Report as an “Assist”
• What to Report as Number of Assists Provided
– Report assistance by session for the number of
individuals who will benefit from O/E assistance
– Report sessions in which assistance is provided for any
part of the enrollment process, e.g.,:
o Assessing consumer needs
o Assessing consumer knowledge
o Education about basic insurance topics
o Creating an account
o Updating an account profile
o Submitting a Marketplace application
o Understanding eligibility determinations for the Marketplace, Medicaid,
or CHIP
o Selecting a plan
10
What to Report as an “Assist”
• Number of Assists Provided (continued)
– Do not report mass mailings, conference calls, group
presentations, or other education and outreach that do
not allow for customizable messages.
11
What to Report as an “Assist”
•Understanding benefits of and process for submitting a health coverage (i.e., QHP,
Medicaid/CHIP) application
Assistance
Assistance
•Creating an account
Applications
Submitted
•Submitting application to the Marketplace
•Understanding Marketplace verification information and/or eligibility determination*
Estimated Number
Enrolled
•Selecting a QHP
•Submitting information for enrollment in Medicaid or CHIP
•Confirming enrollment in the Marketplace, Medicaid or CHIP
*Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing
reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state)
12
What to Report as “Applications
Submitted”
• Understanding benefits of and process for submitting a health coverage (i.e., QHP,
Medicaid/CHIP) application
Assistance
Assistance
• Creating an account
Applications
Submitted
• Submitting application to the Marketplace
• Understanding Marketplace verification information and/or eligibility determination*
Estimated Number
Enrolled
• Selecting a QHP
• Submitting information for enrollment in Medicaid or CHIP
• Confirming enrollment in the Marketplace, Medicaid or CHIP
*Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing
reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state)
13
What to Report as “Applications
Submitted”
• Number of Applications Submitted
– Report number of applications submitted by the number
of individuals represented in the application
o Include all applications submitted to the Marketplace
with the assistance of a trained O/E assistance
worker.
o Report in the “number of applications submitted” the
total number of individuals included in the application
submission.
o Count both paper and electronic applications.
14
What to Report as an “Estimated
Number Enrolled”
•Understanding benefits of and process for submitting a health coverage (i.e., QHP,
Medicaid/CHIP) application
Assistance
Assistance
•Creating an account
Applications
Submitted
•Submitting application to the Marketplace
•Understanding Marketplace verification information and/or eligibility determination*
Estimated Number
Enrolled
•Selecting a QHP
•Submitting information for enrollment in Medicaid or CHIP
•Confirming enrollment in the Marketplace, Medicaid or CHIP
*Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing
reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state)
15
What to Report as “Estimated
Number Enrolled”
• Estimated Number of Individuals Enrolled
– Report estimated number of individuals enrolled for the
number of individuals who will be covered by the
enrollment
– Include individuals that are assisted with any of the
following:
o Selecting a Qualified Health Plan (QHP).
o Submitting enrollment information for Medicaid or CHIP.
o Confirming enrollment in the Marketplace, Medicaid or CHIP.
16
What to Report as “Estimated
Number Enrolled”
• Estimated Number of Individuals Enrolled (continued)
– Health centers in states with systems that allow health
center O/E assistance workers to track their facilitation of
enrollment, report enrollment as captured by that state
system.
– In states that restrict or prohibit health center facilitation
of enrollment:
o Health centers should report to HRSA only those
activities that are permitted (e.g., number trained,
assists, and/or applications submitted).
o Please explain the state limitations in the narrative
portion of the O/E QPR.
17
Summary
• Understanding benefits of and process for submitting a health coverage (i.e., QHP,
Medicaid/CHIP) application
Assistance
Assistance
• Creating an account
Applications
Submitted
• Submitting application to the Marketplace
• Understanding Marketplace verification information and/or eligibility determination*
Estimated Number
Enrolled
• Selecting a QHP
• Submitting information for enrollment in Medicaid or CHIP
• Confirming enrollment in the Marketplace, Medicaid or CHIP
*Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing
reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state)
18
O/E QPR Definitions
• Issues/Barriers
– Provide clear and specific issues/barriers, such as:
o Difficulties in hiring health center O/E assistance
workers.
o Challenges in organizational certified application
counselor designation and/or training staff
19
O/E QPR Definitions
• Key Strategies and Lessons Learned
– Provide clear and specific key strategies and lessons
learned, such as:
o Health center educational events that attracted lots of
people.
o Successful collaboration with other health centers
and providers in the service area.
o Lessons learned that will inform activities in the next
reporting period and/or potentially assist other health
centers nationwide.
20
Scenarios—One Session
In one session an individual :
• Sets up an account,
• Submits an application, and
• Selects a qualified health plan with the assistance of a trained
health center O/E assistance worker.
The health center should report:
– 1 assist (one assist since there is only one session)
– 1 application submission (assistance resulted in an application
submission in the same session)
– 1 estimated enrollment (assistance resulted in an estimated
enrollment in the same session)
21
Scenarios—One Session
• Understanding benefits of and process for submitting a health coverage
(i.e., QHP, Medicaid/CHIP) application
Assistance
Assist
• Creates an account on 10/15/2013
Applications
Submitted
• Submits an application to the
Marketplace on 10/15/2013
• Understanding Marketplace verification information and/or eligibility
determination*
Estimated Number
Enrolled
• Selects a QHP on
10/15/2013
*Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing
reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state)
22
Scenarios—Multiple Sessions
An individual receives assistance from a trained health
center O/E assistance worker in three separate sessions.
• In session 1, the individual sets up an account.
• In session 2, the individual submits an application
• In session 3, the individual selects a qualified health plan.
The health center should report:
– 3 assists (one assist for each session)
– 1 application submission (session 2 = 1 assist + 1 application
submission)
– 1 estimated enrollment (session 3 = 1 assist + 1 estimated
enrollment)
23
Scenarios
• Understanding benefits of and process for submitting a health coverage
(i.e., QHP, Medicaid/CHIP) application
Assistance
Assist
• Creates an account on 10/15/2013
Applications
Submitted
• Submits an application to the
Marketplace on 10/17/2013
• Understanding Marketplace verification information and/or eligibility
determination*
Estimated Number
Enrolled
• Selects a QHP on
10/21/2013
*Assisting with understanding eligibility for QHP enrollment, premium tax credits, cost-sharing
reductions, Medicaid/CHIP eligibility or initial Medicaid/CHIP assessment (depending on state)
24
Scenarios—One Consumer
Represents Multiple Family
Members
An individual is assisted in a single session to set up an
account, submit an application and enroll her family
(herself and two children) in affordable insurance.
Health centers should report assistance, application
submission, and estimated enrollment by the number of
individuals who will benefit from O/E assistance.
The health center should report:
– 3 assists (to represent all family members assisted in the
session)
– 3 application submissions (to represent all family
members included in the application)
– 3 estimated enrollments (to represent all newly covered
family members)
25
Scenarios—Medicaid-Only
Enrollment Assistance
Prior to October 1, 2013, an individual is assisted to
submit a Medicaid application by a health center staff
person that has been trained to facilitate Medicaid
enrollment, but has not yet completed all required federal
and/or state training for assisting with enrollment through
the Marketplace.
• Individuals who have assisted with Medicaid/CHIP eligibility
and enrollment can continue to do so and report
accordingly.
• These individuals should NOT be included in the total
number O/E assistance workers trained.
The health center should report:
• 1 assist
• 1 application submission
26
O/E QPR – EHB Process
• Accessing the O/E QPR in EHB
– You must have a user account in the HRSA Electronic
Handbook (EHB).
– Your user account must be associated with your
organization.
– You must have the health center H80 grant in your
portfolio.
– You must have the “Edit” or “Submit” access permission
(as appropriate) for Progress Reports from the project
director (PD) for the grant.
27
O/E QPR – EHB Process
• Submitting the O/E QPR
– You must have the “Submit” access permission from the
project director (PD) for the grant to submit the QPR.
– For help with grant registration and access permissions,
see Grants Access and Registration FAQs at:
https://help.hrsa.gov/display/public/EHBSKBFG/Grants+
Access+and+Registration+FAQs
28
O/E QPR – EHB Process
• O/E QPR
– The O/E QPR will be listed as an incomplete submission
in the Pending Tasks – List in the Tasks section of the
health center’s H80 grant folder
– The submission will be entitled O/E Quarterly Progress
Report
– The O/E QPR consists of two forms
o Contact Information - Health centers should identify the person
who will be best positioned to respond to any HRSA questions about
the O/E QPR submission.
o O/E form
29
O/E QPR – EHB Process
• O/E QPR
– Complete both the Contact Information and O/E Form
portions of the O/E QPR
– Review the QPR information before submitting to HRSA
– Once all sections of the O/E QPR are marked as
complete, you will click the Submit button to open the
confirmation page
30
O/E QPR – EHB Process
• HRSA may request changes to the O/E QPR if:
– the data provided do not have sufficient narrative
information to describe the situation (e.g., 0 trained staff
but the issues/barriers narrative does not identify why)
– the narrative portions do not provide sufficient details to
provide a reasonable understanding of the
issues/barriers or strategies/lessons learned for the
reporting period
31
Resources
• PCA Contact List
– http://bphc.hrsa.gov/technicalassistance/partnerlinks/associations.html
• BPHC O/E Team Inbox
– [email protected]
• BPHC O/E supplemental funding technical assistance
website
– http://bphc.hrsa.gov/outreachandenrollment/
• BPHC Helpline – EHB or other technical issues
– 1-877-974-2742
– [email protected]
32
Questions?
33