CMs-10371 Progress Report

Exchange Establishment - Semiannual Progress Report Data Elements

Estimated Annual Hours
Estimated Annual Line Items
Estimated Semiannual Hours
Estimated Semiannual Line
Items

230
233
115

Estimated Avg Hours/Line Item

1.01

Report Section

117

Previous
Line
Items

2012-2017 Total
Activity Areas
Activities
Overall Project
Budget Suppl.
Cost Allocation. Suppl.
IT Supplemental
Total

Semiannual Average
Activities
Sub-Activities
Overall Project
Budget Suppl.
Cost Allocation. Suppl.
IT Supplemental
Total

48
106
6
44
1
28
233
Line
Items
12
13
3
33
0.5
7
69

PPR-B Activities
Legal Authority and
Governance
Legal Authority and
Governance
Legal Authority and
Governance
Legal Authority and
Governance
Consumer and Stakeholder
Engagement and Support
Consumer and Stakeholder
Engagement and Support
Consumer and Stakeholder
Engagement and Support
Consumer and Stakeholder
Engagement and Support
Eligibility and Enrollment
Eligibility and Enrollment
Eligibility and Enrollment
Eligibility and Enrollment
Plan Management
Plan Management
Plan Management
Plan Management

Risk Adjustment and
Reinsurance
Risk Adjustment and
Reinsurance
Risk Adjustment and
Reinsurance
Risk Adjustment and
Reinsurance
Small Business Health Options
Program (SHOP)
Small Business Health Options
Program (SHOP)
Small Business Health Options
Program (SHOP)
Small Business Health Options
Program (SHOP)
Organization and Human
Resources
Organization and Human
Resources

What are the primary strategies your Program
has used to approach this Core Area?
What are some of your Program’s significant
accomplishments or strengths in this Core Area?
What are some of the significant barriers your
program has encountered?
What strategies has your Program employed to
deal with these barriers?
What are the primary strategies your Program
has used to approach this Core Area?
What are some of your Program’s significant
accomplishments or strengths in this Core Area?
What are some of the significant barriers your
program has encountered?
What strategies has your Program employed to
deal with these barriers?
What are the primary strategies your Program
has used to approach this Core Area?
What are some of your Program’s significant
accomplishments or strengths in this Core Area?
What are some of the significant barriers your
program has encountered?
What strategies has your Program employed to
deal with these barriers?
What are the primary strategies your Program
has used to approach this Core Area?
What are some of your Program’s significant
accomplishments or strengths in this Core Area?
What are some of the significant barriers your
program has encountered?
What strategies has your Program employed to
deal with these barriers?
What are the primary strategies your Program
has used to approach this Core Area?
What are some of your Program’s significant
accomplishments or strengths in this Core Area?
What are some of the significant barriers your
program has encountered?
What strategies has your Program employed to
deal with these barriers?
What are the primary strategies your Program
has used to approach this Core Area?
What are some of your Program’s significant
accomplishments or strengths in this Core Area?
What are some of the significant barriers your
program has encountered?
What strategies has your Program employed to
deal with these barriers?
What are the primary strategies your Program
has used to approach this Core Area?
What are some of your Program’s significant
accomplishments or strengths in this Core Area?

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Organization and Human
Resources
Organization and Human
Resources
Finance and Accounting
Finance and Accounting
Finance and Accounting
Finance and Accounting
Technology
Technology
Technology
Technology

Privacy and Security
Privacy and Security
Privacy and Security
Privacy and Security

Oversight, Monitoring, and
Reporting
Oversight, Monitoring, and
Reporting
Oversight, Monitoring, and
Reporting
Oversight, Monitoring, and
Reporting
Contracting, Outsourcing, and
Agreements
Contracting, Outsourcing, and
Agreements
Contracting, Outsourcing, and
Agreements
Contracting, Outsourcing, and
Agreements
State Partnership Exchange
Activities
State Partnership Exchange
Activities
State Partnership Exchange
Activities
State Partnership Exchange
Activities

What are some of the significant barriers your
program has encountered?
What strategies has your Program employed to
deal with these barriers?
What are the primary strategies your Program
has used to approach this Core Area?
What are some of your Program’s significant
accomplishments or strengths in this Core Area?
What are some of the significant barriers your
program has encountered?
What strategies has your Program employed to
deal with these barriers?
What are the primary strategies your Program
has used to approach this Core Area?
What are some of your Program’s significant
accomplishments or strengths in this Core Area?
What are some of the significant barriers your
program has encountered?
What strategies has your Program employed to
deal with these barriers?
What are the primary strategies your Program
has used to approach this Core Area?
What are some of your Program’s significant
accomplishments or strengths in this Core Area?
What are some of the significant barriers your
program has encountered?
What strategies has your Program employed to
deal with these barriers?
What are the primary strategies your Program
has used to approach this Core Area?
What are some of your Program’s significant
accomplishments or strengths in this Core Area?
What are some of the significant barriers your
program has encountered?
What strategies has your Program employed to
deal with these barriers?
What are the primary strategies your Program
has used to approach this Core Area?
What are some of your Program’s significant
accomplishments or strengths in this Core Area?
What are some of the significant barriers your
program has encountered?
What strategies has your Program employed to
deal with these barriers?
What are the primary strategies your Program
has used to approach this Core Area?
What are some of your Program’s significant
accomplishments or strengths in this Core Area?
What are some of the significant barriers your
program has encountered?
What strategies has your Program employed to
deal with these barriers?

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Line Item per Sub-Activity

Response Format

What is the status of this sub-activity?

Drop-down [Complete, Ahead, On
Schedule, Behind, No Activity Planned]

What is your targeted quarter for
completion of this sub-activity?
Document evidence of completion (if
you marked Complete) or Corrective
] Action (if you marked Behind)

Drop-down [Quarter and Year]
Upload attachment

Core Activity

Activity Nickname

Activity Full Description

Legal Authority
and Governance

Enabling authority for
Exchange and SHOP

The State has enabling authority to operate an Affordable
Insurance Exchange, including a Small Business Health Options
Program (SHOP), compliant with Affordable Care Act Section
1321(b) and implementing regulations.

Legal Authority
and Governance

Board and governance
structure

The Exchange has been established with an Exchange Board and
governance structure in compliance with Affordable Care Act
1311(d) and 45 CFR 155.110.

Consumer and
Stakeholder
Engagement and
Support

Stakeholder
consultation plan

The Exchange has developed and implemented a stakeholder
consultation plan and has and will continue to consult with
consumers, small businesses, State Medicaid and CHIP agencies,
agents/brokers, employer organizations, and other relevant
stakeholders as required under 45 CFR 155.130.

Consumer and
Stakeholder
Engagement and
Support

Tribal consultation
plan

Applicable only to States with Federally-recognized Tribes: The
Exchange, in consultation with the Federally-recognized Tribes,
has developed and implemented a Tribal consultation policy or
process, which has been submitted to HHS.

Consumer and
Stakeholder
Engagement and
Support

Outreach and
education

The Exchange provides culturally and linguistically appropriate
outreach and educational materials to the public, including
auxiliary aids and services for people with disabilities, regarding
eligibility and enrollment options, program information, benefits,
and services available through the Exchange, the Insurance
Affordability Program(s), and the SHOP.
In addition, the Exchange has an outreach plan for populations
including: individuals, entities with experience in facilitating
enrollment such as agents/brokers, small businesses and their
employees, employer groups, health care providers, communitybased organizations, Federally-recognized Tribal communities,

Core Activity

Activity Nickname

Activity Full Description
advocates for hard-to-reach populations, and other relevant
populations as outlined in 45 CFR 155.130.

Consumer and
Stakeholder
Engagement and
Support

Consumer and
Stakeholder
Engagement and
Support

Consumer and
Stakeholder
Engagement and
Support

Call center

The Exchange provides for the operation of a toll-free telephone
hotline (call center) to respond to requests for assistance from
the public, including individuals, employers, and employees, at no
cost to the caller as specified by 45 CFR 155.205(a).

Internet Web site

The Exchange has established and maintains an up-to-date
Internet Web site that provides timely and accessible information
on Qualified Health Plans (QHPs) available through the Exchange,
Insurance Affordability Program(s), and the SHOP, and includes
requirements specified in 45 CFR 155.205(b).

Navigators

The Exchange has established or has a process in place to
establish and operate a Navigator program that is consistent with
the applicable requirements of 45 CFR 155.210, including the
development of training and conflict of interest standards, and
adheres to privacy and security standards specified in 45 CFR
155.210 and 45 CFR 155.260.

Consumer and
Stakeholder
Engagement and
Support

Agents/brokers

Consumer and
Stakeholder
Engagement and
Support

Web brokers

Eligibility and
Enrollment

Single streamlined
application(s) for
Exchange and SHOP

If applicable: If the State permits activities by agents and brokers
pursuant to 45 CFR 155.220(a), the Exchange has clearly defined
the role of agents and brokers including evidence of licensure,
training, and compliance with 45 CFR 155.220(c)-(e). The
Exchange will have agreements with agents/brokers consistent
with 45 CFR 155.220(d), which address agent/broker registration
with the Exchange, training on QHP options and Insurance
Affordability Program(s), and adherence to privacy and security
standards, as specified in 45 CFR 155.260.
If applicable: If the State permits activities by agents and brokers
pursuant to 45 CFR 155.220(a), the Exchange has clearly defined
the role of web brokers including evidence of licensure, training,
and compliance with 45 CFR 155.220(c)-(e). Specifically, the
Exchange has agreements with web brokers consistent with 45
CFR 155.220(d), which address agent/broker registration with the
Exchange, training on QHP options and Insurance Affordability
Program(s), and adherence to privacy and security standards, as
specified in 45 CFR 155.260.
The Exchange has developed and will use an HHS-approved
single, streamlined application for the individual market – or will
use the HHS-developed application – to determine eligibility and
collect information that is necessary for enrollment in a QHP for
the individual market and for insurance affordability programs as
specified in 45 CFR 155.405. The Exchange has developed and will
use an HHS-approved application for SHOP or will use the HHSdeveloped application for SHOP employers and employees as
specified in 45 CFR 155.730.

Core Activity

Activity Nickname

Activity Full Description

Eligibility and
Enrollment

Coordination strategy
with Insurance
Affordability Programs
and the SHOP

The Exchange has developed and documented a coordination
strategy with other agencies administering Insurance
Affordability Programs and the SHOP that enables the Exchange
to carry out the eligibility and enrollment activities.

Eligibility and
Enrollment

Application, updates,
acceptance and
processing, and
responses to
redeterminations

The Exchange has the capacity to accept and process applications,
updates, and responses to redeterminations from applicants and
enrollees, including applicants and enrollees who have disabilities
or limited English proficiency, through all required channels,
including in-person, online, mail, and phone.

Eligibility and
Enrollment

Notices, data
matching, annual
redeterminations and
response processing

The Exchange has the capacity to send notices, including notices
in alternate formats and multiple languages; conduct periodic
data matching; and conduct annual redeterminations and process
responses in-person, online, via mail, and over the phone
pursuant to 45 CFR 155, subpart D.

Verifications

The Exchange has the capacity to conduct verifications pursuant
to 45 CFR 155, subpart D, and is able to connect to data sources,
such as the Federal Data Services Hub, and other sources as
needed.

Document acceptance
and processing

The Exchange has the appropriate privacy protections and
capacity to accept, store, associate, and process documents
received from individual applicants and enrollees electronically,
and the ability to accept, image, upload, associate, and process
paper documentation received from applicants and enrollees via
mail and/or fax.

Eligibility and
Enrollment

Eligibility
determination

The Exchange has the capacity to determine individual eligibility
for enrollment in a QHP through the Exchange and for employee
and employer participation in the SHOP. In addition, the
Exchange has the capacity to assess or determine eligibility for
Medicaid and CHIP based on Modified Adjusted Gross Income
(MAGI).

Eligibility and
Enrollment

Eligibility
determinations for
APTC and CSR

The Exchange has the capacity to determine eligibility for
Advance Payments of the Premium Tax Credit (APTC) and Cost
Sharing Reductions (CSR), including calculating maximum APTC,
independently or through the use of a Federally-managed service.

Eligibility and
Enrollment

Applicant and
employer notification

The Exchange has the capacity to independently send notices, as
necessary, to applicants and employers pursuant to 45 CFR 155
subpart D that are in plain language, address the appropriate
audience, and meet content requirements.

Eligibility and
Enrollment

Eligibility and
Enrollment

Core Activity

Activity Nickname

Activity Full Description

Eligibility and
Enrollment

Individual
responsibility
requirement and
payment exemption
determinations

The Exchange has the capacity to accept applications and
updates, conduct verifications, and determine eligibility for
individual responsibility requirement and payment exemptions
independently or through the use of Federally-managed services.

Eligibility and
Enrollment

Eligibility appeals

The Exchange has the capacity to support the eligibility appeals
process and to implement appeals decisions, as appropriate, for
individuals, employers, and employees.

QHP selections and
terminations, and
APTC/advance CSR
information processing

The Exchange and SHOP have the capacity to process QHP
selections and terminations in accordance with 45 CFR 155.400
and 155.430, compute actual APTC, and report and reconcile QHP
selections, terminations, and APTC/advance CSR information in
coordination with issuers and CMS. This includes exchanging
relevant information with issuers and CMS using electronic
enrollment transaction standards.

Eligibility and
Enrollment

Electronically report
results of eligibility
assessments and
determinations

The Exchange has the capacity to electronically report results of
eligibility and exemption assessments and determinations, and
provide associated information to HHS, IRS, and other agencies
administering Insurance Affordability Programs, as applicable.
This includes information necessary to support administration of
the APTC and CSR as well as to support the employer
responsibility provisions of the Affordable Care Act.

Eligibility and
Enrollment

High Risk Pool
Transition Plan

The Exchange has a transition plan for high risk pools including
State-based PCIP programs and other similar programs.

Plan
Management

Appropriate authority
to perform and
oversee certification of
QHPs

The Exchange has the appropriate authority to perform the
certification of QHPs and to oversee QHP issuers consistent with
45 CFR 155.1010(a).

Plan
Management

QHP certification
process

The Exchange has a process in place to certify QHPs pursuant to
45 CFR 155.1000(c) and according to QHP certification
requirements contained in 45 CFR 156.

Plan
Management

Plan Management
system(s) for processes
that support the
collection of QHP
issuer and plan data

The Exchange uses a plan management system(s) or processes
that support the collection of QHP issuer and plan data; facilitates
the QHP certification process; manages QHP issuers and plans;
and integrates with other Exchange business areas, including the
Exchange Internet Web site, call center, quality, eligibility and
enrollment, and premium processing.

Eligibility and
Enrollment

Core Activity

Activity Nickname

Activity Full Description

Plan
Management

Ensure ongoing QHP
compliance

The Exchange has the capacity to ensure QHPs’ ongoing
compliance with QHP certification requirements pursuant to 45
CFR 155.1010(a)(2), including a process for monitoring QHP
performance and collecting, analyzing, and resolving enrollee
complaints.

Plan
Management

Support issuers and
provide technical
assistance

The Exchange has the capacity to support issuers and provides
technical assistance to ensure ongoing compliance with QHP
issuer operational standards.

Plan
Management

Issuer recertification,
decertification, and
appeals

The Exchange has a process for QHP issuer recertification,
decertification, and appeal of decertification determinations
pursuant to 45 CFR 155.1075 and 155.1080.

Timeline for QHP
accreditation

The Exchange has set a timeline for QHP issuer accreditation in
accordance with 45 CFR 155.1045. The Exchange also has
systems and procedures in place to ensure QHP issuers meet
accreditation requirements (per 45 CFR 156.275) as part of QHP
certification in accordance with applicable rulemaking and
guidance.

Plan
Management

QHP quality reporting

The Exchange has systems and procedures in place to ensure that
QHP issuers meet the minimum certification requirements
pertaining to quality reporting and provide relevant information
to the Exchange and HHS pursuant to Affordable Care Act
1311(c)(1), 1322(e)(3), and as specified in rulemaking.

Risk Adjustment,
and Reinsurance

Risk adjustment
program

The State has the legal authority to operate the risk adjustment
program per 45 CFR 153 and Affordable Care Act 1343, if the
State chooses to administer its own risk adjustment program.

Risk Adjustment,
and Reinsurance

Reinsurance program

The State operates its own reinsurance program per Affordable
Care Act 1341 requirements.

Small Business
Health Options
Program (SHOP)

SHOP compliance with
45 CFR § 155 Subpart
H

The SHOP is compliant with regulatory requirements pursuant to
45 CFR 155 Subpart H.

Small Business
Health Options
Program (SHOP)

SHOP premium
aggregation

The Exchange has the capacity for SHOP premium aggregation
pursuant to 45 CFR 155.705.

Plan
Management

Core Activity

Activity Nickname

Activity Full Description

Small Business
Health Options
Program (SHOP)

Electronically report
results of eligibility
assessments and
determinations for
SHOP

The SHOP Exchange has the capacity to electronically report
information to the IRS for tax administration purposes.

Organization
and Human
Resources

Organizational
structure and staffing
resources to perform
Exchange functions

The Exchange has an appropriate organizational structure and
staffing resources to perform Exchange activities.

Finance and
Accounting

Long-term operational
cost, budget, and
management plan

The Exchange has a long-term operational cost, budget, and
management plan.

Technology

Compliance with HHS
IT Guidance

The Exchange technology and system functionality complies with
relevant HHS information technology (IT) guidance.

Technology

Adequate technology
infrastructure and
bandwidth

The Exchange has the adequate technology infrastructure and
bandwidth required to support all of the Exchange activities.

Technology

IV&V, quality
management and test
procedures

The Exchange effectively implements IV&V, quality management,
and test procedures for Exchange development activities and
demonstrates it has achieved HHS-defined essential functionality
for each required activity.

Privacy and
Security

Privacy and Security
standards policies and
procedures

The Exchange has established and implemented written policies
and procedures regarding the Privacy and Security standards set
forth in 45 CFR 155.260(a)-(g).

Privacy and
Security

Safeguards based on
HHS IT Guidance

The Exchange has established and implemented safeguards that
(1) ensure the critical outcomes in 45 CFR 155.260(a)(4), including
authentication and identity proofing functionality, and (2)
incorporates HHS IT requirements as applicable.

Privacy and
Security

Safeguard Protections
for Federal information

The Exchange has adequate safeguards in place to protect the
confidentiality of all Federal information received through the
Data Services Hub, including but not limited to Federal tax
information.

Oversight,
Monitoring, and
Reporting

Routine oversight and
monitoring of the
Exchange’s Activities

The Exchange has a process in place to perform required activities
related to routine oversight and monitoring of Exchange activities
(and will supplement those policies and procedures to implement
regulations promulgated under the Affordable Care Act 1313).

Core Activity

Activity Nickname

Activity Full Description

Oversight,
Monitoring, and
Reporting

Track/report
performance and
outcomes metrics
related to Exchange
Activities

The Exchange has the capacity to track and report performance
and outcome metrics related to Exchange Activities in a format
and manner specified by HHS necessary for, but not limited to,
annual reports required by Affordable Care Act 1313(a).

Oversight,
Monitoring, and
Reporting

Uphold financial
integrity provisions
including accounting,
reporting, and auditing
procedures

The Exchange has instituted procedures and policies that
promote compliance with the financial integrity provisions of
Affordable Care Act 1313 (and will supplement those policies and
procedures to implement regulations promulgated under the
Affordable Care Act 1313), including the requirements related to
accounting, reporting, auditing, cooperation with investigations,
and application of the False Claims Act.

Contracting,
Outsourcing,
and Agreements

Contracting and
outsourcing
agreements

The Exchange has executed appropriate contractual, outsourcing,
and partnership agreements with vendors and/or State and
Federal agencies for all Exchange activities and functionality as
needed, including data and privacy agreements.

State
Partnership
Exchange
Activities

Plan Management
agreements

The State has appropriate agreements in place to operate the
Plan Management activities for a State Partnership Exchange.

State
Partnership
Exchange
Activities

Capacity to interface
with the Federallyfacilitated Exchange

The State has the capacity to interface with the Federallyfacilitated Exchange, as necessary, to ensure a seamless
consumer experience.

Consumer Assistance
agreements

The State has appropriate agreements in place to coordinate with
the Federally-facilitated Exchange and has a plan for providing
the Consumer Assistance activity(ies), including in-person
assistance, for its State Partnership Exchange consistent with 45
CFR 155.205(d) and (e).

State
Partnership
Exchange
Activities

PPR-Overall Project

#

Line Item

Response Format

1 Project Status
2 Percentage of project completed [by quartile]
3 Overall Progress Narrative
Document approved changes to your Program's work
4 plan.
Please describe any changes to key personnel assigned
5 to this project, including contractual staff.
6 Request CCIIO consultation

Drop-down [Complete, Ahead, On
Schedule, Behind, No Activity Planned]
Drop-down [0-24%, 25-49%, 50-74%, 7599%, 100%]
Free text
Free text/upload
Free text/upload
Free text/check box

Cost Allocation Supplemental

Cost Allocation Methodology

Budget Supplemental

Financial
Progress Report
State Personnel
IT
Non-IT
Fringe
Travel

Total
Federal
Funds
Authorized
$
-

Federal
Federal
Share of
Share of
Unliquidated Total Federal
Expenditures Obligations
Share
$
$
$
$
$
$
$

Unobligated
Balance of
Federal Funds
$

-

$

-

$

-

$
$

-

Financial
Progress Report

Total
Federal
Funds
Authorized

Supplies

$
-

IT
Non-IT
Equipment

$
-

IT
Non-IT
Contractual

$
-

IT
Non-IT
Consultant

$
-

IT
Non-IT
Other [please
specify]
TOTAL DIRECT
COSTS

Contractual - Detail
Award Date
Contractor if known
Amount
Period of
Performance
Services
IT-PROF

$
-

Federal
Federal
Share of
Share of
Unliquidated Total Federal
Expenditures Obligations
Share
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
-

Unobligated
Balance of
Federal Funds

$

-

$

-

$

-

$

-

$

-

$

-

$

-

$

-

$

-

$

-

$

-

$

-

$

-

$

-

Line Item

#
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State Population (2010)
Medicaid Enrollment (as of 12/31/2010)
Projected Newly Enrolled in Medicaid
Identify the percentage of your State's population that is uninsured.
Identify the percentage of your State's population that receives employeesponsored health insurance benefits.
Identify the percentage of your State's population that purchases health
insurance coverage through the individual market.
Identify the percentage of your State's population that are Medicaid
beneficiaries.
Identify the percentage of your State's population that are Medicare
beneficiaries.
Identify the percentage of your State's population that are forms of public
insurance other than Medicaid or Medicare.
Name of Medicaid Program
Name of State Medicaid Agency
Does your State have a 1115 Comprehensive Demonstration Medicaid
Waiver, and if so, what is the demonstration period?
Does your State have an Early Option Coverage?
Current Delivery System(s): address Fee For Service, Managed Care, and
Other systems.
Is Children's Health Insurance Program (CHIP) run as a Medicaid expansion,
or separately?
Name of CHIP Program
Name of Agency that Administers CHIP
Identify Medicaid Management Information System (MMIS) Vendor
Identify MMIS Platform
Identify age of current MMIS core system
Identify Medicaid/IE Eligibility System Vendor
Identify Medicaid/ IE Eligibility Platform
Identify age of current Medicaid/IE Eligibility Core System
Identify Exchange Vendor
Identify Proposed Exchange Platform
Identify Vendor Performing IT Gap Analysis
Is your Program developing to 7 S&C’s?
Current Status of APD and RFP

Response
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