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ENTITY MANAGEMENT TRAINING
ENTITY MANAGEMENT TRAINING
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To Complete Training
• This training will take approximately 30min to complete
• For questions email:
COURSE INSTRUCTIONS
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Definitions• Certified Entities includes entities affiliated with any of these
Enrollment Assistance Programs:
* Navigator Program (NAV)
* Certified Application Counselor Program (CAC)
* Medi-Cal Managed Care Plan Program (MMCP)
• Certified Counselor includes:
* Individuals affiliated to any of the entities
• CC: Covered California
DEFINITIONS
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1. Introduction
a. Enrollment Assistance Program Overview
2. Phase 1: Becoming an Active Certified Entity with Certified Counselors
a. Steps to Becoming an Active Certified Entity
b. Steps to Becoming a Counselor, including:
• Training
• Fingerprinting and Background Check
c. Roles and Responsibilities
3. Phase 2: Understanding Consumer Service and Enrollment Assistance Support
a. Consumer Service and Enrollment Assistance Support
b. Systems and Resources
As part of this training process, the Primary Contact of the Entity will be
required to attest that they clearly understand the requirements associated
with becoming an Entity.
TABLE OF CONTENTS
PROGRAMS OVERVIEW
1. CERTIFIED APPLICATION COUNSELOR (CAC)
2. NAVIGATOR PROGRAM (NAV)
3. MEDI-CAL MANAGED CARE PLAN (MMCP)
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WHAT IS THE CERTIFIED APPLICATION
COUNSELOR PROGRAM
Certified Application Counselor Program
Certified Application Entity
Certified Application Counselor
The CAC program is for entities interested in
assisting consumers to enroll in Covered
California’s Health Plans and other insurance
affordability programs.
CAE: An entity or individual registered by
Covered California to oversee CACs who provide
one-on-one consumer assistance. A CAE is not
eligible to receive compensation for enrollments.
CAC: An individual who is certified by Covered
California and affiliated with a CAE, to provide
face-to-face, one-on-one consumer assistance.
Certified Application Counselor (CAC) Program
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The Navigator (NAV) program engages trusted
Certified Enrollment Entities (CEE) to conduct
outreach, education, enrollment assistance,
renewal assistance and post enrollment services
on behalf of Covered California.
NAV Grantees: A Grantee will provide Outreach
& Education, Enrollment, Renewal and Post
Enrollment activities as well as Enrollment
Assistance.
Navigator: A Certified Enrollment Counselor
(CEC) who is affiliated with a Certified Enrollment
Entity that is registered in the Navigator Program.
WHAT IS THE NAVIGATOR PROGRAM
Navigator Program
Navigator Grantees
Navigator
Navigator Program
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The MMCP Program is for entities contracting with
the Department of Health Services (DHCS) to
provide health care services to those enrolled in
Medi-Cal
MMCP: An entity contracting with the DHCS to
provide health care services to enrolled Medi-Cal
beneficiaries.
MMCPE: An individual that is an employee or
contractor of a Medi-Cal Managed Care Plan who
provides enrollment assistance pursuant to this
agreement.
WHAT IS THE MEDI-CAL MANAGED CARE PLAN
ENROLLMENT ASSISTANCE PROGRAM
Medi-Cal Managed Care Plan Program
Medi-Cal Managed Care
Plan
Medi-Cal Managed Care Plan Enroller
Medi-Cal Managed Care Plan
(MMCP) Program
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It is your duty to carefully review and understand all contents within the
program regulations and the Entity Agreement, independent of this training.
The California Health Benefit Exchange established the Certified Application
Counselor Program within Title 10 of the California Code of Regulations. The
regulations that govern your organization’s relationship with Covered California
are available using the following web links:
• CAC: http://hbex.coveredca.com/regulations/index%20-%20Certified%20Application%20Counselors.shtml
• Navigator: http://hbex.coveredca.com/regulations/index%20-%20Enrollment%20Assistance.shtml
• MMCP: http://hbex.coveredca.com/regulations/index%20-%20Medi-Cal%20Managed%20Care.shtml
Entity Agreement
A copy of your fully executed agreement will be available for download on the
online system, In-Person Assistance System (IPAS):
https://ipas.ccgrantsandassisters.org. Any updates to the Agreement will be
published and communicated by Covered California to you and your Entity.
PROGRAM REGULATIONS
PHASE 1: BECOMING AN
ACTIVE ENTITY WITH
COUNSELORS
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This section of the training will focus on steps needed to prepare your
organization to perform enrollment assistance on behalf of Covered
California. The following process shows the steps needed for Entities to
become Active:
Entities can build a Counselor team roster by adding individuals’ names
to the application in the IPAS application
If you have questions about adding Counselors to your roster, uploading
the Counselor agreement or their photograph into IPAS, please contact:
The Entities Primary Contact (you) must complete this Entity
Management Training prior to any of your affiliated Counselors carrying
out any consumer assistance functions.
OVERVIEW OF THE PROCESS TO BECOME ACTIVE
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An Entity becomes Active when the following (3) requirements are met:
1. The Primary Contact has completed the Entity Management Training
2. The Entity has uploaded the Entity Management Completion Form
and Conflict of Interest Prevention Plan to their “My Files” in IPAS:
3. The Entity has at least one fully certified Counselor
Once, these requirements have been met, the Primary Contact for the
Entity will receive an email from [email protected]
with the subject: “Your Entity CoveredCA.com login credentials”
Expect to receive this email within 3-5 business days after your entity has
become Active.
NOTIFICATION ONCE AN ORGANIZATION IS ACTIVE
STEPS FOR COUNSELORS TO
BECOME CERTIFIED
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The following graphic outlines how individuals affiliated to your Entity will
become a Certified Counselor:
Note: the background check/fingerprinting process may happen concurrently
with training, individuals do not need to complete these steps in sequence.
Individuals should begin both steps as soon as possible.
Individuals who are currently active and certified with another Entity will not
need to complete the training and background clearance process again.
OVERVIEW OF THE STEPS TO BECOME CERTIFIED
COUNSELOR TRAINING
REQUIREMENTS
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Counselors will receive login credentials to the Learning Management
System (LMS) once their application is submitted and approved in IPAS.
All training components are located in the LMS at
https://learning.coveredca.com.
CERTIFICATION TRAINING OVERVIEW
Counselor logs in to the LMS and accesses the appropriate Counselor Certification Training
Completes the Computer-Based Training courses online
Passes the Counselor exam
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Courses for Counselor Certification Training:
1. Introduction to the Affordable Care Act
2. Introduction to Health Insurance
3. Covered California for Small Business
4. Understanding Your Role
5. Eligibility for Individuals and Families
6. Covered California Plan Options
7. Privacy, Security and Compliance
8. The Application Process
9. Application Updates
*Recertification Training is required annually.
TRAINING CURRICULUM
FINGERPRINTING AND
BACKGROUND CHECK
PROCESS FOR INDIVIDUALS
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Remember that the background check is not dependent on training
completion. Counselors should begin background check and complete
training as soon as possible.
The Entity Primary Contact (PC) downloads the forms:
The background check requires Counselors to complete two forms provided
by the PC, and available in IPAS:
1. (2 copies) Request for LiveScan Service (fingerprinting)
2. Criminal Disclosure Form
CRIMINAL BACKGROUND CHECK AND
FINGERPRINTING OVERVIEW
Forms are available in IPAS.
PCs click the “Download
Forms” link next to each
Counselor applicant’s name.
The link will only appear
when the Counselor’s
application has been fully
completed.
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You will print TWO pre-populated Request for Live Scan
Service forms and provide to the Counselor. The
Counselor will complete the remaining blank fields.
Counselors must use Covered California approved
service locations. Live Scan sites for the Covered
California approved vendor can be located at:
https://www.applicantservices.com/CapitalLiveScan/Liv
eScan_Locations
Covered California pays the fingerprinting fees for
individuals applying to become Navigator or CAC
Enrollment Counselors.
1. For MMCP Counselors. The entity shall pay
fingerprinting fees for individuals applying to
become enrollment counselors.
2. The Counselor schedules an appointment at
his/her chosen Covered California approved
fingerprinting location and brings two completed
prepopulated Live Scan Forms. MMCP Counselor
applicants shall pay for fingerprinting service when
rendered.
COMPLETING THE LIVESCAN FORM
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2. Entity personnel are NOT allowed to process,
view, collect, or mail this disclosure form for
the individual. ONLY the individual completing
the Criminal Disclosure Form may view, mail,
or fax the form.
3. Faxed to: (916) 228-8905 (preferred)
Or
4. Mailed to:
HBEX/California Health Benefit Exchange
CONFIDENTIAL – BACKGROUND CHECKS
Office of Legal Affairs
1601 Exposition Blvd.
Sacramento, CA 95815
COMPLETING CRIMINAL DISCLOSURE FORM
1. An individual applying to become a Counselor must also complete the Criminal
Disclosure Form. The form is available for download in IPAS using the download forms
link in your Counselor roster. This form is to be completed by the individual applying to
become a Counselor. **The Entity may not assist in this process.
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Receiving the Delegation CodeOnce an entity has completed all requirements (see slides 11 and 12), a
Counselor applicant becomes Certified when the following requirements
are met:
1. Cleared background check
2. Completed all training requirements
3. Passed certification exam
4. Badge photo uploaded to counselor profile
Within 3 – 5 business days after becoming Certified, the Counselor will
receive an email from [email protected] with
a delegation code and additional information to create an account on the
web-based enrollment portal, CoveredCA.com.
FINAL STEPS FOR COUNSELORS
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Counselors will receive an ID badge 5-7 business days
after they are certified. Before a badge can be issued,
Entities must upload a headshot photo in the
Counselor’s application in IPAS. The photo must be
taken from the shoulders up and have a plain
background. The following images are appropriate
badge photos:
IDENTIFICATION BADGES
The Entity will guarantee that its affiliated Counselors wear ID badges issued
by Covered California at all times when providing consumer assistance.
Counselors are required to show the ID badge to consumers before they
provide enrollment assistance.
ROLES AND RESPONSIBILITIES
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Roles and responsibilities covered in this section apply to both Entities
and Counselors.
MEETING PROGRAM EXPECTATIONS
Under the guidance of the Entities, Counselors are expected to:
• Provide information about available Covered California Health Plans and
financial help in the form of premium assistance and cost-sharing reductions.
• Explain the enrollment options available on CoveredCA.com.
• Educate consumers about the value of health insurance and answer their
questions.
• Inform consumers about premium costs and the benefits of obtaining health insurance coverage.
• Provide consumers with support and access to tools and resources that assist
in comparing costs, benefits and coverage options.
• Assist eligible consumers with enrollment into Covered California Health Plans
and/or other Insurance Affordability Programs, to include Medi-Cal.
• Provide information about consumer assistance hotlines and resources, such as
the Medi-Cal ombudsman, and the Office of Patient Advocate.
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The Entity will ensure that affiliated Counselors NEVER:
• Fail to disclose conflicts of interest
• Coach the consumer to provide inaccurate information on the
application
• Coach or recommend one plan or provider over another
• Accept premium payments from the consumer
• Pay any or part of the premium or any other type of consideration to or
on behalf of the consumer
• Induce or accept any type of direct or indirect remuneration from the
consumer
• Intentionally create multiple applications from the same household
• Invite, influence, or arrange an individual to separate from employer-
sponsored plan
PROHIBITED ACTIVITIES
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The Entity is accountable for and must comply with Covered
California’s fraud prevention policies
The Entity and any of its affiliated Counselors must not have had a
criminal case filed or a legal pleading issued, or have been convicted
of a felony or been implicated in a complaint, related to the business
of insurance or to issues of fraud or moral turpitude
The Entity must report to Covered California, within 30 days, any
incidence of fraud or any new criminal case filed or legal pleading
issue related to the business of insurance, or to issues of fraud or
moral turpitude
COMPLIANCE STANDARDS
Failure to report a known instance of fraud may result in
PERMANENT termination of the Entity
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California, Title 10, Article 11 §6864 (a) (4) requires compliance with
federal law pertaining to handling and safeguarding a consumer’s
personally identifiable information.
What information must be protected?
• Personally Identifiable Information (PII)
• Protected Health Information (PHI)
• Federal Tax Information (FTI)
Elements of protected information are required as part of the enrollment
process. Entities and Counselors who assist consumers will discuss,
view and, if necessary, input this information into a Covered California
enrollment application. PII is information that can be used to distinguish
or trace an individual’s identity, either alone or when combined with other
personal or identifying information. The following are examples of PII:
PRIVACY AND SECURITY STANDARDS
• Name
• Birthplace
• Date of Birth
• Age
• Social Security Number
• E-mail Address
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PHI whether verbal or written:
1. Is created or received by a health care provider, health plan, public
health authority, employer, life insurer, school or university, or health
care clearing house (e.g., a 3rd party medical biller); and
2. Relates to the past, present or future physical or mental health or
condition of an individual; or past, present or future payment for the
provision of health care to an individual
FTI is information from the Internal Revenue Service (IRS), contained in federal
tax returns, including:
– any tax information
– declaration of estimated tax
– claim for refund
– a taxpayers’ identity
– the nature, source or amount of income, payments, receipts; deductions,
exemptions, credits, assets, liabilities, net worth, tax liability, tax withheld,
deficiencies, over-assessments, or tax payments
– Other information related to a tax return
PROTECTED HEALTH INFORMATION AND
FEDERAL TAX INFORMATION
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Key Safeguarding Practices:
• Establish policies related to appropriate/prohibited access, use and
disclosure of PII, PHI and FTI
• Communicate the policies to Counselors, staff and colleagues
• Monitor Counselor compliance with policies
• Reinforce Covered California training on protecting information
Counselors shall never:
• Disclose or transmit PII/PHI/FTI over unsecure medium (e.g., email,
phone) or in a public venue
• Discuss PII/PHI/FTI with anyone other than the person who is the
subject of the information
• Ask for, or use, a consumer’s Covered California account log-in
information without their authorized consent
• Unnecessarily retain any PII/PHI/FTI
• Directly access the Consumer’s Covered California account rather
than through the designated Counselors account
PRIVACY AND SECURITY SAFEGUARDS
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Utilizing collateral material will help your Entity enrollment services.
It is important to use consistent, branded materials and messages
to maintain the integrity of the Covered California program.
The Entity must use approved materials with Covered California
branding (e.g., tablecloths, banners and signs) when conducting
Counselor activities
The Entity must maintain adequate supplies of collateral materials and
compliance with established policies with Covered California
marketing/branding guidelines available on CoveredCA.com at:
http://hbex.coveredca.com/toolkit/
Entities can order materials via the online Print Store which will be
discussed later in this course
USING COVERED CALIFORNIA MARKETING AND
COLLATERAL MATERIAL – CAC AND NAVIGATOR
PHASE 2: UNDERSTANDING
CONSUMER SERVICE AND
ENROLLMENT SUPPORT
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In this section the training will focus on what to do AFTER your
organization is Active and your counselors are Certified.
The topics we will review in this phase include:
Understanding how to support and provide enrollment assistance
services to consumers
How to utilize Covered California websites, systems and resources so
you and your team can be successful
OVERVIEW OF PHASE 2
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Under the oversight of the Entity, Counselors are expected to:
• Utilize the CoveredCA.com web-based portal to assist consumers
with completing and submitting their application for health care
coverage in Covered California health plans and Medi-Cal
• Educate consumers regarding first payment requirement to enroll
in a Covered California health plan
• Refer, when appropriate to consumer assistance hotlines, such as
ombudsman, Department of Mental Health Care, Office of Patient
Advocate, Plans, Department of Social Services, and the Covered
California Service Center
• Assist consumers with annual renewal applications during open
enrollment periods and special enrollment applications utilizing the
CoveredCA.com web-based enrollment portal.
DELIVERING ENROLLMENT ASSISTANCE SERVICES
* Consumers may enroll outside of the open-enrollment period through a special
enrollment due to a qualifying life event, such as: birth or adoption, marriage,
change in residence, loss of a job.
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HOW TO HELP YOUR TEAM BE SUCCESSFUL
Use these helpful hints to ensure your Counselors are
empowered and effective:
• Develop and train Counselors on internal processes
• Provide Counselors with the necessary resources to be effective
in their role
• Participate in identifying and building local partnerships for
collaborative enrollment efforts
• Develop a list of resources in your community
• Determine networking contacts that could support outreach and
education efforts
• Identify already scheduled events in the community that may be
leveraged and brainstorm underserved populations that may be
eligible
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Entities and affiliated Counselors should never act in a manner that
discriminates on the basis of:
• Race, ethnicity, gender, age, national origin, or religion
• Mental or physical disability
• High or low-income areas
• Health status
• Newly eligible beneficiaries over other beneficiaries
• Claims experience, genetic information, or evidence of insurability
To ensure that consumer assistance is accessible to people with
disabilities:
• Provide enrollment resources, websites and tools that are accessible
to individuals with disabilities
• Provide assistance in a location and manner that is physically and
otherwise accessible
• Maintain knowledge to refer people with disabilities to long term
services and support programs when appropriate
NON-DISCRIMINATION
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Supporting consumers with culturally and linguistically appropriate services is a fundamental requirement of Covered California. As you build your enrollment assistance population, make sure you and your Counselors are:
BUILDING CULTURAL COMPETENT ASSISTANCE
PROGRAMS
Identifying community organizations that the entity may be able to
partner with for community outreach
Developing and maintaining general knowledge about racial, ethnic
and cultural groups
Providing consumers with information and assistance in the
consumer’s preferred language when appropriate
Receiving ongoing education and training in culturally and linguistically
appropriate service delivery
Implementing strategies to recruit, support and promote a staff that is
representative of the demographics of the target communities
Maintaining an inventory of printed materials from Covered California
in the languages necessary to support target markets (ordering printed
materials will be discussed later in this course)
SYSTEMS AND RESOURCES
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There are four (4) systems that will be important for Entities to
become familiar and utilize for their work with Covered California.
These systems include:
1. In-Person Administrative System (IPAS)
2. CoveredCA.com (CalHEERS)
3. Learning Management System (LMS)
4. Covered California Print Store
UNDERSTANDING THE SYSTEMS USED FOR
COVERED CALIFORNIA
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The IPAS homepage also houses additional information and resources for
Entities and their affiliated Counselors. The IPAS homepage is:
https://ipas.ccgrantsandassisters.org/
Frequent this page regularly as new information is uploaded to the IPAS
homepage often.
Entity Status Board
The Entity status board is available in IPAS and allows the entity to track the
certification process of all individuals in their counselor roster as well as report
changes.
To view your Entity Status board, simply login to your IPAS account and click on
the speedometer icon as shown:
IN-PERSON ADMINISTRATIVE SYSTEM (IPAS)
*Questions related to IPAS should be sent to: [email protected]
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This system is the online portal that
allows individuals and small businesses
to sign up for health care coverage
through Covered California or Medi-Cal.
The Counselors affiliated with your
Entity will use this system to enroll
consumers in Covered California.
Entities will use this system to monitor
Counselor enrollment activities.
Questions on CoveredCA.com should
be directed to the Certified
Representative Help Line at:
1-855-324-3147
COVEREDCA.COM
CoveredCA.com, also known as the California Healthcare Eligibility,
Enrollment, and Retention System (CalHEERS).
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This system is an online training site
used to administer and track
Counselors training and examination
progress. The LMS can be accessed
at: https://learning.coveredca.com
As the Primary Contact you will not
have access to this system unless
requested. However, it is important
that you understand its purpose to
help you better manage your
Counselors certification progress.
Questions regarding LMS should be
directed to:
LEARNING MANAGEMENT SYSTEM (LMS)
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Once a Entity becomes active on CoveredCA.com, the Primary Contact (or
IPAS user) will receive Print Store credentials from Covered California.
Entities are allotted an annual budget to purchase collateral materials. Budget
amounts are based on funding availability. Amounts allotted to each Entity can
be found online in the Entity Print Shop account.
PRINT STORE RESOURCES
For CAC and NAV
Covered California provides printed and other collateral materials available for
purchase through: http://360.kpcorp.com/coveredca/Login.aspx
Questions related to the Print Shop should
be directed to:
For Print Shop User ID/Login
assistance e-mail:
***The Print Store Resources are not available for the MMCP.
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ADDITIONAL INFORMATION AND RESOURCES
PRIMARY POINTS OF CONTACT:
ENTITY/COUNSELOR HELP LINE at 1-855-324-3147 8:00 a.m. – 6 p.m.
Call center line dedicated to
Entities and Counselors. Provides
support related to:
General CoveredCA.com questions and system errors
CoveredCA.com login issues
CoveredCA.com Entity dashboard
Interpreting CoveredCA eligibility results
Troubleshooting all issues with CoveredCA new applications, change
requests for current applications, and renewals of applications
CoveredCA Counselor PIN resets
COVERED CALIFORNIA SERVICE CENTER: 1-800-300-1506
Covered California operated call
center, supporting activities
related to:
All Counselor Helpline issues that arise outside of the business hours
of the Counselor Helpline
E-MAIL SUPPORT FOR CERTIFICATION: [email protected]
To assist Entities/Counselors in
activities related to:
Adding or withdrawing Counselors from an entity
Reporting changes to an entity’s contacts or sites
Updating the “Find Help Near You” information on CoveredCA.com
Counselor certification status
COUNSELOR TRAINING HELP DESK: [email protected] dedicated to assist
Counselors in activities related to:
Learning Management System (LMS) access
Training requirements, status and progress
PRINT STORE RESOURCES HELP DESK: [email protected] Entities can purchase
marketing material to support
enrollment assistance services.
Access the print shop at: http://360.kpcorp.com/coveredca/Login.aspx
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ADDITIONAL INFORMATION AND RESOURCES (CONT.)
KEY PROGRAM RESOURCES AVAILABLE ON IPAS
Program Resource Page
https://ipas.ccgrantsandassisters.org/
Program home page that list a wealth of program resources,
including: Job Aids, FAQs, Welcome to Answers and other important information
Program Webinars
Index of all program webinars
Index of all program webinar and topic areas covered, includes links to webinar recording and presentation slides
Community Partner Communications Index
Community Partner Communications Index
These newsletters are equipped with the latest program updates,
resources and announcements related to Entities and Counselors and their role with Covered California.
COUNSELOR INFORMATION
Certified Application Counselor Application/Agreement
Required form, Counselors must submit
Criminal Disclosure FormCounselors MUST submit completed pre-populated form to Covered
California. The Primary Contact of the affiliated entity retrieves and
provides this pre-populated form to the counselor.
Live Scan Request Form
Counselors MUST submit copies of the pre-populated Official Live
Scan Request Form to a Covered California approved Live Scan
location. The. Primary Contact of the affiliated entity retrieves and
provides these pre-populated Official Live Scan Forms to the
counselor.
Live Scan LocationsLocate nearest Covered California approved location for Live Scan
processing
Contact Live Scan at (877) 888-8802 or Email by Clicking Here
Email or call with questions re: fingerprinting or background check
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ADDITIONAL INFORMATION AND RESOURCES
(CONT.)
OTHER RESOURCES
Federal health care reform www.healthcare.gov
Office of the Patient Advocate www.opa.ca.gov
The Centers for Medicare and Medicaid Services’
Center for Consumer Information and Insurance
Oversight
http://cciio.cms.gov/
California Health Benefit Exchange www.healthexchange.ca.gov
Department of Managed Health Care (DMHC) and
its programs
www.dmhc.ca.gov
California Department of Insurance www.insurance.ca.gov
RECEIVING CREDIT FOR
COMPLETING THIS TRAINING
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NEXT STEP
Next Steps (1 of 2):
Click on the underlined text to download and
complete the Entity Management Training
Completion Form
Upload the completed form to My Files in IPAS
(see screen shot below)
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NEXT STEPS
Next Steps (2 of 2):
Click on the underlined text to download:• Conflict of Interest Prevention Plan Instructions
• Conflict of Interest Prevention Plan Template
Upload the completed template to My Files in
IPAS (see screen shot below)
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THANK YOU
This concludes the
Entity Management Training.
Thank you for your participation!
For additional questions, please email:
