State of New Mexico Additional Level One Establishment Cooperative Agreemeni CFDA 93.525 State efNew Meidce Martinez: May 15, 20-1 3 Tha Hanoralnie Hathieen Seheliua secretary, LLS. Department af Health and Human Sewines independence Avenue SW Washington, DC. ECIQD1 RE: Ne. 53.525 -- Cmpemfive Agreemeni fa Supper! Establishment Of State Clpexeted Heafah fnaurenee Exchanges Dear Secretary Eebeliusz I am pleased In endorse New appiicetitm fur an addilinnal Level One Heailh Insurance Exchange Estehiiehmeni Grant and imperative I hereby -Eleeigrlfiie the New Maxim Human Dupe rtment as the iniflal eppii-neat entity far this grant. Piizfacl Tine: New Mexiea Health ineuranee Exchange Lewes Cline Brent Applicant Name: New Maxim Human Senricee Department Pmject Director: Sidnnie Squier, Secretary Phune: (EH53 Email: New Mexiee will create a state-based exeha FEQB and wiit work with the Centers far Medicare and Medicaid Services: and the Banter fur Cansurrzer infenfieflun and infiurenee Oversight to im plament lhe New Mexico Health insurance Exchange. Thank gran fer the apfiurtunity to apply for this grant funding to aliew us to mu-ue ahead with pmviding increased choice in health ntwerege that heat meets the needs at individuals and email businesses in New Sineeretsr. Susana ttaiartinez Governor cf New Metcicn 436-130m 1| Page I Additional Level One Establishment Cooperative Agreement CFDA 93.525 FONIIE-HBE-I2-001 I I State of New Mexico I I I l't'lIJl'-IS Fit. mt: SFT4 3 CIHEEF :5 -[Li 7' I I 2:3 Tm Iiflthimn (sf Hesulth and I-Immn Sawiirea zew mg: .55. 153:2. -- his ?_IrJ_rJ;1uf;n* rg: The New gappiieatiun an 931:1 iin with Inwrannzr "that is-srr,-natrm. '?99 tee In a of .a1'eaa. and P-Eans-, will he ii Iijiiariazriship in ma'-i arms; by tI'n_there'all . 5 I I rr-.3 I Page 2 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 _l !-itmana. {jaw-emazr i. Eiurlrmie Equizzr, 3:1. 11:11:24 Swhufiius . anti Sraniiacs 5 -- - Mcxim E-E-us-'mm ifaimfiisz-a3 Ifiiv?a?nwir is gsfiemzad p.ra.widc "this a_-and pami;-sipaliun. an -Katmai: -and As. mt: we arr: "Ix: E51 15110;: Em mid fat than Maxim E-xashamge. We wiifi ta tint: -hf! hay in rgfi; ii'-we gfiixutramge hi! amid rat' W-1: "ha them ncl*i's'iEi'm 2'3 'fife ta -?aruiwap the ifiaafilh Ersaur-ma:-r-e i . igliie . miical Aasietamnc Division H3 Ilm: 1.11:; ix; (5255: i Page 3 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 The Hfinorethle Kathleen Sebelius Secretary, 1.1.8. Department of Health and Human Services 200 Avenue. SW Wasl1ingt011, DC 2020] i CFIM Na. 93.52.? C.'ar2per'afive xlg2'eemem' fa Heairh Fxclirmges Dear Scbelius: I As Board chair :11" the New Mexicu I-'Ieaith insurance Exciiztnge I am 'pleased to support New Maxine'; application Ibr an aciditional Level One i Heait.11 Exchange (fhopcmtivc We will work ccmperativialy in pm*tne1'si1ip with as well as the New Mexico Ilivisioiz of I and the I-Iuman Services Departmeilt in of the Exchange. CFDA No. 93.525 has spt-:cifications oi'for.m and content that ad? applications must meet. The Board establislicd by the Act has unanimously voted to request filnding for a very specific portion o'l'New Mexicds responsibilities to comply with requireluents for slatc>>bascd The Board requests that CCIIO keep in mind the that we have met.0n1y once, at the time of this grant submittai, and that policy decisions regarding many 01" the specifications No. 93.525 have yet to be estabiisiled. The NMIJIX is rapidly working to put in piace 1'equi1'e.me11ts to be able to receive of all Level One gram' t'm1ds and is on at l.'as1' track inipiemcntation. grant will specifically allow us to implement outmach, eclurjzatioll, and enroiimellt activities in 8 tinicly manner. We look furwarcl to im.plL:111c.r:tation of an etTt_:c:tive and cfficient that meets the llcetis of New S1119:-wal y, ames R. Damion, FACR Page 4 State of New Mexico Additional Level One Establishment Cooperative Agreemeni CFDA 93.525 Mmfir.-.22. Gan-emur Secretary May 14., "291 3- The Honorable offleatih and Human Services EGEI Independence Avenue SW washi_ngmn, DC 2020} i 93. 525 -- C790-fiaraiimsie A 31*-eerrzeraa' to ofSmi'e -Upemfieri Ifeairh Jam D-mar I am gaieased to submit New appiiczaiin-:1 for an additional flat: I-Iealfih Inaumntas: itkrn-glerativas Agreement- The Applicmat entity $en'ices Department; - Project New "Mexico I-Iealth Insumnim Additi-tmai Una -Gram Applinant Name: New' Maxim Human Sfixrvices Sidmiie Secmtary jufigrgr, Lexrai (3133 fusfiing, to New Mexico will be tranitifimi-:31 in receenttg.-' Maxim Health Insuranizc Exehangc cnmpiafion of its organizing aciivities pursuant to this enabling statute. W31il?: the work to the has been undertaken by my for over two yceirs, wt: are in a transitic-n phase. The new NMHIX Emmi has me: nszce and wit! continue the started by making pflliflj' ?E::c.isio::3 needed. This grant zipplicatioxl fmmses on uutrmuih, educzat?on, and xn_ark.e1ing axztivitias and refiems aha: decision made by the lioaxti In Ekglga-E3.' for an additi-anal Um: -Grant an its 'first We appreciate the to apply for this funding for imd marka'-ting activitim. 1 +1 :71? . .. {i 47 Sidcnaiiz Scguier, Secretaiy New "Mexico Human Scrvitsm Dmne mu: Pu am 1:45 re, 1"-ax. 1'56-5'3 Page 5 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 ONJE-HBEJ 2-00] ABSTRACT .1- Title: New Mexico Additional Level One Health Insurance Exchange Establishment Grant CFDA 93.525 FON IE-HBE-1 1-004 Applicant: New Mexico Human Services Department Address: P.O. Box 2348 Santa Fe, NM 87504 Congressional Districts Served: NM 1, 2, 3 Contact: Sidonie Squier, Secretary Phone: (505) 827-7750 Fax: (505)827-6286 Email: sidonie.squier@state.nrn.us Website: wvvw.hsd.state.n1n.i1s Category of Funding: Level One Project Dates for Project Completion: July 1, 2013-June 30, 2014 New Mexico is applying for an additional Level One Health Insurance Exchange Establishment Grant to establish the New Mexico Health Insurance Exchange (NMHIX). The applicant organization is the New Mexico Human Services Department. Of New Mexico's population of two million, Medicaid covers 550,000, Medicare covers 300,000 and 430,000 are uninsured. Of the uninsured, an estimated 175,000 will become eligible for Medicaid and up to 21 1,433 for NMHIX between 2014 and 2020. It is estimated that as many as 171,557 of the uninsured will enroll in 2014 (89,000 through the expansion of Medicaid, and 82,557 through the NMHIX). Legislation was enacted in March 2013 to create the New Mexico Health Insurance Exchange as the entity to house the NMHIX. After that entity is fully developed this requested grant funding will be transferred from to the NMHIX. This requested funding provides for comprehensive outreach, education, and marketing activities for the NMHIX. A total of $20 million in funding is requested for this additional Level One grant. Page 6 State of New Mexico Additional Level One Establishment Cooperative A greemenf CFDA 93.525 NEW MEXICO HEALTH INSURANCE EXCHANGE LEVEL ONE GRANT TABLE OF CONTENTS REQUIRED LETTERS OF SUPPORT .. 1 LETTER FROM GOVERNOR MARTINEZ .. LETTER FROM NEW MEXICO DIVISION OF INSURANCE .. 2 LETTER FROM HUMAN SERVICES MEDICAID AGENCY .. 3 LETTER FROM NEW MEXICO HEALTH INSURANCE EXCHANGE .. 4 COVER LETTER .. 5 ABSTRACT .. 6 TABLE OF CONTENTS .. 7 ACRONYMS .. 8 PROJECT NARRATIVE .. 9 DISCUSSION OF EXISTING EXCHANGE PLANNING AND PROGRESS. . . . . 10 Background Research .. 10 Legal Authority and Governance .. 10 Stakeholder Consultation .. 1 Long-term Operational Costs .. 12 Program Integration .. 13 Business Operations of the Exchange .. 13 IT Gap Analysis and Exchange IT Systems .. 17 Reuse, Sharing, and Collaboration .. l7 Organizational Structure .. 18 Program Integrity .. 18 ACA Requirements .. 19 SHOP .. 19 PROPOSAL TO MEET PROGRAM REQUIREMENTS .. 20 Exchange Pathway ..-. .. 20 Strategy to Complete Activities and Early Benchmarks .. 21 Proposed Solution for IT System and IT Standards .. 22 Organizational Structure ..23 Coordination .. 23 Reuse, Sharing, and Collaboration ..23 Financial Integrity .. 23 Challenges .. 23 SHOP ..24 WORKPLAN .. 25 BUDGET AND BUDGET NARRATIVE .. 29 DESCRIPTION OF KEY PERSONNEL .. 30 ATTACHMENT 1: BIOSKETCHES OF KEY PERSONNEL .. 30 ATTACHNIENT 2: COST ALLOCATION .. 32 APPENDIX 1: NMHIX STATUTE ..33 Page 7 ACA AHBE APTC CSR DOH DOI DWS FPL GSA HSD IAD ILC IHCIA ISD ISDZR MAD MMIS MAGI NAIC NMHIA NMHIX NMMIP OHCR OSI PSC QHP RFP SCI SDLC SERFF SHOP SOA State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 ONJE-HBE--I 2-001 ACRONYMS Patient Protection and Affordable Health Care Act American Health Benefits Exchange Advance Premium Tax Credits Cost Sharing Reductions New Mexico Department of Health New Mexico Public Regulation Commission Division of Insurance New Mexico Department of Workforce Solutions Federal Poverty Limit Governmental Services Agreement New Mexico Human Services Department New Mexico Indian Affairs Department Interagency Leadership Committee Indian Health Care Improvement Act Income Support Division Integrated System Delivery Replacement Project New Mexico Medical Assistance Division Medicaid Management Information System Modified Adjusted Gross Income National Association of Insurance Commissioners New Mexico Health Insurance Alliance New Mexico Health Insurance Exchange New Mexico Medical Insurance Pool New Mexico Office of Health Care Reform Office of the Superintendent of Insurance Professional Services Contract Qualified Health Plan Request for Proposals State Coverage Insurance Software Development Life Cycle System for Electronic Rate and Form Filing Small Business Health Options Plan Service Oriented Architecture Page 8 Store of New Mexico Additional Level One Establishment Cooperative Agreement" CFDA 93.525 PROJECT NARRATIVE INTRODUCTION The Affordable Care Act (ACA) allows states to develop Health Insurance Exchanges to help individuals and small businesses purchase health insurance. The New Mexico Health Insurance Exchange (NMHIX) will be high quality, cost-efficient, self-sustaining, and tailored to meet the diverse needs of New Mexicans. New Mexico faces many challenges in developing and implementing NMHIX, including a high rate of uninsured; health workforce shortages, language and cultural barriers, significant poverty, poor educational attainment, and that a majority of its small businesses do not offer health insurance to employees. Of New Mexico's population of two million, Medicaid covers 550,000 individuals, Medicare covers 300,000 and 430,000 are uninsured. Of the uninsured, an estimated 175,000 may become eligible for Medicaid and up to 211,433 for between 2014 and 2020. An estimated 171,557 uninsured will enroll in 2014; approximately 89,000 through Medicaid expansion, and 82,557 in the NMHIX. New Mexico applied for and, on November 29, 2011, received a Level One Health Insurance Exchange Establishment Notice of Award of $34.3 million to develop the NMHIX. The initial Level One grant was awarded to the New Mexico Human Services Department (HSD) and will be transferred to the new NMHIX as required by statute. New Mexico is in a transition phase as it implements the NMHIX under the new statutory requirements and is therefore in the process of realigning and reconfiguring certain functions, activities, and roles. Additional information on work plans and other aspects of NMHIX development will he provided and updated as the NMHIX Board makes various policy and budget decisions. This grant application focuses on outreach, education, and marketing activities as directed and voted on by the NMHIX Board at its initial meeting April 29 30, 2013. Other information on the current status of activities may be found in the previously submitted Blueprint information and publiclv-released RFP documents. The New Mexico Legislature passed SB 221, the "New Mexico Health Insurance Exchange Act," (the "Act") during the 2013 Regular Session, and Governor Martinez signed the Act on March 28, 2013. The Governor has designated HSD as the applicant for this grant. This grant and most remaining funds from the initial Level One grant will be transferred as soon as possible to the NMHIX as it completes its fonnation as an operating entity. A MOU is being executed between NMHIX and the D01 for the regulatory functions related to Qualified Health Plans. All plans in this proposal assume a State Based Exchange. The NMHIX Board is evaluating Exchange options and will work with CCIIO to partner on the Exchange model and configuration that provides the most favorable outcome to New Mexico. Through this proposal, New Mexico seeks $20 million to implement comprehensive outreach, education, and marketing activities. Page 9 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 A. DISCUSSION OF EXISTING EXCHANGE PLANNING AND EXCHANGE ESTABLISHMENT PROGRESS Key Findings of Background Research New Mexico conducted in-depth planning and research activities during the initial Level One grant period. HSD worked with consultants to refine the fiscal, actuarial, and population tools to assist in planning and development. Significant work was done to modify and clarify assumptions, refine calculations, and develop more detailed projections. In May 2012, HSD selected, through a competitive RFP process, Leavitt Partners to assist for 12 months with overall development of the and assigned them the following tasks: 0 Developing a strategic plan and implementation activities to include further stakeholder consultation, health insurance market reforms, and business operations of the exchange 0 Assist with the development of rules, regulations, and policy governing the NIVIHIX 0' Assist in preparing reports and materials required by HHS pursuant to the Level One grant award. Enrollment projections refined by Leavitt Partners indicates the following projected take-up for the NMHIX for both the individual and SHOP markets: Proieeted Enrollment of Coverage Groups for NMHIX 2014-2020 2014 2015 2016 2017 2018 2019 2020 Individual 73,876 102,605 128,637 153,389 173,855 172,779 177,574 SHOP 8,681_ - 16,147 20,296 28,751 33,890 33,896 33,859 2. Legal Authority and Governance Governance and Exchange Structure--The Exchange will be operated by the New Mexico Health Insurance Exchange (NMHIX). The NMHIX was created by the New Mexico Legislature in 2013 as a quasi-governmental nonprofit entity to: "Provide qualified individuals and qualified employees with increased access to health insurance in the state and shall be governed by a board of directors constituted pursuant to the provisions of the New Mexico Health Insurance Exchange Ac The legal authority for establishment of the Exchange is provided in the Act, which is included as Appendix 1. The NMHIX is governed by a 13-member board of directors that was appointed in April 2013; the members have outstanding qualifications and will comply with state and federal conflict of interest requirements. Page 10 State of New Mexico Additional Levei One Establishment Cooperative Agreement CFDA it 93.525 Composition of the Governing Body and Selection By statute, the NMHIX Board has 13 voting directors: 0 The Superintendent of Insurance or his designee. 0 Six directors appointed by the Governor (including the secretary of HSD, a health insurance issuer, and a consumer advocate); 0 Six directors appointed by appointed by the Legislatures (with three appointed by the president pro tempore of the senate including one health care provider, and three appointed by the speaker of the house of representatives including one health insurance issuer. One of the directors appointed by the president pro tempore and one of the directors appointed by the speaker shall be from a list of at least two candidates provided by the minority leader of the senate and the minority leader of the house of representatives.) Coordination with Act requires HSD and the NMHIX to coordinate and to provide for contracting with the NMHIX for federal funding received for an Exchange. The statute also requires HSD to coordinate with the to share information and facilitate transitions in enrollment between the Exchange and Medicaid. D01 --The Act charges the Superintendent of Insurance with promulgating rules necessary to implement and carry out the NMHIX, including rules to establish the criteria for certification of Qualified Health Plans offered on the exchange. Initial guidelines for QHPS were promulgated in April 2013. Coordination with Native Americans--The Act requires designation of a Native American liaison to assist the Board in developing and ensuring implementation of communication and collaboration between the NMHIX and Native Americans in the state. The NIVIHIX is in the process of appointing the Native American Liaison. The Native American liaison will serve as the contact person between the NMHIX and the New Mexico Indian nations, tribes, and pueblos and will ensure that training is provided to the ,staff of the to ensure cultural competency, understanding of Indian health laws, and other Native American issues. The Act also allows establishment of a Native American Service Center to ensure that the NMHIX is accessible to all Native Americans, complies with the provisions of the Indian Health Care Improvement Act and lndian--specif1c provisions of the ACA, and facilitates meaningful, ongoing consultation with Native Americans. 3. Stakeholder Consultation The Human Services Department has held public stakeholder meetings since December 2010. With Establishment Planning Grant funding, the state contracted with 13 entities to provide information for development of In August 2011, New Mexico established a comprehensive, ongoing process for stakeholder input for HSD has maintained a website with NIVIHIX information for the public and stakeholders at In addition, HSD completed qualitative research and in--depth interviews with state agencies and stakeholders to maximize coordination and integration with entities that will directly interface with the NMHIX. Page 11 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 2-00} In June 2012, HSD established the NMHIX Exchange Advisory Task (ATP), composed of 14 members, and NMHIX Advisory Work Groups, composed of 12-18 members. The ATP and its eight Work Groups were asked to respond to pertinent questions and to advise NMHIX decisions. The Task Force and Work Groups represented a variety of perspectives, including consumers, tribal representatives, large and small employers, self-employed people, health care providers, hospitals, insurance carriers, brokers, govemment leaders and agencies, underserved populations, and other community representatives. These members acted in an advisory role to inform and provide recommendations in the following areas: Essential Health Benefits Outreach, Education, Adoption, and Enrollment Employer Participation Exchange Market Regulation Native Americans Program Integration Financial Sustainability Legislative The ATF and Work Groups were launched in June 2012, and operated through April 2013. Public attendance was encouraged at every meeting, dial-in phone numbers were provided, and press releases were submitted to newspapers of general circulation and posted on the HSD website to encourage participation. An email box, exchange.comments@state.nm.us, was created to allow public comments and acknowledge requests for information through email. The NMHIX law requires establishment of the following advisory groups: Native American, transitioning, and stakeholders and those advisory groups are being formed. Tribal Consultation-New Mexico's State Tribal Consultation statute, SB 196 (signed into law in 2009), requires state agencies to consult, communicate and collaborate with the 22 Tribes in New Mexico as a government-to-government positive collaboration on various issues. Governor Martinez hosted the annual summit in September of 201 1 with Native American leaders. At the summit, HSD received input from Native.Arnerican stakeholders on topics including Medicaid Modernization, Health Care Reform, Health Insurance Exchange and Health Disparities. HSD hosted two other Native American Stakeholder gathering and held two formal Tribal Consultations. NMHIX will continue to hold Tribal Consultations. 4. Long Term Operational Costs The Act provides that the Board may "generate funding, including charging assessments or fees, to support its solelyfor the administrative costs of the will continue to develop and refine financial modeling and actuarial analyses. has established 21 Finance Committee which is refining budget and actuarial analyses and developing a sustainability plan. Page 12 State of New Mexico Additional Level One Establishment Cooperative A greemem' CFDA 93.525 5. Program Integration Program Integration --The NMHIX will continue to work with all stakeholders to address any remaining issues that could have an impact on the development and implementation of the NMHIX. The Act requires establishment of an advisory committee comprised of members insured through the New Mexico Medical Insurance Pool (NMMIP) and the New Mexico Health Insurance Alliance (NMHIA) to ensure smooth transition of the NMIWIP and the NMHIA into the NMHIX. The NMHIX is in the process of appointing thisadvisory committee. Memoranda of Understanding--The Act requires transfer of the Exchange grant funds from HSD to the NMHIX. The Act, at Section 9, requires HSD and MAD to cooperate with the and a MOU will specify responsibilities to meet the requirement of this Section 9. A MOU will also provide for D01 regulatory functions for the NMHIX. There will be no duplicative uses of funds. 6. Business Operations of the Exchange Outreach and Education--Comprehensive outreach and education efforts are being developed to assure the success of the NMHIX, including coordination of efforts among state agencies, community organizations, insurance carriers, and providers. The Outreach, Education, Adoption, Enrollment ATF Work Group made recommendations to the ATF and defined core strategies and target audiences, including primary and secondary audiences, which are: 0 Educated health care consumers who are enrollees in individuals and entities with experience in facilitating enrollment in health coverage; 0 Advocates for enrolling hard to reach populations, which include individuals with mental health or substance abuse disorders; 0 Small businesses and self-employed individuals; 0 State Medicaid and CHIP agencies; Federally-recognized Tribes, as defined in the Federally Recognized Indian Tribe List Act of 1994; Public health experts; Health care providers; Large employers; Health insurance issuers; and Agents and brokers. The NMHIX may use a variety of methods to reach and engage these populations, and guide them to the NMHIX website or a Navigator or Assister where they can learn more about their options and enroll, including: materials development, earned media, paid media (advertising), social media, stakeholder engagement, partnerships and grassroots engagement and state employee communications. Page 13 State of New Mexico Additional Level One Establishment Cooperative A greernenr CFDA ii 93.525 2-001 Proposed general public marketing channels (in English and Spanish) include, but are not limited to: print, radio, TV, social media/Facebook, web, healthfairs, billboards other health events; coordination and engagement with Chambers of Commerce, nonprofit organizations, federally- qualified health centers, rural clinics, hospitals, schools, churches, shopping malls, and Medicaid offices; and coordination and engagement with statewide distribution services such as through the New Mexico Taxation and Revenue Department, Division of Motor Vehicles, and gas and electric companies. Native American marketing channels will include, but are not limited to: print, radio, TV, social media/Facebook, web, health fairs, other events; educational website hotlinks for Native Americans; face to face meeting opportunities; coordination and engagement of Chapter Houses, senior centers, health fairs and Pow Wows; marketing through Native American Radio: Singing wire and Native American calling and Public Service Announcements; marketing and educational efforts through social and alumni organizations through newsletters; and advertising on buses and bus stops. The Outreach, Education, Adoption, Enrollment ATF Work Group recommended the initial campaign include the following public relations and advertising messages to: Individuals the General Public: benefits of having coverage; increased access, increased choice; who can participate, how it will work; Advance Premium Tax Credits (APTC) Cost Sharing Reductions navigator agent/broker assistance; and premium calculator. Small employers: increased access, increased choice; who can participate, how it will work; Small Business Tax Credits; and comparison tools Native Americans (members of federally recognized Tribes)--increased access on a basis; increased choice of providers and facilities; and strengthen H-IS services and access Navigators, Agents and Brokers: how NMHIX can help get their clients covered; who can participate, how it will work; and how they are compensated. NMHIX will contract for qualified vendor services to create culturally and linguistically appropriate outreach and education materials. NMI-IIX will procure the services of a qualified telephonic translation service to comply with this provision. will work with the D01 to establish a program through which eligible public or private entities or individuals will be certified to serve as Navigatorsl Assisters. The Navigator/Assister program will have a set of standards developed by the NMHIX and D01 to prevent and mitigate conflicting interests to ensure that participating entities and individuals have reliable integrity, in accordance with federal regulations. Page 14 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 FONJE-HBE--12-001 The training standards required of all entities and individuals participating in the Navigator/Assister program will ensure expertise in: the needs of underserved and vulnerable populations; eligibility and enrollment rules and procedures within the range of QHP options and insurance affordability programs; and the privacy and security standards set forth in 45 CFR 155.260 and as may otherwise be adopted by NMHIX. The ATP Outreach, Education, Adoption and Enrollment Work Group recommended that Navigator/Assister training program include the following components: Abbreviated Presumptive Eligibility/Medicaid On--site Application Assistance Medicaid training: Medicaid Overview (What is Medicaid); Non- financial eligibility factors (Residency, other insurance policies, SSN, pregnancy); Determination of the household size; Financial Eligibility; and Universal Application Assistance. The NMHIX Board will reach out to HSD to coordinate on training. Cultural training: New Mexico Department of Health On line Training and New Mexico Indian Affairs Department: Classroom Training. NMHIX Training: Eligibility Enrollment; Qualified Health Plans; APTC and Premium Calculator; Native American Eligibility; -Privacy and Security (HIPAA, Personal Identification Information); and Registration with NMHIX. Insurance Market training: Commercial Market Insurance Basics; NMHIX Insurance basics for individuals and small employer groups; and Income changes and impact on APTC and CSR. NMHIX may mandate the following duties for all entities or individuals acting as a Navigators/ Assisters: Maintain expertise in eligibility, enrollment, and program specifications and conduct public education activities to raise awareness about Provide information and services in a fair, accurate and impartial manner, including the acknowledgement of other health programs; Facilitate selection of Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under section 2793 of the Public Health Service Act, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; and Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being service by NMHIX, including individuals with limited English proficiency, and ensure accessibility and usability of Navigator/Assister tools and functions for individuals with disabilities in accordance with the Americans with Disabilities Act and section 504 of the Rehabilitation Act. Page 15 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 will select a community and consumer-focused non-profit group and at least one of the following categories to serve as Navigators/Assisters: Trade, industry, and professional associations; Commercial organizations, ranching and farming organizations, with New Mexico- specific industries under consideration; chambers of commerce; unions; resource partners of the Small Business Administration; and other eligibie public or private entities or individuals, including without limitation, Indian Health Services, Indian tribes, tribal organizations, urban Indian organizations, and State or local human service agencies. Initial and ongoing Navigator/Assister regulatory oversight will include background checks; training completion documentation; initial licensing and recertiflcation; cultural training; NMHIX training; and complaint reporting. The Consumer/Navigator umbrella organization will be subject to the oversight of NMHIX. Any consumer/Navigator organizations contracted with NMHIX would be charged with field oversight over Navigators/Assisters under their supervision. NMHIX will exercise authority over Navigators/Assisters to ensure compliance with the program and to prohibit Navigators/Assisters from: being a health insurance issuer or a subsidiary thereof; or being an association that includes members of, or lobbies on behalf of, the insurance industry; or receiving any consideration directly or indirectly from any health insurance issuer in connection with the enrollment of any individuals or employees in a QHP or a non~QHP. Navigators/Assisters will be required to execute conflict of interest statements that will include compliance with HIPAA and PII rules, and any other requirements determined to be appropriate. Navigator/Assister compensation guidelines will assure compliance with ACA requirements. Payments will be consistent across markets and products. Accountability standards will be tied to payments, such that organization entities will be accountable to NMHIX, and Navigators/Assisters will be accountable to their organizational entity. NMHIX is developing an RFP directed to consumer and nonprofit organizations to develop NMHIX Navigator/Assister programs. Navigator/Assister programs are being designed to eliminate barriers in accessing the application process by providing in person assistance in community-based locations frequented by target populations at times that are convenient to working families, including evenings and weekends. Federal funds will support the development of training programs for the Navigators and for implementation of the Assister program. When the NMHIX is fully operational, agents and brokers will assist individuals, employers and qualified employees in the comparison and selection of QHPS. NIVIHIX will determine how best to use these agents and brokers to help consumers access coverage through NMHIX. The ATP Outreach and Education Work Group has recommended that agents and brokers act as the primary assistance resource for small employers who wish to purchase plans in the SHOP NIVIHIX. Page 16 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 Agents and brokers, including web brokers, who wish to sell NMHIX products will be required to meet licensing requirements and take additional training on NMHIX protocols. Agents and brokers will register with NMHIX as required by rule, receive training on QHP options and other publicly subsidized insurance programs, and comply with privacy and security standards. NMHIX will coordinate with DOI to create training and licensure requirements that are ACA-compliant. Agents and Brokers--Agents and brokers will receive compensation from carriers for enrollment in NMHIX, in accordance with the brokers' contracts with the carriers. The enrollment system will accept a Broker ID and transmit that data to the carrier so that the Broker can receive the commission. As in the current small group market, brokers will continue to serve as the primary sales force for small group insurance in New Mexico. Financial Management New Mexico has administrative policies and statutory and regulatory provisions to ensure appropriate financial management of grant fl.1I'1ClS. Grant funds are administered following comprehensive written procedures approved by the Department of Finance and Administration to document all major aspects of the financial management system. This includes quality assurance and oversight to make sure the system disburses, tracks, and accounts for grant disbursements. The NMHIX is developing detailed financial management and oversight procedures for strong internal monitoring for all NMHIX operations and expenditures and to ensure proper use and oversight of federal funds. As indicated in the Blueprint, NMHIX intends to institute procedures and policies in compliance with the financial integrity provisions of ACA 1313, including compliance with Government Accounting Standards Board and OMB Circular A-123, "Management's Responsibility for Internal Control." Establishment Reviews by CIIO CCIIO performed an establishment review in October 2012. New Mexico received conditional approval for its State Based Exchange in January 2013. 7. IT Gap Analysis and Exchange IT Systems IT Gap analysis was provided in the initial Level One grant. IT Reviews with CCIIO New Mexico has had ongoing IT discussions and meetings with CCIIO. 8. Reuse, Sharing, and Collaboration As outlined in agreements with HHS, all Exchange systems and system components financed with federal funds are non-proprietary, utilize open architecture standards, and permit re-use by other states and jurisdictions. New Mexico will inform and assist other states through various means, including HHS Learning Collaboratives and User Groups. Beyond reuse and sharing of IT, New Mexico is committed to leverage existing infrastructure" and re-purpose business functions and processes to maximize resources and is working with other states to determine how aspects of their systems can be replicated in New Mexico. Page 17 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93. 525 9. Organizational Structure The NMHIX is currently developing the organizational structure. Please see Appendix 1 for the NMHIX statutory requirements. Key leadership is shown in the following section: Sidonie Squier, Cabinet Secretary, New Mexico Human Services Department--Governor Susana Martinez nominated Sidonie Squier to serve as her Cabinet Secretary of the Human Services Department on December 23, 2010. Squier served as the director of the Office of Family Assistance at the U.S. Department of Health and Human Services from June 2005 through January 2009, where she oversaw the 'provision of help to needy families through the Temporary Assistance for Needy Families Program (TANF). She has worked at both the state and Federal levels on various social assistance programs and areas, including TANF, Medicaid, nutrition and domestic violence. Secretary Squier has also served as an associate commissioner in the Office of Family Services with the Texas Health and Human Services Commission, as well as the director of economic self-sufficiency and welfare reform administrator in the Florida Department of Children and Families. She is a graduate of California State University, Long Beach, with B.A. and M.A. degrees in Communications. The Human Services Department administers and oversees several federal and state programs including; the enforcement of child support payments, the administration of substance abuse and mental health programs, and the provision of food, financial assistance and health care to those who qualify. John G. Franchini, Superintendent of Insurancew-Mr. Franchini is a native New Mexican and graduate of Creighton University, with 35 years' experience in the insurance industry. He joined Consolidated Agency, his father's independent insurance agency, purchased it ten years later and expanded it to four locations employing 82 people and servicing nearly 15,000 customers. He served on the New Mexico Workers' Compensation Assigned Risk Pool Board of Governors, the Patient Compensation Administration Board of Directors, and was elected president of the Independent Insurance Agents of New Mexico. In 1998, Poe Brown, a national insurance broker, purchased the business. He was named vice president. His responsibilities included new business production, development of specialized insurance programs, and agency acquisitions. He joined New Mexico Mutual in 2002 and later named Vice President of Government and industry Affairs. He is a member of the Leadership New Mexico Class of 2007, former board member of the Rocky Mountain Insurance Information Association, and past president of the NM Insurance Association. James R. Damron, M.D., FACR, NMHIX Board Chair - Dr. Damron is an attending radiologist at UNM, Health Science Center, School of Medicine and teaches in the specialty of Clinical Mammography, overseeing radiology residents and providing lectures to medical students on state and federal health policy issues. Prior to UNM, he was President of Santa Fe Radiology, P.C., providing diagnostic radiology imaging services in Santa Fe for 30 years before he retired. Page 18 State of New Mexico Additional Level One Establishment ooperaiive A greemeni CFDA 93.5.25 Dr. Damron received his Medical Degree from Indiana University School of Medicine, his radiology training at the University of Kentucky Medical Center and did a Nuclear Medicine Fellowship at the University of New Mexico. He is Board Certified by the American Board of Radiology and the American Board of Nuclear Medicine. He is a Fellow in the American College of Radiology. Dr. Damron has been associated with numerous state and national professional organizations and boards and is the author of several peer-reviewed articles. He has received several national awards, such as the Capitol Dome award and the Physician's Award for Outstanding Service from ACS, the 2006 Physician of the Year award from the National Republican Congressional Committee and the NRCC 2007 Congressional Order of Merit. He also serves on the NM Coalition for Literacy Board, the St. Vincent Hospital Foundation Board and has served on other numerous community boards, state committees and task forces. Dr. Damron was the Republican Nominee for Governor in 2006 and a candidate for Lt. Governor in 2010. Jason Sande], NMI-IIX Vice-Chair- is a native of Farmington, New Mexico and was elected to the Farmington City Council in March of 2006. Jason Sande] is the Executive Vice-President of Aztec Well Servicing and its subsidiaries in Aztec, New Mexico. He is the 3rd generation of the Sande] family to dedicate himself to the company and the community. Jason attended the University of New Mexico where he received a B.A. in Political Science and served as a Senior" Leadership Analyst for the New Mexico State Senate. Along with his appointment to the Board of the New Mexico Health Insurance Exchange, Jason serves as the Vice-Chairman of the New Mexico Medical Insurance Pool, immediate past President of the Four Corners Safety Council, member of the New Mexico Oil and Gas Executive Committee, former member of the Statewide Economic Development Commission, and was honored with the Paul Harris award by the San Juan Rotary Club. 10. Program Integrity Progress on Financial Integrity Mechanisms to Prevent Fraud, Waste, and Abuse and Provide Oversight of Cooperative Agreement Funds New Mexico is developing administrative policies and statutory and regulatory provisions to ensure appropriate financial management of the cooperative agreement based on provisions in the Act. NMHIX will adhere to HHS financial monitoring activities for the additional Level One cooperative agreement, and is developing the financial management structure to comply with requirements. 11. Progress in Implementing Other ACA Requirements Health Insurance Market Reforms-The Department of Health and Human Services (HHS) determined that New Mexico has an effective rate review program in August, 2011. Governor Martinez has stated that New Mexico will participate in a Medicaid expansion program. Page 19 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93 .525 12. SHOP Summary of State 's Small Group Market New Mexico's current small group market has approximately 60,500 covered lives with $277 million in earned premiums. Market shares are as follows}: Carrier Members Market Earned Premium Market Share (2011) Share (2011) Blue Cross Blue Shield of 19,566 32.4% $100,722,000 36.4% NM . Lovelace Health Plan 16,355 27.1% $68,451,360 24.7% Presbyterian Health Plan 17,821 29.5% $74,432,5 80 26.9% United Health Care 6,693 11.1% $33,202,618 12.0% Total 60,435 100% $276,858,558 100% Research/Reports on Small Group Market Issues/SHOP Operations and Stakeholder Consultation on Employer Participation work group held extensive meetings to work on various SHOP issues and provide recommendations. Issues reviewed included participation requirements, definition of "small business", adverse selection issues, defined contribution, premium aggregation, and plan selection. The Employer Participation Work Group made a number of recommendations to the NMHIX, which the Board is taking under advisement. b. PROPOSAL TO MEET PROGRAM REQUIRENEENTS 1. Current Exchange Pathway New Mexico will establish a State--Based Exchange and the will be the Exchange entity, pursuant to the Act. New Mexico is completing the planning and designing phases and is actively developing the NMHIX. On December 14, 2012 New Mexico submitted its Blueprint application to HHS to operate a State-Based Exchange and the Blueprint was conditionally approved on December 31, 2012. All plans in this proposal assume a State Based Exchange. The NM1-EX Board is evaluating all available Exchange options and will work with CCIIO to partner on the Exchange model and configuration that provides the most favorable outcome to New Mexico. New Mexico is in a transition phase as it implements the NMHIX under the new statutory requirements and is therefore in the process of realigning and reconfiguring certain functions, activities, and roles. Additional information on work plans and other aspects of NMHIX development will be provided and updated as the NMHIX Board makes various policy and budget decisions. 1 Data from NMHIA contracted actuary. Page 20 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 This grant application focuses on outreach, education, and marketing activities as directed and voted on by the NMHIX Board at.its initial meeting April 29 _30, 2013. Other information on the current status of activities may be found in the previously submitted Blueprint information and publicly-released RFP documents. The NMHIX has established the following committees to continue the Exchange development on a fast track: Information Technology, Marketing, Finance, and Operations. These committees are meeting once or twice a week to ensure that activities can be implemented on schedule. The Board will meet at least once a month. The NMHIX is in the process of establishing various advisory committees for stakeholder input and transitioning processes for the NMHIA and the NMMIP. It is anticipated that the will have necessary configurations in place to receive Exchange grant funds from HSD no later than July 1, 2013. 2. State's Strategy To Complete the Exchange Activities The Act which created the gives it the authority to operate the Exchange and SHOP. Advisory groups will provide input to the NNIHIX throughout the development and implementation of the NMHIX to ensure stakeholder engagement and support. A comprehensive outreach and education plan is being developed that will ensure culturally and linguistically appropriate materials and will ensure access to information and enrollment for individuals with disabilities. A Navigator/Assister program with associated training requirements and broker roles is being developed. (See additional information in the following section.) The NIVIHIX will work to meet all requirements to ensure adequate oversight, monitoring, and reporting. Funding for Exchange grants will be transferred from HSD to the NMHIX as soon as the NMHIX is configured to receive the funds. Navigator/Assister Outreach, Education, and Enrollment Program New Mexico plans an aggressive program to ensure that all New Mexicans can enroll in coverage programs. This will include a comprehensive outreach and education plan that will reach all areas of the state and all populations. NMHIX will contract with two entities to develop Navigator/Assister programs and implement comprehensive outreach, education, and enrollment strategies. NMHIX plans to issue RFPS and execute contracts for the Navigator/Assister programs and the outreach, education, and marketing activities. it is anticipated that training programs will be implemented in August 2013 and Navigators/Assisters will begin enrollment in October 2013. Substantial resources will be necessary for this program based on New Mexico's geographical and cultural challenges. The Navigator/Assister entities chosen through the RFP process will then subcontract with community-based organizations and others to provide the In Person Assistance activities throughout the state. Page 21 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 FONJE-HBE--12-001 The model is based on the following assumptions: an average of two hours to complete an application with associated support; 25 percent time to be allocated to outreach and 75 percent to enrollment; average cost per enrollment of $50, and 15 percent management/oversight costs for the two entities to ensure effective and efficient program implementation. These assumptions are based on reviews of systems in other states with adjustments to reflect New Mexico's rural and cultural challenges. Targeted Native American assistance programs will also be developed to serve New Mexico's Native American population. About 10 percent of New Mexico's population is Native American population, totaling approximately 200,000 people in 22 tribes. More than one-third of the nation's Navajo population resides in the state and there are 19 pueblos located in seven counties throughout the state. Many Native Americans have never had health insurance, live in remote rural areas with limited or no access to technology, and significant education and outreach will be necessary to ensure access to information and resources for NMHIX enrollment. The Native American services will provide outreach, education, and support services to ensure all Native Americans understand their options for coverage and how to enroll. The NMHIX is in the process of developing the Native American services and will work in partnership with the Native American Liaison and the Native American work group. The NMHIX wili contract for overall development of the comprehensive outreach and education program, development of training programs for Navigators and Assisters, and to manage the development of the Navigator/Assister system. This will include the following activities: development of training modules and manuals; creation of performance evaluation plan, metrics, and business processes for the system; management of RFPS for the system; design, development, and support for a recruitment strategy; and support for administration of system. 3. State's Strategy to Address Early Benchmarks in Section I.4 Please see the New Mexico Blueprint document for information on early benchmarks. The NMHIX has received correspondence from CCIIO regarding this issue. 4. Proposed Solution for Exchange IT Systems Please see the New Mexico Blueprint document for information on Exchange IT systems. 5. IT Seven Standards and Conditions Please see the New Mexico Blueprint document for information on Exchange IT systems. Page 22 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 2-00] 6. Organizational Structure The NMHIX organizational structure is being developed. The Act requires HSD to transfer Level One grant fiinds to the NMHIX and provide for coordination with Medicaid. HSD will designate the NMHIX as the grantee of record as soon as the NMHIX has' its legal fiamework fully implemented. The NMHIX and D01 will execute a MOU to provide for QHP regulatory activities. The Act, at Section 9, requires HSD and MAD to cooperate with the NMHIX, and a MOU will specify responsibilities to meet the requirement of this Section 9. 7. Coordination with the Federal Government on Exchange Activities NMHIX will coordinate with the federal govemment on all NMHIX development and implementation issues. 8. Strategies for Reuse, Sharing, Collaboration for NM Exchange Activities with the Federal Exchange and Other States As outlined in agreements with HHS, all Exchange systems and system components financed with federal funds are non-proprietary, utilize open architecture standards, and permit re-use by other states and jurisdictions. New Mexico will inform and assist other states through various means, including HHS Learning Collaboratives and User Groups. Beyond reuse and sharing of IT, New Mexico is committed to leverage existing infrastructure and re-purpose business functions and processes to maximize resources. The NMHIX is working with other states to determine how aspects of their systems can be replicated in New Mexico. 9. Strategies to Ensure Financial Integrity Mechanisms to Prevent Fraud, Waste, and Abuse and Provide Oversight of Cooperative Agreement Funds and the Exchange New Mexico has administrative policies and statutory and regulatory provisions to ensure appropriate financial management of grant funds. Grant funds are administered following comprehensive written procedures approved by the Department of Finance and Administration to document all major aspects of the financial management system. This includes quality assurance and oversight to make sure the system disburses, tracks, and accounts for grant disbursements. New Mexico will ensure NMHIX program operations and management integrity, and that federal cooperative agreement dollars are expended as budgeted in its cooperative agreements and contracts. 10. Challenges That May Affect Progress in Work Plan Although New Mexico has resolved a number of issues with the enactment of the NMHIX legislation, unanticipated scheduling delays could potentially impact implementation of the NMHIX. Page 23 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA ii 93.525 11. SHOP Market Challenges"-Over 85 percent of New MeXico's small businesses have fewer than 50 employees and many have never purchased health insurance. This will be a market challenge as the is implemented. The rural nature of New Mexico will also play a large role in how outreach and education efforts are conducted. Strategic SHOP will be developing SHOP plans over the coming months. Six major insurers in New Mexico have applied to be QHPS, including six for individual plans and five for SHOP. The NIVTHIX also anticipates there will be at least three stand-alone dental plans. B. WORKPLAN Note: All plans in this proposal assume a State Based Exchange. The NMHIX Board is evaluating all available Exchange options and will work with CHO to partner on the Exchange -model and configuration that provides the most favorable outcome to New Mexico. New Mexico is in a transition phase as it implements the under the new statutory requirements and is therefore in the process of realigning and reconfiguring certain functions, activities, and roles. - Additional information on work plans and other aspects of development will be provided to CCIIO as the Board makes various policy and budget decisions. 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MED Kama mUwmO.~u.mmufiWx ODWRME Store of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 F. BUDGET AND BUDGET NARRATIVE New Mexico requests $20 million in federal funding for an additional Level One Establishment cooperative agreement for the period July 1, 2013 through June 30, 2014. The initial grant funding would go to HSD and then transferred to NMHIX as soon its legal configuration is complete. New Mexico received $34.3 million for an initial Level One grant in November 2011 and the project period for that grant was later extended through November 2013. The initial Level One grant was awarded to HSD and approximately" $2.6 million was spent on project staffing, the Leavitt Partners consulting contract, and ATP activities. The Act requires HSD to transfer most of the Exchange grant funds to the NMHIX. The NMHIX is now working on a financing plan for NMHIX operations and activities based on the new law and project developments. The NMHIX plans to submit additional grant applications for NMHIX operations and activities until the required sustainability is achieved. The following chart shows the requested expenditures for this proposed grant by Exchange Activity Area: Exchange Activity Area TOTAL Consumer and Stakeholder Engagement and Support $13,524,768 Eligibility and Enrollment 6,475,232 Total $20,000,000 - The following chart shows the planned expenditures from the proposed Additional Level One grant: SECOND LEVEL ONE GRANT CONTRACTUAL SERVICES MARKETING MATERIALS AND ACTIVITIES 6,350,000 OUTREACH AND EDUCATION, STAKEHOLDER SUPPORT, TRIBAL CONSULTATIONS 7,174,768 IN PERSON ASSISTANCE - 6,475,232 TOTAL CONTRACTUAL COSTS 20,000,000 20,000,000 TOTAL 20,000,000 Page 27 State ofNew Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 Detailed budget information for the NMHIX is shown in the following sections. Supplies and travel costs are variable and other costs are fixed. Contracts Total: $20,000,000 Exchange Establishment Cooperative Agreement: $20,000,000 Other Funding: -0- Required Information for Hiring Consultants Duration of the Consultation: July 1, 2013-June 30, 2014 Expected Rate of Compensation: Bid contracts either with a competitive hourly rate or through a fixed price contract. Required detail will be provided for each contract. Method of Accountability: Base payment on specific contract deliverables and timelines. Comprehensive Outreach and Education Plan, Stakeholder Support, Native American Outreach and Education Activities, and Marketing and Media Nature of Services to Be Rendered: Development and implementation of a comprehensive outreach and education plan with multifaceted strategies to maximize enrollment throughout the state to all populations. It will include overall plan development and management The NMHIX will contract for overall development of the comprehensive outreach and education program, deveiopment of training programs for Navigators and Assisters, and to manage the development of the Navigator/Assister system. This will include the following activities: development of training modules and manuals; creation of performance evaluation plan, metrics, and business processes for the system; management of RFPS for the system; design, development, and support for a recruitment strategy; and support for administration of system. Also included is funding for extensive local events 'and activities including partnerships with nonprofit organizations, counties, schools/universities, faith communities, providers, business organizations, and other community-based organizations, tribal consultations, targeted tribal outreach and education, stakeholder education and outreach, and other education and outreach activities purchased media including radio, TV, billboards, etc. and marketing materials and activities It will include comprehensive outreach to all Native American communities, including targeted messaging, print, radio, TV, social media/Facebook, web, health fairs, other events; educational website hotlinks for Native Americans; face to face meeting opportunities; coordination and engagement of Chapter Houses, senior centers, health fairs and Pow Wows; marketing through Native American Radio: Singing wire and Native American calling and Public Service Announcements; marketing and educational efforts through social and alumni organizations through newsletters; and advertising on buses and bus stops. A total of $13,524,768 is requested for planning, implementation, and management of the comprehensive outreach, education, marketing, and stakeholder support plan. Page 28 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 Relevance of Service to the Project: Maximize enrollment and take-up of NMHIX. Duration of the Consultation: July 1, 2013-June 30, 2014 Expected Rate of Compensation: Contracts through a- competitive bid process. Required detail will be provided for each contract. Method of Accountability: Base payment on specific contract deliverables and timelines. In Person Assistance Plan Nature of Services to Be Rendered: Develop and implement the Navigator/Assister plan including designation of two entities to manage and implement the Navigator/Assister system, coordinating with brokers/agents, and developing the Navigator and Assister curriculum, training, cross training and certification processes. A total of $6,475,232 is requested for start-up activities in 2013 to recruit and train staff, develop training curricula, hire central management staff, and contract with the two Navigator/Assister entities to implement the system. The Navigator/Assister entities would then subcontract with community-based organizations and others to provide the In Person Assistance activities throughout the state. The requested amount includes development of the training programs training costs such as background checks and other certification costs and the Navigator/Assister system costs to ensure adequate coverage of In Person Assistance throughout the state Navigator/Assister costs are based on the following assumptions: an average of two hours to complete an application with associated support; 25 percent time to be allocated to outreach and 75 percent to enrollment; average cost per enrollment of $50, and 15 percent management/oversight costs for the two entities to ensure effective and efficient program implementation. Relevance of Service to the Project: Maximize NMHIX uptake rate. An effective Navigator/Assister system is critical to successful NMHIX establishment. Duration of the Consultation: July 1, 2013-June 30, 2014 Expected Rate of Compensation: Contracts through a competitive bid process. Required detail will be provided for each_contract. Method of Accountability: Base payment on specific contract deliverables and timelines. G. ADDITIONAL LETTERS OF AGREEMENT Letters of agreement and participation are included from the Governor, the Superintendent of DOI, HSD/Medicaid agency, and the NMHIX. H. DESCRIPTION OF KEY PERSONNEL The NMHIX is in the process of identifying key personnel and developing and organizational structure. Key leadership is outlined in Attachment 1. Page 29 Siate of New Mexico Additional Level One Establishment ooperaii ve Agreement CFDA it 93.525 . . ATTACHMENT 1 B10 SKETCHES OF KEY PERSONNEL The NIVIHIX is in the process of identifying key personnel and developing an organizational structure. Key leadership is outlined in the following section: Sidonie Squier, Cabinet Secretary, New Mexico Human Services Department--Governor Susana Martinez nominated Sidonie Squier to serve as her Cabinet Secretary of the Human Services Department on December 23, 2010. Squier served as the director of the Office of Family Assistance" at the U.S. Department of Health and Human Services from June 2005 through January 2009, where she oversaw the provision of help to needy families through the Temporary Assistance for Needy Families Program (TANF). She has worked at both the state and Federal levels on various social assistance programs and areas, including TANF, Medicaid, nutrition and domestic violence. Secretary Squier has also served as an associate commissioner in the Office of Family Services with the Texas Health and Human Services Commission, as well as the director of economic selfisufficiency and welfare reform administrator in the Florida Department of Children and Families. She is a graduate of California State University, Long Beach, with B.A. and MA. degrees in Communications. The Human Services Department administers and oversees several federal and state programs including; the enforcement of child support payments, the administration of substance abuse and mental health programs, and the provision of food, financial assistance and health care to those who qualify. John G. Franchini, Superintendent of Insurance~Mr. Franchini is a native New Mexican and graduate of Creighton University, with 35 years'_ experience in the insurance industry. He joined Consolidated Agency, his father's independent insurance agency, purchased it ten years later and expanded it to four locations employing 82 people and servicing nearly 15,000 customers. He served on the New Mexico Workers' Compensation Assigned Risk Pool Board of Governors, the Patient Compensation Administration Board of Directors, and was elected president of the Independent Insurance Agents of New Mexico. In 1998, Poe Brown, a national insurance broker, purchased the business. He was named vice president. His responsibilities included new business production, development of specialized insurance programs, and agency acquisitions. He joined New Mexico Mutual in 2002 and later named Vice President of Government and Industry Affairs. He is a member of the Leadership New Mexico Class of 2007, former board member of the Rocky Mountain Insurance Information Association, and past president of the NM Insurance Association. James R. Damron, M.D., FACR, NMHIX Board Chair - Dr. Damron is an attending radiologist at UNM, Health Science Center, School of Medicine and teaches in the specialty of Clinical Mammography, overseeing radiology residents and providing lectures to medical students on state and federal health policy issues. Prior to UNM, he was President of Santa Fe Radiology, P.C., providing diagnostic radiology imaging services in Santa Fe for 30 years before he retired. Page 30 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 Dr. Damron received his Medical Degree from Indiana University School of Medicine, his radiology training at the University of Kentucky Medical Center and did a Nuclear Medicine Fellowship at the University of New Mexico. He is Board Certified by the American Board of Radiology and the American Board of Nuclear Medicine. He is a Fellow in the American College of Radiology. Dr. Damron has been associated with numerous state and national professional organizations and boards and is the author of several peer-reviewed articles.- He has received several national awards, such as the Capitol Dome award and the Physician's Award for Outstanding Service from ACS, the 2006 Physician of the Year award from the National Republican Congressional Committee and the NRCC 2007 Congressional Order of Merit. He also serves on the NM Coalition for Literacy Board, the St. Vincent Hospital Foundation Board and has served on other numerous community boards, state committees and task forces. Dr. Damron was the Republican Nominee for Governor in 2006 and a candidate for Lt. Governor in 2010. Jason Sande], NMHIX Vice-Chain is a native of Farmington, New Mexico and was elected to the Farmington City Council in March of 2006. Jason Sandel is the Executive Vice~--President of Aztec Well Servicing and its subsidiaries in Aztec, New Mexico. He is the 3rd generation of the Sande] family to dedicate himself to the company and the community. Jason attended the University of New Mexico where he received a BA. in Political Science and served as a Senior Leadership Analyst for the New Mexico State Senate. Along with his appointment to the Board of the New Mexico Health Insurance Exchange, Jason serves as the Vice~Chairman of the New Mexico Medical Insurance Pool, immediate past President of the Four Corners Safety Council, member of the New Mexico Oil and Gas Executive Committee, former member of the Statewide Economic Development Commission, and was honored with the Paul Harris award by the San Juan Rotary Club. Page 31 Store of New Mexico Additional Level One Establishment Cooperative A greemem' CFDA 93.5.25 ATTACHMENT 2 COST ALLOCATION New Mexico will develop a plan to allocate costs to reflect the planned configuration of the NMHIX. Following the completion of procurement activities and additional analysis of projections and associated costs, the cost allocation methodology will be developed and modified as appropriate. New Mexico will evaluate all options for cost allocation methodology. The NMHIX will review cost allocation plan methodologies used in states with similar demographics and systems. NMHIX will work with CCIIO and CMS to ensure that the cost allocation plan conforms with all requirements. Page 32 State of New Mexico Additional Level One Establishment Cooperative Agreement CFDA 93.525 Appendix 1 SB 221, the Health Insurance Exchange Act Page 33 NOTE TO BOARD MEMBERS: Only the cover page of SB221 is attached to conserve paper. I can the bill to you if you d0I1't have. Thank you. 0m1i.p0o1@state.n1n.us 505-476-6866 The Legislature of the _5;_s;__Legislafure, _.._1.st__Session [?kXfi7S . 2013 SENATE CORPORATIONS AND TRANSEQRTATION COMMITTEE SUBSTITUTE FOR SENATE PUBLIC AFFAIRS COMMITTEE SUBSTITUTE FOR I . In SENATE PUBLIC AFFAIRS COMMITTEE SUBSTITUTE FOR SENATE BILL 589, as amended, with emergency clause Introduced by CHAPTER QLAUSE