The California Health Benefit Exchange in collaboration with the Department of Health Care Services, and the Managed Risk Medical Insurance Board are soliciting proposals for a new Exchange system. The system is referred to as the “California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS).
The Draft Solicitation released December 20, 2011 seeks comments due December 30, 2011 to enable the public and vendors to provide input in advance of the final solicitation to be released January 18, 2012. The final proposal submission is due February 24, 2012.
According to the Draft Solicitation, the vendors are expected to:
• Design, develop, test, and deliver a fully integrated automated system delivering services through a web format in English and Spanish to be used by persons with disabilities and provide for feedback regarding ease of accessibility
• Enable customers to access consumer accounts via the CalHEERS web portal using role-based security
• Enable individuals to create an account, submit applications, update case information, appeal an eligibility determination, allow application processing across affordability programs, enable users to browse anonymously, provide for seamless and timely transition between health programs with no gap in service, and enable individuals to be able to shop and compare health plan options
• Provide capabilities to determine real-time eligibility for all Exchange Health Services Programs, Healthy Families, and for Med-Cal income-based eligibility
• Promote transparency and accountability through compliance with federal guidelines
• Build on existing systems where appropriate and build on an architecture that is scalable, flexible, modular, and dynamic
• Build on a single comprehensive and integrated security and privacy framework that implements multiple federal and California state security and privacy policies and protects consumer information
• Operate and maintain the automated system for the life of the contract and provide for administrative maintenance and case maintenance tasks
• Implement the automated system statewide with minimal business disruption, prepare CalHEERS user groups and facilitate their implementation, deliver training, equipment, materials, organization, logistics, and staffing
It is expected that vendors will need to proactively monitor other States and their exchange developments and implementations and be able to incorporate public domain software in their proposed solutions to the solicitation.
Go to www.healthexchange.ca.gov/Solicitations/Pages/Default.aspx to view the draft solicitation then click on “Draft CalHEERS Solicitation for Development and Operations Services”.