1. Preliminary Discussions with IT and Implementation Subcommittee – Strategic IT Decisions November 21, 2011

2. Role is to provide guidance to COHBE executive leadership and early input into major strategic decisions such as IT investments, acquisition of services and procurement strategy These initial acquisition decision(s) will likely be in the order of tens of millions of dollars over the first 3 – 5 years Procurements 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 procurements activities and operational decisions 2

3. 1.Should the Exchange use a SAAS model or acquire (borrow/build/buy) the capital IT Exchange assets? – analysis framework provided 2.Should the Exchange consider the Federal partnership model? If so, for which of the core areas? – analysis framework provided 3.Should the State develop a vision and strategy for replacing or upgrading CBMS so that investments in modifying CBMS and PEAK to meet the requirements of healthcare reform are rationalized against the strategic direction? – Yes and analysis framework confirmed with HCPF After analysis frameworks (alternatives and criteria) are confirmed with COHBE Board, analysis will be completed and presented in mid-December COHBE “owns” #1 and #2 State (HCPF, DHS) “owns” #3 3

4. 4 Note: Accompanying timeline for required enhancements to PEAK & CBMS not shown

5. Schedule is extremely tight for a product release of this magnitude and complexity, i.e. 20 months until SHOP “go-live” Implementation dependencies with changes to CBMS and PEAK increase complexity and schedule risk Asset acquisition (with federal funds) likely to result in lower sustainability costs vs. SAAS model with lower upfront costs Three major components must be procured: Exchange technology solution (acquire/license or rent) Exchange technology solution hosting (outsource) Exchange administrative and customer support services (outsource) Procurements will be: Well-structured Efficient Competitive Fair Transparent Opportunities to coordinate solutions, procurements, etc., with other states is challenging and becomes more challenging daily; coordinating across states (and multiple state agencies for each state) in this political environment creates additional dependencies and increases execution risk Federal Exchange partnership model is not compatible with Colorado having its own Exchange 5

6. Exchange Alternatives SAAS Model COBHE Acquires Asset; Operated by 3 rd Party Criteria Cost Implementation 5-Year operations Risk Schedule risk Cost risk Consumer experience Reliability/simplicity in getting consumers enrolled Reliability/backend complexity of having all solution components fully functioning Ability to share solution components with CBMS Privacy and security Impact on COHBE operations/and alignment with ops plan Strategic direction and latitude Stakeholder acceptability 6

7. Should the Exchange use a SAAS model or acquire the IT Exchange assets and have the asset operated by a 3 rd party? 7 AlternativeDescription/ Functions CostRisk Consumer Experience Employer/ Employee (Richness of Features & Functionality Reliability/ Simplicity in Getting Consumers Enrolled Reliability/Back end Complexity of Having All Solution Components Fully Functioning Ability to Share Solution Componen ts w/ CBMS Privacy and Security Impact on COHBE Operations /and Alignment w/ Ops Plan Strategic Direction and Latitude Political Acceptability Implementati on Costs 5-Year Operationa l Costs Schedule Risk Cost Risk SAAS Model w/ or w/o shared rules engine Acquire Asset Operated by 3 rd Party Other-TBD

8. Eligibility Screening & Eligibility Determination MA/CHIP/PTC/RCS Enrollment HIX Customer A Plan Shopping & Selection Enrollment Carrier Systems State Systems/ Programs Customer B PEAK CBMS SNAP, TANF, MA/CHIP/MA ABD/LTC MMIS Federal and State Real-Time Data Exchanges MA/CHIP Eligibility Rules & Real-time Eligibility Decision Interoperability Layer What interoperability is feasible? 8

9. Considerations of Federally-facilitated Exchange: Cost of Federally-facilitated Exchange is TBD; likely to charge carriers HHS is responsible and accountable for ensuring the Exchange meets all of the standards; State role is limited Two proposed areas of partnership that can be operated by states as part of the agreement are Plan Management and some Consumer Services For Plan Management, State helps select plans and collects a standardized set of data on them to plug into Federally-facilitated Exchange's eligibility and enrollment functions. For Consumer Services, HHS coordinates with the State regarding plan oversight, including consumer complaints and issues 9

10. 2.Should the Exchange consider the Federal partnership model? If so, for which of the two optional areas?. Strategic IT Issues that Need to be Resolved 10

11. CategoryGuiding 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. 11