Blueprint Certification

Federal law required Minnesota to file an application by November 16, 2012 to the U.S. Department of Health and Human Services (HHS), showing that Minnesota can or will meet the 12 requirements of how our exchange will operate. It was not necessary that Minnesota have all decisions on the exchange set in place at that time. Rather, the application documented which requirements Minnesota had achieved, and provided a plan and timeline for completing all remaining requirements.

HHS provided a step-by-step template that outlined the requirements for certification:

Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges

On December 19, 2012, HHS granted conditional approval to the state to open a Minnesota health insurance exchange. See the news release and view the letter from HHS to the Governor.

Application Documents

A number of documents were submitted as part of the Blueprint Certification Application. In addition to a declaration letter, each of the twelve sections were presented with a section cover page and supporting documents.

Declaration Letter

1.0 Legal Authority and Governance

Section Cover Page

1.1: Enabling Authority
- Included within cover page

1.2: Board and Governance Structure
- Included within cover page
2.0 Consumer and Stakeholder Engagement and Support

Section Cover Page

2.1: Stakeholder Consultation
      - White Paper

2.2: Tribal Consultation
      - Tribal Consultation Policy
      - Work Group Meetings and Agenda
      - Tribal Resolutions

2.3: Outreach and Education
      - White Paper
      - 2012 Integrated Marketing Communications Plan
      - Public Education and Outreach RFP
      - Public Education and Outreach Market Research Report
      - Salter Mitchell Contract
      - Himle Rapp Contract
- Outreach-Education Marketing Materials

2.4: Call Center
- Contact Center Summary

2.5: Internet Website
      - Included within cover page
- Technical Infrastructure Contract -see drop-down section below
      - End-to-End Business Process Models - see drop-down section below
- Project Management Plan
      - IT Gap Analysis

2.6: Navigators / 2.7: In-Person Assistance Program / 2.8: Agents/Brokers
      - White Paper
      - Current Landscape
      - Service Levels and Training, Certification & Licensing
      - Recommendations to the Advisory Task Force
      - Presentation to the Advisory Task Force

2.9: Web Brokers
      - Included within cover page
3.0 Eligibility and Enrollment

Section Cover Page

Referenced in multiple 3.0 sections:
- Technical Infrastructure Contract -see drop-down section below
      - End-to-End Business Process Models - see drop-down section below

3.1: Streamlined Application for Individual and SHOP
      - Single Streamlined Application Data Elements
      - Application Form Policy Analysis

3.2: Coordination Strategy between Insurance Affordability Programs and SHOP
      - MACCSA Fall Conference Presentation
      - RACI
      - HIX/DHS Inter-Agency Agreement
      - Medicaid Eligibility and Enrollment Work Groups
      - Inter-Agency Coordination

3.3: Applications, Updates, Acceptance, Processing and Re-Determination Responses
      - Included within cover page

3.4: Notices, Data Matching, Re-Determinations
      - Renewals Overview Policy Analysis
      - Medicaid Renewal Timeline

3.5: Verifications
      - Verifications Overview Policy Analysis
      - Verification Procedures

3.6: Document Acceptance and Processing
      - Included within cover page

3.7: Eligibility Determination
      - Minnesota Policy Documents by Topic
      - SSN Policy Analysis
      - Possible IAP Eligibility Determination in Minnesota - Medicaid Path
      - Access WG Criteria for Adult Coverage
      - Expansion Options Presentation

3.8: Eligibility Determination for APTC and CSR
- QHP Enrollment Period Policy Analysis

3.9: Applicant and Employer Notification
      - Client Notice Policy Analysis

3.10: Individual Responsibility Requirement and Payment Exemption Determinations
      - Individual Mandate Overview Policy Analysis
      - Personal Exemption Verification Policy Analysis

3.11: Eligibility Appeals
      - Eligibility Appeals Work Description
      - Appeals Process Flows
      - Citation to the State Laws Describing DHS

3.12: QHP Selections/Terminations and APTC/Advance CSR Information Processing
      - Calculating the Advance Premium Tax Credit

3.13: Electronically Reporting Results of Eligibility Assessments and Determinations
- Included within cover page

3.14: Pre-Existing Condition Insurance Plan (PCIP) Transition Procedure
      - Minnesota will use the federal plan
4.0 Plan Management

Section Cover Page

Qualified Health Plans (QHPs) Certification Requirements
      - referenced in multiple 4.0 sections

4.1: Appropriate Authority to Perform and Oversee Certification of QHPs
- Included within cover page

4.2: QHP Certification Process
- White Paper
- State Certification Process Diagram
- SERFF Process Diagram
- MDH and Commerce Regulatory Bulletin

4.3: Plan Management Systems/Process to Support Collection of QHP Issuer and Plan Data
        - White Paper
      - Technical Infrastructure Contract, Exhibit A
      - IT Process Flow

4.4: Ensure Ongoing QHP Compliance
- White Paper
      - HMO Regulatory Process
      - Non-HMO Regulatory Process
      - Minnesota HMO Complaint Form and Process
      - Minnesota HMO Reporting Requirements and Oversight Processes
      - Minnesota MCO Quality Assurance and Performance Measurement
      - Minnesota Health Insurance Claim Appeal
      - Minnesota Insurance Complaints Process

4.5: Support Issuers and Provide Technical Assistance
- White Paper

- Organizational Chart

4.6: Issuer Re-Certification, De-Certification and Appeals
- White Paper
- SERFF Process Diagram

4.7: Timeline for QHP Accreditation
      - Included within cover page

4.8: QHP Quality Reporting
   - Included within cover page
5.0 Risk Adjustment and Reinsurance

Section Cover Page

5.1 - Risk Adjustment Program
- Included within cover page

5.2 - Reinsurance Program
- Included within cover page
6.0 SHOP

Section Cover Page

6.1: SHOP Compliance with 45 CFR 155 Subpart H
- White Paper
- MDH and Commerce Regulatory Bulletin

6.2: SHOP Premium Aggregation
- Included with 6.1

6.3: Electronically Reporting Results of Eligibility Assessment and Determinations for SHOP
- Included with 6.1
7.0 Organization and Human Resources

Section Cover Page

7.1 - Organizational Structure and Staffing Resources to Perform Exchange Activities
        - Position Descriptions
        - Organization Chart
      - Staff Hiring Strategy Work Plan
      - Contractor Hiring Strategy Work Plan
8.0 Finance and Accounting

Section Cover Page

8.1: Long-Term Operation Cost, Budget and Management Plan
      - Finance Work Group Report
      - Funding Options Tables
      - Budget Estimates 2011-2016
      - Grant Management
9.0 Information Technology

Section Cover Page

9.1: Compliance with HHS IT Guidance
      - Technical Infrastructure Contract -see drop-down section below
      - End-to-End Business Process Models - see drop-down section below
- Independent Verification & Validation (IV&V) RFP
      - Enterprise MN.IT Standards, Systems, Tools and Development Frameworks
      - IT Exchange Life Cycle Artifacts List
- Project Management Plan
      - PMP Attachments:
          A: Project Sessions Schedule Example
          B: Stakeholder Register Example
          C: Project Charter
          D: Project Presentation Template
          E: Project Meeting Agenda Template
          F: Change Request Form
          G: Deliverable Definition Document Example
          H: Deliverable Document Template
          K: Communications Distribution List Example
          L: Issues Log Example
          M: Project Status Report Example
          N: Risk Register Example
          O: Risk Identification Checklist
          Q: Risk Response Plan Guideline
          R: Issues Identification and Escalation
          S: Session Attendance Roster Example
          T: Project Organization Chart

9.2: Adequate Technology Infrastructure and Bandwidth
- Included with 9.1

9.3: IV&V, Quality Management and Test Procedures
- Included with 9.1
10.0 Privacy and Security

Section Cover Page

10.1: Standard Policies and Procedures
      - Initial Gap Analysis
      - DHS Policies and Procedures
- IT Exchange Life Cycle Artifacts List

10.2: Safeguards Based on HHS IT Guidance
- Included with 10.1

10.3: Safeguard Protection for Federal Information
- Included with 10.1
11.0 Oversight and Monitoring

Section Cover Page

11.1: Routine Oversight and Monitoring of Exchange Activities
- White Paper
      - Timeline

11.2 - Track/Report Performance and Outcome Metrics
- Included within the cover page

11.3: Uphold Financial Integrity Provisions (Accounting, Reporting, Auditing)
- Included with 11.1
12.0 Contracting, Outsourcing and Agreements

Section Cover Page

12.1: Contracting and Outsourcing Agreements
- Contract List
Technical Infrastructure Master Planning and Contract Documents

Solution Planning Document

Project Schedule
Project Management Plan
IT Gap Analysis

Contract Documents

1. MAXIMUS, Inc. PT Contract

1A. MAXIMUS, Inc. Exhibit A

1B. MAXIMUS, Inc. Exhibit B

1C. MAXIMUS, Inc. Exhibit C

1D. MAXIMUS, Inc. Exhibit D

1E. MAXIMUS, Inc. Exhibit E

IBM’s Curam Solution Software License and Support Services Agreement

IBM’s Curam Solution Order Form

Connecture, Inc. Software License and Software Maintenance Agreement

EngagePoint Billspan Software License and Support Agreement

EngagePoint ezNotify Software License and Support Agreement

EngagePoint ezAudit Software License and Support Agreement
End-to-End Business Process Models

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Blueprint Certification

Application Documents