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The purpose of this solicitation is to obtain technical assistance services to develop the Affordable Care Act Section 1332 State Innovation Waiver application (waiver application) and manage the waiver application development process.
Section 1332 of the Affordable Care Act (ACA), also known as State Innovation Waivers, authorizes states to request five-year renewable waivers from the U.S. Departments of Health and Human Services (HHS) and the U.S. Treasury. These waivers allow for flexibility regarding the ACA’s key coverage provisions, including those related to benefits and subsidies, exchanges, and the individual and employer mandates. States may propose waivers to pursue broad alternative approaches to expand coverage or targeted fixes to improve consumers’ experiences. Some ACA provisions, such as guaranteed issue, may not be waived and all applications must demonstrate that coverage remains as accessible, comprehensive, and affordable as before the waiver and that the proposed changes will not contribute to the federal deficit.
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As set forth in 45 CFR Part 155 Exchange Establishment Standards and Other Related Standards under the Affordable Care Act, Subpart M-Oversight and Program Integrity Standards for State Exchanges, § 155.1200(c) External Audits, the Exchange must engage an independent qualified auditing entity which follows generally accepted governmental auditing standard (GAGAS) to perform an annual independent external financial and programmatic audit and must make such information available to the Department of Health and Human Services (HHS) for review.
In addition, 2 CFR Part 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Subpart F – Audit Requirements, § 200.501(a) and (b) requires a non-federal entity that expends $750,000 or more during the non-federal entity’s fiscal year must have single or program specific audit conducted for that year in accordance with § 200.514 Scope of audit except when elected to have a program-specific audit.
As summarized, 2 CFR § 200.514 Scope of Audit, encompasses an audit of Covered California’s financial statements in accordance with GAGAS and generally accepted accounting principles (GAAP); an assessment of internal control over Federal programs; compliance with Federal statues, regulations, and the terms and conditions of Federal awards that may have a direct and material effect; follow-up procedures on prior audit findings for reasonableness; and completion of the data collection form as part of the report submission.
According to 2 CFR § 200.512 Report Submission, the Single Audit must be submitted by the earlier of 30 calendar days after receipt of the auditor’s report(s), or nine months after the end of the audit period to the Federal Audit Clearinghouse (FAC). Covered California must electronically submit to the FAC the data collection form and the reporting package must include the following:
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The purpose of this RFP is to obtain print and fulfillment services to support the Outreach, Education and Enrollment functions of Covered California.
Covered California is a rapidly evolving organization with need for a Print and Fulfillment vendor that can manage complex collateral production, mailings and distribution needs across California. Collateral pieces will be used by the statewide outreach, education and enrollment network to raise awareness of and educate consumers. Messages and or piece components may be changed based on refinement requirements, and it is important for Covered California to partner with a vendor that can assist in balancing appropriate production approaches to meet demand for materials, while minimizing waste of stored materials that may be updated or replaced with new versions. Critical to success is the ability to maintain awareness of utilization and versions of materials that are in circulation.
In addition to managing production, the selected Contractor will be required to manage order accounts for multiple grantees, entities and partners.
Covered California reserves the right to retain the services of the organization selected as a result of this RFP to assist with other related activities and projects embarked upon by Covered California during the established contract period, or through a contract amendment.
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Contractor shall provide Employee Fitness For Duty Psychological Evaluations to determine an employee’s capacity to perform their job functions, for one or both of the following Covered California regions, with a contract term through June 30, 2017.
Region 1:
Fresno Service Center, 7202 N. Palm Avenue, Fresno, CA 93711
Region 2:
Headquarters Office, 1601 Exposition Boulevard, Sacramento, CA 95815 Rancho Cordova Service Center, 10877
White Rock Road, Rancho Cordova, CA 95670 CalHEERS Field Office, 2329 Gateway Oaks, Suite 100, Sacramento,
CA 95833
Contractor shall provide Employee Fitness For Duty Physical Evaluations to determine an employee’s capacity to perform their job functions, for all of the following Covered California locations, with a contract term through June 30, 2017.
Headquarters Office, 1601 Exposition Boulevard, Sacramento, CA 95815
Rancho Cordova Service Center, 10877 White Rock Road, Rancho Cordova, CA 95670
CalHEERS Field Office, 2329 Gateway Oaks, Suite 100, Sacramento, CA 95833
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Contractor shall provide Employee Fitness For Duty Physical Evaluations to determine an employee’s capacity to perform their job functions, for one or both of the following Covered California regions, with a contract term through June 30, 2017.
Region 1:
Fresno Service Center, 7202 N. Palm Avenue, Fresno, CA 93711
Region 2:
Headquarters Office, 1601 Exposition Boulevard, Sacramento, CA 95815 Rancho Cordova Service Center, 10877
White Rock Road, Rancho Cordova, CA 95670 CalHEERS Field Office, 2329 Gateway Oaks, Suite 100, Sacramento,
CA 95833
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Provide a technical solution for the collection and review of the 2017 certification applications.
For Plan Year 2017, the Exchange will certify all QHP and QDP applicants during the annual solicitation period which only occurs over three (3) months of each year. The process will include new and existing QHP and QDP bidders. Bidders must demonstrate that their proposed plans meet or exceed the Exchange’s certification standards which include offering adequate provider networks; meeting or exceeding accreditation and quality requirements; proposing best practices and innovations in delivery system reforms; and other detailed and unique standards for the geographic areas they propose to serve. The Exchange will select and certify QHPs and QDPs based on their ability to meet or exceed the Exchange’s certification standards and that offer value and distinct choice and quality healthcare at an affordable cost.
The Exchange will require the technical support services of a Contractor with the system capability to collect the data submissions of individual product offerings for both the individual and small group markets from QHP and QDP Issuers for Plan Year 2017. This Request for Proposal (RFP) will be for a two (2) year contract spanning two annual solicitation cycles which includes the Certification and Recertification of QHPs and QDPs for Plan year 2018 as well as the 2017 Certification solicitation.
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Contractor shall provide Employee Fitness For Duty Psychological Evaluations to determine an employee’s capacity to perform their job functions, for one or both of the following Covered California regions, with a contract term through June 30, 2017.
Region 1:
Fresno Service Center, 7202 N. Palm Avenue, Fresno, CA 93711
Region 2:
Headquarters Office, 1601 Exposition Boulevard, Sacramento, CA 95815 Rancho Cordova Service Center, 10877
White Rock Road, Rancho Cordova, CA 95670 CalHEERS Field Office, 2329 Gateway Oaks, Suite 100, Sacramento,
CA 95833
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RFP 2015-08 Addendum #1
The purpose of this Request for Information (RFI) is to gather information on potential solutions available to Covered California for:
The information sought includes:
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Part of the CalHEERS Project is the development of premium accounting and reconciliation functions, which includes compensating assisters. This work entails working with the health plans to perform accounting and reconciling of premium payments, calculating and collecting the California Health Benefit Exchange’s (Exchange) fee, developing and implementing the accounting and cash processes to compensate Assisters, and establishing proper controls and fraud prevention that will be associated with the continued implementation of the Exchange.
The purpose of this Request for Proposal (RFP) is to obtain the services of consultants to provide the Exchange with premium accounting and reconciliation support.
2/13/15: Please see Addendum 1 documents below
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Covered California requires strategic leadership and consulting services to under-serviced communities for the purposes of education and enrollment. Individual proposals will be specific to an identified community (ie; African American, Latino, Asian-Pacific Islander).
10/29/2014: Covered California has lifted the suspension on this Request for Proposal and has issued Addendum 3 to update the interview date and the date of the notice of intent to award. Bidders will be contacted individually to schedule interviews.
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The California Health Benefit Exchange/Covered California is seeking renewal and new entrant applications from issuers proposing to sell Qualified Health Plans (QHP) and Qualified Dental Plans (QDP) through the Exchange for Plan Year 2016.
In the links below please find information related to submitting applications. Please submit completed Notice of Intent with a cover letter. Only applicants who have submitted a Notice of Intent will be given access to on-line applications (non-PDF) which will be made available on March 2, 2015.
Covered California is seeking an analytics solution to support its role as an “active purchaser,” which requires a sophisticated analytics capacity to support a wide range of enterprise needs including product/benefit design, marketing, pricing, actuarial, access to care, health disparity reduction, quality and network management decisions and policy commitments.
Covered California encourages all interested parties to fully review this Request for Proposal (RFP), and if qualified, to respond.
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1/20/2015 – Please see Addendum 5 documents below.
12/22/2014 – Please see Addendum 4 documents below.
11/25/2014 – Please see Addendum 3 documents below.
11/6/2014 – See below for Covered California’s responses to the questions submitted by potential bidders on 10/30/2014.
10/20/2014 - This is now an ACTIVE SOLICITATION. See Addendum 2 items below which replace the original RFP.
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