Individual Experience Advisory Group August 7, 2012

2 Agenda Welcome & Introductions10 min Policies75 min – Navigators Review consensus from 1 st and 2 nd discussions – Overview of SHOP Recommendations on Broker relationships and compensation – Uniform Enrollment Application and Data Elements Wrap-up 5 min

3 Consensus Areas on Navigator Program 1. The Navigator Program, Navigator Entities and people servings as Navigators should be clearly defined. 2. Certified Navigator entities will be expected to have the capacity to provide both education and enrollment services to their target populations. 3. Some organizations should be allowed to provide education/outreach services, and not enrollment, to help facilitate higher enrollment into the Exchange. A distinction should be made between these groups and certified navigators. 4. Under the umbrella of the state-wide Navigator program, COHBE should develop distinct programs for the Individual Exchange and the SHOP Exchange. However, the group said they believed navigator organizations should be able to be certified to provide services to small businesses for SHOP should they want to do so.

4 Consensus Areas on Navigator Program 5. A competitive grant process would be a good approach to use in the selection of navigator entities and it should build in evaluation for outcomes that include quality measures and completed enrollment by number. 6. Support offering grants of different amounts for groups depending on what they do - if they are certified enrollment grantees, assistors or education/outreach groups. Initial grants will likely be larger for navigators to build up their systems. 7. The grant system should consider needs of Colorado including: – regional coverage, – meeting the needs of consumers new to insurance/diverse groups, – be culturally competent, – include grantees who can provide outreach in different ways

5 Consensus Areas on Navigator Program 8.There should be one centralized training program for all navigator entities to ensure consistent and standardized training across the state. 9. Navigator organizations should be expected to complete ongoing education, especially as the Exchange changes. 10. Training should include considerations for cultural needs throughout the state – must have people who speak different languages and have people who can communicate with people with disabilities 11. Preference to keep certification with Exchange, not DOI. 12.There should be ongoing oversight of Navigators to determine whether they are meeting consumer expectations, as well as enrolling individuals.

6 Consensus Areas on Navigator Program 13. Background checks may be necessary should Navigators be taking personal info (like SSNs) 14. Evaluation of Navigators should be conducted quarterly during the initial implementation of the Exchange. 15. COHBE should conduct a needs assessment to inform the development of the Navigator program that incorporates feedback from stakeholders and the Board.

7 Essential Questions SHOP AG discussed about the role and relationship with brokers: − How will COHBE partner with brokers? − Will brokers be appointed and certified? Will brokers need to be appointed with all of the carriers on the Exchange? Should COHBE try to develop a process to simplify becoming appointed with all carriers? − Will brokers be compensated and if so, how? Should all plans offer the same commission in the Exchange?

8 General Recommendations from SHOP AG on Broker Relationships and Compensation − COHBE should partner with brokers. − In addition to current DOI licensing, brokers should be certified to sell through the Exchange, both initially and ongoing. − This certification process should enable brokers to sell all plans for all carriers in the Exchange. − Individuals should NOT be required to use a broker. − The broker compensation structure should be the same inside and outside the Exchange. Commission rates would continue to be set by the carriers for plans sold on and off the Exchange.

9 Uniform Enrollment Application Starting October 2013 there will be one application through which individuals may apply for coverage through the Exchange or a Medicaid or CHIP agency and receive an eligibility determination. Specific data must be collected to make such determinations and enroll qualified individuals into the appropriate coverage program.

10 Upcoming policy topics Customer Service Center Aug/Sept Consumer Rights & ResponsibilitiesSept