December 01, 2017

The Silver State Health Insurance Exchange, Nevada’s Affordable Care Act health insurance marketplace, is requesting information about an integrated online health insurance exchange platform and associated consumer assistance center. This request is being issued in anticipation of a transition towards operation as a State Based Marketplace effective November 1, 2019, to provide enrollment in Qualified Health Plans with coverage effective January 1, 2020.

The Request for Information (RFI) document can be downloaded using the following link: NV_SSHIX_RFI_2017-12-01.pdf


December 29, 2017

Questions and Answers

Responses to submitted questions are provided below.

Questions for Part One: Health Insurance Exchange Platform

Question 1: Will NV consider the future exchange solution as another door for applying for Medicaid? In this event, most states have cost allocation between Medicaid and Exchange to accommodate processing of applications for Medicaid. Does NV have any such cost allocation and how much revenue is expected through this?

Response to Question 1: The solution is intended only to assess potential Medicaid eligibility and not to process Medicaid applications, therefore the Exchange does not anticipate cost allocations.

Question 2: Is the system expected to include only health plans, or would it also include dental, vision etc. insurance plans?

Response to Question 2: The solution is expected to offer both Qualified Health Plans and Stand Alone Dental Plans, with the potential to accommodate additional ancillary or innovative health care products as appropriate.

Question 3: Does NV have enrollment projections for 2018 given CSR rollback and increased premiums? Also, has NV created enrollment projection in the event individual mandate is repealed?

Response to Question 3: Plan selections for 2018 totaled 91,003 (source: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-12-28.html), which represents an increase over the 2017 total of 89,061, even in spite of the CSR rollback and increased premiums. While it’s difficult for the Exchange to predict the impact of uncertainty regarding the individual mandate, historical trends suggest that approximately 85% of consumers with plan selections–or approxiamtely 77,000 individuals–will effectuate their 2018 policies.

Question 4: Does the “Single Streamlined Application” need to be customized for QHP applications only? Or Does the state want to collect information for eligibility determination for other Medicaid programs as well?

Response to Question 4: The solution is intended to assess potential Medicaid eligibility and will therefore require the full, non-customized Single Streamlined Application. However, Medicaid eligibility determinations will continue to be issued by the Nevada Division of Welfare and Supportive Services (DWSS).

Question 5: What level of integration with the state Medicaid agency system is expected? Example: Sharing of enrollment information between systems for eligibility determination, sharing of FDSH services with the Medicaid agency, real time checks to confirm if someone is already enrolled in Medicaid (vice-versa), Medicaid eligibility rules, Single Sign On between NV-HIX and State Medicaid agency system,  Data transfer capability for enhanced user experience etc.

Response to Question 5: In order to minimize the risk of disruption to existing business processes the solution is expected to interface with the Medicaid system in precisely the same manner as the current integration with healthcare.gov. Data transfers between the system would be limited to the Account Transfer BSD, which would include data from the FDSH. Single Sign On is not a requested feature for the solution.

Question 6: Has NV decided to keep premium aggregation in or out of exchange functionality?

Response to Question 6: Regarding the optional aggregation of individual premiums, the solution is not expected to collect premiums from individuals for the purpose of paying an aggregated sum to QHP issuers.

Regarding the required aggregation of SHOP premiums, HHS’ Notice of Benefit and Payment Parameters for 2019 advises that, “State-based Exchanges would be given the flexibility to… take advantage of the proposed regulatory flexibilities to design a SHOP that best meets the needs of the small group market in their state” (source: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/Proposed-2019-HHS-Fact-Sheet.pdf, page 2). SHOP functionality has not been included in the RFI because the Exchange is currently exploring which option would be the most efficient choice for Nevada’s market. If applicable, detailed requirements for SHOP functionality–including premium aggregation–will be included in the Exchange’s forthcoming RFP document.

Question 7: How many calls is NV anticipating to serve for Medicaid clients? Is NV open to outsource the call center operations to another vendor (i.e. other than the Systems Integration vendor)?

Response to Question 7: Nevada has received no data from CMS regarding Medicaid caseload in the healthcare.gov call center, which would be required to make such a projection. The intent of the RFI is to explore all possible options for call center operations.

Question 8: Has NV considered outreach implication in the event FFM does not share data for conversion?

Response to Question 8: While CMS has expressed a willingness to assist Nevada with its transition to operation as a State Based Marketplace the Exchange is nonetheless exploring a contingency plan for this scenario. However, the Exchange is not currently seeking a vendor proposal for this outreach and messaging effort.

Question 9: Does NV have a set budget of  $1 million for the Design, Development and Implementation of the Exchange solution, and $5.8 million per year for the ongoing M&O of the exchange solution and call center operations?
Note: The budget information mentioned in this question is as per the publicly available information ( Source: https://www.fiercehealthcare.com/payer/centene-fine-nevada-private-exchange-northam-medicaid)

Response to Question 9: The amounts listed were derived from multiple vendor quotes and were calculated only to provide a baseline for spending authority requests. Annual operating expenses for the solution must provide a net cost savings versus healthcare.gov, inclusive of all functions currently handled by the federal exchange.

Question 10: Does NV know how many correspondences are sent out to current enrollees annually? Is the printing cost and processing cost part of anticipated vendor solution and budget?

Response to Question 10: The Exchange is able to estimate correspondence volume based on enrollment and effectuation figures. While correspondence costs have not been included in the RFI the solution must provide a net cost savings versus healthcare.gov, inclusive of print correspondence. The ideal solution would minimize both the sending and receiving of print correspondence by offering extensive consumer/partner self-service options, including direct upload of supporting documents. Detailed information on correspondence requirements will be included in the Exchange’s forthcoming RFP document.

Question 11: Does NV have any plans to implement SHOP? RFI only refers to individual exchange so we assume that NV plans to only include individual exchange in RFP. Please confirm.

Response to Question 11: HHS’ Notice of Benefit and Payment Parameters for 2019 advises that, “State-based Exchanges would be given the flexibility to… take advantage of the proposed regulatory flexibilities to design a SHOP that best meets the needs of the small group market in their state” (source: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/Proposed-2019-HHS-Fact-Sheet.pdf, page 2). SHOP functionality has not been included in the RFI because the Exchange is currently exploring which option would be the most efficient choice for Nevada’s market. If applicable, detailed requirements for SHOP functionality will be included in the Exchange’s forthcoming RFP document.

Question 12: Does the Exchange have any ACA eligibility standards or regulations that are unique to the Silver State Exchange?

Response to Question 12: The Exchange is currently bound only by the eligibility standards and regulations defined in the Affordable Care Act. No additional exchange functions are currently required by Nevada state law, however the ideal solution would flexible enough to offer innovative health care products other than QHPs and SADPs, or to accommodate state-specific changes to eligibility standards which might occur in the future.

Question 13: Can the Exchange confirm that when a consumer application fails a HUB check and receives a Data Matching Issue that the Exchange plans to adjudicate those within the federal regulatory guidelines?

Response to Question 13: Yes, the solution is expected to handle data matching issues in a similar manner to the federal platform (as defined on healthcare.gov at https://www.healthcare.gov/verify-information/), including support for direct upload of verification documents. The Exchange plans to adjudicate such cases within federal regulatory guidelines.

Question 14: Can the Exchange define what they mean by “a single, streamlined application”?

Response to Question 14: As defined in 45 CFR 155.405 (https://www.law.cornell.edu/cfr/text/45/155.405) a single, streamlined application must gather all information necessary for enrollment in Medicaid, CHIP, or a QHP, including the calculation of APTC and CSR benefits.

Question 15: Is SSHIX interested in leveraging mobility and mobile applications for consumers, assisters/brokers and workers or mainly interested in a web based platform?

Response to Question 15: The Exchange does not consider these options to be mutually exclusive; the ideal platform would be web-based and would provide a responsive, highly-optimized front end for desktop or mobile devices of all types. The Exchange is not interested in platform-specific applications (such as Android or iOS apps) at this time.

Question 16: Does SSHIX need to capture application and enrollment information for Medicaid customers and perform Medicaid Eligibility determination and transfer enrolled customers to the DWSS systems, or just do a Medicaid Eligibility Assessment in the SSHIX system and transfer customers to the DWSS systems.

How does SSHIX want to handle mixed households that have members with Medciad/CHIP as well as QHP/APTC/CSR?

Response to Question 16: The solution is intended only to assess potential Medicaid eligibility and not to process Medicaid applications. Medicaid eligibility determinations will continue to be issued by the Nevada Division of Welfare and Supportive Services (DWSS).

In order to minimize the risk of disruption the solution is expected handle mixed households in precisely the same manner as the federal platform. However, information on innovative solutions for handling mixed households is welcomed and encouraged.

Question 17: Has DWSS or another agency in Nevada implemented any integration with the Federal Data Services Hub, and does this need to be reused in any way for this platform?

Response to Question 17: The Nevada Division of Welfare and Supportive Services (DWSS) maintains Nevada’s authority to connect to the FDSH. The solution will be required to share this connection with DWSS. However, information on innovative solutions for FDSH verification which do not require a state-specific authority to connect is welcomed and encouraged.

Question 18: Does SSHIX require the platform to implement single sign on with the DWSS consumer and/or worker systems?

Does SSHIX require the platform to use existing security infrastructure at DWSS for authentication and access control?

Response to Question 18: Single sign on with the DWSS system is neither requested nor desired at this time. The ideal solution would include a propreitary, self-contained system for user authentication and authorization.

Question 19: What languages does SSHIX require to be supported on the consumer facing and worker facing platforms?

Response to Question 19: The preferred solution would be capable of supporting consumer-facing interfaces in English, Spanish, and Tagalog, as well as a worker-facing interface in English. The ideal solution would also provide broker- and partner-facing interfaces in English and Spanish.

Question 20: What is the total expected number of members in the system?

Response to Question 20: The initial configuration should be capable of servicing 100,000-125,000 individual QHP consumers.

Question 21: Does SSHIX need to comply with any specific standards, certifications or mandates, such as HIPAA Compliance?

Response to Question 21: The solutions is expected to fully comply with all state and federal regulations regarding accessibility, as well as the secure processing and retention of PII and FTI. The solution is not expected to process or retain Protected Health Information as defined in HHS’ Privacy Rule, for example data regarding utilization of health care services.

Question 22: Does SSHIX have any restrictions regarding what Cloud Hosting services/vendors can be used?

Response to Question 22: Nevada law does not restrict the Exchange’s choice of cloud hosting service providers, however the ideal solution would be hosted with a service provider who has already received FedRamp certification.

Question 23: Does SSHIX need the system to be developed on premises in Nevada, or can the vendor do the development at their development center?

Response to Question 23: For clarification, the Exchange is seeking a proven solution which has previously demonstrated successful operation as a state based health insurance marketplace under the Affordable Care Act, therefore we are not seeking a solution for which a significant development effort would be necessary. However, the Exchange understands that a certain amount of customization will be required for Nevada’s specific needs, and it is not a requirement that the IT personnel completing this work be located in Nevada.

Question 24: In relation to Section 1 B, can you share the CMS Blueprint DRAFT document as to how CMS will approve eligibility flow with Nevada Division of Welfare and Supportive Services (DWSS),  and  your transition off FFM (gate reviews)?

Response to Question 24: The Exchange is not currently at liberty to share the Exchange Blueprint document due to its unapproved draft status.

Question 25: In relation to Section 3 F and G, in your system’s current state, how do you expect to handle Medicaid failures?

Response to Question 25: The Exchange is unsure of what specific condition is being referred to as a “Medicaid failure.” Part one, Section 3 (F & G) is intended to gather information on innovative solutions for processing inbound Account Transfers. The Exchange is particularly interested in minimizing orphaned account transfers from consumers who end up enrolling in a QHP, as these cases complicate consumer messaging efforts aimed at improving churn management between the two systems.

Question 26: In relation to Section 6  C, Is there an option for a seasonal call center that could flux operations during periods of heavy member activity?

Response to Question 26: The intent of the RFI is to explore all possible options for call center operations. Novel or innovative solutions for managing peak-demand periods are welcomed and encouraged.

Questions for Part Two: Consumer Assistance Center

Question 27: How many personnel/staff does NV currently have to support the FFM operations, and what is the vision on the new staffing for NV to support the SBM?

Which all user groups are expected to use NV exchange solution? Will the Eligibility Workers work on the NV HIX solution?

Response to Question 27: The Exchange does not currently employ any individuals whose sole responsibility is supporting FFM operations, however we anticipate that additional staff members will be necessary to support our operation as a State Based Marketplace. The ideal solution would provide dedicated user interfaces for all Exchange staff and customer service user roles—in addition to carrier, broker/agency, navigator/enrollment partner, and consumer self-service interfaces—each accessing a single, common data store; it would also minimize staffing requirements by automating routine tasks related to eligibility determinations/redeterminations, program integrity, and carrier reconciliations, and by providing extensive self-service options for consumers and partners.

Question 28: Because we do not know the anticipated service levels that would be required under a contract with the Silver State Health Insurance Exchange (SSHIX), the staffing levels could vary widely. Is the SSHIX asking about the staffing levels where the proposed solution is already installed?
Please be aware that service level expectations, what agents would be required to perform (i.e. full applications over the phone or just assistance/status updates), and expected scripting/consumer services will vary between state contracts with various vendors.

Response to Question 28: Yes, the Exchange is asking for a proportional estimate, corrected for the relative difference in caseload/population, based upon current operations where the proposed solution is already installed.

Question 29: The questions in Part 2 of the RFI focus on the respondent’s solution for the SSHIX, but there does not appear to be a section where the solution for the SSHIX should be described. Please clarify where the solution should be briefly described.

Response to Question 29: For Part 2 of the RFI, the responses to Section 1: Personnel and Infrastructure should describe the operational aspects of the solution. The combined responses to Section 2: Technology and Section 3: Integration with Exchange Platform should described the technological aspects of the solution.

Question 30: There is some confusion on this request, as section 155.202 does not appear in 45 CFR. Can the Exchange please clarify the Subpart and section (i.e. 45 CFR, Subpart C, 155.200 (f),(2)) it is referring to?

Response to Question 30: The Exchange regrets to confirm that this was a typographical error; the intended reference was to 45 CFR 155.200 – Functions of an Exchange, exclusive of subsection (f).

Question 31: Does SSHIX require the call center to be established in Nevada or can the vendor use their existing call center which may be out of State

Response to Question 31: The intent of the RFI is to explore all possible options for call center operations. Responses from vendors who maintain out of state call centers are welcome.

General Questions

Question 32: Can the Exchange confirm the provision of these services/systems at the federal level satisfy the experience criterion?

Response to Question 32: The Exchange is seeking a solution that will offer an improved user experience versus the federal platform to consumers, exchange staff, support staff, enrollment partners, and carriers. The ideal solution would provide extensive consumer/partner self-service options, automation of reconciliation and program integrity tasks, and comprehensive reporting of individualized consumer data.

Question 33: Does your funding source for this effort provide any constraints regarding your solution? For example, could you purchase services on a transaction basis or do you need ownership of a technology platform?

Response to Question 33: No specific constraints are provided by the funding source, however the solution is expected to offer a net cost savings versus the federal platform. The intent of the RFI is to explore a wide variety of licensing and service-level options; ownership of a technology platform is not a requirement.

Question 34: Does the Exchange currently have its own mailroom solution or is that of interest in the response as well?

Response to Question 34: The Exchange does not currently operate a mailroom solution. While correspondence costs have not been included in the RFI the solution is expected provide a net cost savings versus healthcare.gov, inclusive of print correspondence. The ideal solution would minimize both the sending and receiving of print correspondence by offering extensive consumer/partner self-service options, including direct upload of supporting documents. Detailed information on correspondence requirements will be included in the forthcoming RFP document.

Question 35: Does the Exchange want a full SHOP solution as well? Or are they looking to place that work with the carriers per proposed CMS guidance?

Response to Question 35: HHS’ Notice of Benefit and Payment Parameters for 2019 advises that, “State-based Exchanges would be given the flexibility to… take advantage of the proposed regulatory flexibilities to design a SHOP that best meets the needs of the small group market in their state” (source: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/Proposed-2019-HHS-Fact-Sheet.pdf, page 2). SHOP functionality has not been included in the RFI because the Exchange is currently exploring which option would be the most efficient choice for Nevada’s market. If applicable, detailed requirements for SHOP functionality will be included in the Exchange’s forthcoming RFP document.

Question 36: Can the Exchange confirm it plans to do a soft launch prior to November 1, 2019 in an attempt to incrementally implement the new solution?

Response to Question 36: The Exchange plans to do a soft launch in Q3 of 2019 to facilitate plan certification and data conversion/import activities.

Question 37: Would the potentially successful bidder be expected to provide eligibility related correspondences?  Does the platform need to have the ability to auto generate correspondences?

Response to Question 37: While correspondence costs have not been included in the RFI the solution must provide a net cost savings versus healthcare.gov, inclusive of print correspondence. The ideal solution would minimize both the sending and receiving of print correspondence by offering extensive consumer/partner self-service options, including direct upload of supporting documents. Detailed information on correspondence requirements will be included in the forthcoming RFP document.

Question 38: Please provide the most recent forecast/projections for QHP enrollees, including projected premiums.

Response to Question 38: Plan selections for 2018 totaled 91,003 (source: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-12-28.html), which represents an increase over the 2017 total of 89,061. Historical trends suggest that approximately 85% of consumers with plan selections–or approxiamtely 77,000 individuals–will effectuate their 2018 policies.

Approved 2018 heatlh insurance rates for Nevada, including 2018 QHP premium amounts, are available on the Nevada Division of Insurance’s website at: http://doi.nv.gov/News_Notices/Press_Releases/Approved_2018_Health_Insurance_Rates_are_Now_Available_to_the_Public/.

Question 39: How will ongoing system enhancements be budgeted?  If significant changes are needed in the system, is additional funding available?

Response to Question 39: The Exchange is seeking a proven solution which has previously demonstrated successful operation as a state based health insurance marketplace under the Affordable Care Act, therefore we are not anticipating that ongoing system enhancements will comprise a significant portion of the Exchange’s operating budget. The preferred solution would either incorporate those software maintenance costs required to keep the platform in compliance with changing ACA regulations into the base cost structure agreement, or it would divide such costs among member states as part of a shared platform agreement. The preferred solution would also utilize a cloud-based hosting provider so that hardware and hosting costs, including scalability for peak periods of utilization, can be incorporated into the base cost structure agreement. Funding for state-specific enhancements or feature requests which aren’t part of the Exchange’s Legislatively Approved budget would require approval from Nevada’s Interim Finance Committee.

Question 40: Does the new platform require a  SHOP marketplace?

Response to Question 40: HHS’ Notice of Benefit and Payment Parameters for 2019 advises that, “State-based Exchanges would be given the flexibility to… take advantage of the proposed regulatory flexibilities to design a SHOP that best meets the needs of the small group market in their state” (source: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/Proposed-2019-HHS-Fact-Sheet.pdf, page 2). SHOP functionality has not been included in the RFI because the Exchange is currently exploring which option would be the most efficient choice for Nevada’s market. If applicable, detailed requirements for SHOP functionality will be included in the Exchange’s forthcoming RFP document.

Question 41: What is Nevada’s plan for dealing with premium aggregation?

Response to Question 41: Regarding the optional aggregation of individual premiums, the solution is not expected to collect premiums from individuals for the purpose of paying an aggregated sum to QHP issuers.

Regarding the required aggregation of SHOP premiums, HHS’ Notice of Benefit and Payment Parameters for 2019 advises that, “State-based Exchanges would be given the flexibility to… take advantage of the proposed regulatory flexibilities to design a SHOP that best meets the needs of the small group market in their state” (source: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/Proposed-2019-HHS-Fact-Sheet.pdf, page 2). SHOP functionality has not been included in the RFI because the Exchange is currently exploring which option would be the most efficient choice for Nevada’s market. If applicable, detailed requirements for SHOP functionality–including premium aggregation–will be included in the Exchange’s forthcoming RFP document.

Question 42: Has Nevada confirmed with the FFM that data will be shared for the conversion?

Response to Question 42: While CMS has expressed a willingness to assist Nevada with its transition to operation as a State Based Marketplace the Exchange is nonetheless exploring a contingency plan in the event that the Exchange is unable to obtain a high quality data export. Novel or innovative proposals for this contingency are welcomed and encouraged.

Question 43: Does Nevada anticipate Medicaid enrollee auto renewal to be performed through the exchange’s new platform? If a platform currently processes Medicaid eligibility and enrollment and provides a hand-off to the Medicaid agency, would this function need to be rebuilt.

Response to Question 43: The Exchange does not anticipate Medicaid enrollee auto-renewal to be performed through the new platform. Medicaid eligibility determinations, including periodic redeterminations, will continue to be issued by the Nevada Division of Welfare and Supportive Services (DWSS).

Question 44: Does Nevada expect the new system to serve as an additional door for Medicaid?

Response to Question 44: The solution is intended only to assess potential Medicaid eligibility and not to process Medicaid applications. Medicaid eligibility determinations will continue to be issued by the Nevada Division of Welfare and Supportive Services (DWSS).

Question 45: Some states encourage brokers to be an active part of the advice and enrollment process, in others, the exchange prefers to run enrollment directly and minimize the broker role. Can you describe your stance with respect to brokers in some detail please?

Response to Question 45: In recognition of the significant value that the broker/producer community offers to Nevada’s consumers the Exchange began a broker store front pilot program in 2017 for the purposes of facilitating and promoting assisted enrollment. During the Plan Year 2018 Open Enrollment period the Exchange certified and partnered with over 100 producers, and one staff position within the Exchange is dedicated entirely to the ongoing coordination, development, and program monitoring of the broker/producer community. The Exchange plans to continue working closely with this network to ensure that Nevadans maintain their access to free, in-person assistance with the selection of QHPs appropriate for their individual or family needs.

Question 46: What is the percentage of passive renewals that the exchange experienced during the 2018 open enrollment season?

Response to Question 46: While the total number of plan selections for Open Enrollment has been reported at 91,003 (source: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-12-28.html) CMS has not yet publicized what share of that total resulted from passive renewals.

Question 47: What is the percentage of enrollments executed by brokers during the 2018 open enrollment season?

Response to Question 47: While the total number of plan selections for Open Enrollment has been reported at 91,003 (source: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-12-28.html) CMS has not yet publicized what share of that total was executed by brokers.

Question 48: Can you please provide the volume of calls the FFM call center received during the 2017 and 2018 Open Enrollment seasons from NV residents? What was the average handling time (duration) of each call?

Response to Question 48: Nevada has received no data from CMS regarding state-specific call volume in the healthcare.gov call center, nor any data regarding average call duration. The Exchange’s internal records indicate that our on-site customer assistance center handled 6596 calls during the 2017 Open Enrollment period (11/01/16-01/31/17), and 4172 calls during the 2018 Open Enrollment period (11/01/17-12/15/17), but without comparable data from the healthcare.gov call center we are unable to calculate what share of the total call volume from Nevadans is processed by each location.

Question 49: Do you operate a customer support center that augments the FFM call center today? If yes, can you please describe what its focus is? Can you please provide the call volume, assuming you expect the respondent’s call center to provide the same customer support call center services?

Response to Question 49: The Exchange operates a consumer assistance center which is located within the Exchange’s Carson City, NV, facility. The focus of this operation is to provide basic consumer education and first-tier assistance with consumer complaints. During Plan Year 2017 the consumer assistance center processed just over 25,000 individual cases using it’s customer relations management system; approximately 30% of these cases resulted in referrals (i.e. warm transfers) to the healthcare.gov call center, and approximately 12% of these cases resulted in referrals to the state Medicaid agency (DWSS).

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