1. health and fitness

COVER SHEET
IDENTIFYING INFORMATION
GRANT OPPORTUNITY: State Planning and Establishment Grants for the Affordable
Care Act’s Exchanges, CFDA: 93.525
DUNS #: 8073637910000
GRANT AWARD:
$1,000,000
APPLICANT:
Kansas Insurance Department
420 SW Ninth Street
Topeka KS 66621
PRIMARY CONTACT:
Linda J. Sheppard
Director, Accident and Health Division
TELEPHONE NUMBER:
(785) 296-7895
FAX NUMBER:
(785) 296-2537
E-MAIL ADDRESS:
[email protected]
1
CONTENTS OF APPLICATION PACKET:
FORM SF-424, APPLICATION FOR FEDERAL ASSISTANCE
FORM SF-424A, BUDGET INFORMATION
FORM SF-424B, ASSURANCES – NON-CONSTRUCTION PROGRAMS
PROJECT/PERFORMANCE SITE LOCATION
FORM SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
PROPOSAL:
COVER SHEET
PROJECT ABSTRACT
PROJECT NARRATIVE
PROPOSED BUDGET AND NARRATIVE
TIME LINE AND WORK PLAN
RESUME / JOB DESCRIPTIONS FOR PROJECT DIRECTOR AND ASSISTANT
DIRECTORS
DESCRIPTION OF ROLES AND RESPONSIBILITIES
APPLICANT ATTESTATION
SEPARATE FILES:
LETTER OF ENDORSEMENT FROM GOVERNOR
COVER LETTER FROM INSURANCE COMMISSIONER
SYSTEMS INTEGRATION SCHEMATIC
ORGANIZATIONAL CHART
2
PROJECT ABSTRACT
The Kansas Insurance Department (KID) is the Kansas state agency responsible for requesting
$1,000,000 in funding from HHS for planning the Kansas Health Benefits Exchange. As part of
a multi-year effort to provide Kansas small businesses and consumers with affordable,
competitive health insurance, KID is prepared to convene a multifaceted outreach and statewide
planning process from October 2010 through September 2011. One-year milestones for our
proposed work include (1) commencement of a vibrant, inclusive statewide planning process
with an effective steering function that ensures buy-in and maximizes participation, (2) an
assessment of the health benefits exchange function, its market potential, and identified gaps that
could impede viability, (3) schematics for governance, organizational form, and a business
model, and (4) an implementation plan for subsequent development activities.
Elements of the planning phase include the following:












Assemble data and conduct analysis relevant to planning a state health benefits exchange.
Initiate an inclusive statewide planning and communications function to foster input and
participation.
Appoint an advisory panel and work groups to coordinate efforts and identify options.
Discuss government agency/authority versus an independent organizational model.
Work with the legislature and agency staff to build statutory and regulatory flexibility.
Address macro issues affecting affordability, subsidies, and losses.
Design an Exchange model with business rules and a supporting actuarial basis for a
viable set of plans and benefits.
Begin drafting an Exchange charter, governing structure, by-laws, and set of
accountabilities.
Address all major financial factors and cost drivers impacting the viability of an
Exchange.
Discuss capacity requirements including information technology and other infrastructure
elements that will comprise the Exchange footprint (both enterprise wide and as an
accountable unit).
Model redesigned systems and scenarios for realigning responsibilities and improving
coordination among multiple programs.
Draft time lines, budget allocation, outsourcing requirements, and other work to replace,
install, upgrade or modify functions in support of a state exchange.
HHS funding will allow KID to create an evidence-based, executable plan with a time line and
set of roles and responsibilities. A clear picture of a Kansas Health Benefits Exchange and its
potential to improve coverage and access for Kansans will come into view.
3
PLANNING GRANT PROPOSAL FOR
THE KANSAS HEALTH BENEFITS EXCHANGE
The Kansas Insurance Department (KID) is the authorized state agency applying for $1,000,000
in grant funding from the U.S. Department of Health and Human Services (HHS) under Section
1311 of the Affordable Care Act of 2010 for the planning and establishment of an American
Health Benefits Exchange for Kansas. KID is prepared to convene a multifaceted outreach and
statewide planning process beginning in October 2010 through September 2011. At the one-year
point, an executable plan, time line, and set of roles and responsibilities will be in place for
developing a state health benefits exchange, slated to be operational in 2014 and self-sustaining
thereafter. Points on the time line and list of tasks underlying initial start-up and ongoing grant
operations are covered in the Time Line and Work Plan (below, see Tasks A1, A2, A4, and A5).
ONE-YEAR MILESTONES: Our objectives are to discuss design options for a health benefits
exchange, to decide on its functionality, and to lay out a clear path for implementation. Key
attributes of the proposed exchange are that it (a) promote greater consumer choice and
affordability, (b) improve coordination and possible functional integration with other agencies
and carriers, (c) serve as a source for reliable measures of risk selection, quality of care, and
pricing comparability, and (d) merit ongoing legislative support and a statutory basis for
effective, sustainable operations.
Year-one milestones include:
4

Commencement of a vibrant, inclusive statewide planning process with an effective
steering function that ensures buy-in and maximizes participation; See Task A3 in Time
Line and Work Plan.

A thorough assessment of the health benefits exchange function, its market potential, and
any identified gaps that could impede its viability; See Task B9.

An achievable schematic for a governance structure, organizational form, and health
benefits exchange business model;

An implementation plan to assemble and enhance the necessary infrastructure elements
required for subsequent phases of development activity. See Task A6.
BACKGROUND RESEARCH: KID will be responsible during the planning cycle for
consolidating relevant data, reviewing issues affecting the marketplace, assessing potential
demand for a state health benefits exchange, and communicating this information among
stakeholders and participants. Here is a description of the steps to be taken and selected topics to
be investigated.
Organizing a Supportive Research and Information Function – Among the early planning steps
will be a focus on assembling and consolidating information relevant to the development of a
Kansas health benefits exchange. Assembling the best data will be a byproduct of questions
asked by a health benefits exchange advisory panel (discussed below in Stakeholder
Involvement). We propose the following approach:

Appoint an advisory panel to frame a set of information requirements that support
decision making for a design phase and an operational phase. See Task B1.
5

Staff the project and task out work; conduct an inventory of available data sources;
evaluate data quality; design prototype tables and charts; manage Requests for
Information with organizations hosting selected data sources. See Task B2 and B3.

Staff will work with the advisory panel to match the assembled information with their
policy and decision points; the point is to ensure that all relevant subgroups and
segments, benefits choices and other factors receive attention.
Specify Current and Future Data Requirements – Staff will identify information gaps. They will
specify which steps and sources or suppliers are needed to produce new data or revise
outdated information. A core set of tables, charts, and technical notes will be designed and
adopted for reporting. Benchmarks and performance standards will be collected where
available. Relevant comparative information from U.S. or state sources will be acquired to
help round out comparisons. See Task B4. Specific target topics will include:

Kansas and regional market characteristics and trends;

Estimated numbers of uninsured (individual, small groups, other);

Estimated potentially eligible for participation in an Exchange;

Estimated eligible but not enrolled in Medicaid or employer coverage;

Current plan options, pricing, and benefit design;

Profiles of utilization, health status, claims history;

Identifying and noting special demographic, socioeconomic and other subgroups.
Initial Target List of Data Sources and Topics – Four immediate efforts are on the planning list.
6

Update KID’s Kansas Health Insurance Study. See Task B6. This August 2001
telephone survey (8,000 interviews; 160 in Spanish) estimated uninsured by region, under
age 65, annual family income, percent under the federal poverty level, age, ethnicity/race,
employment status, education, and gender. It was conducted by a university department.

Update KID’s Small Business Health Insurance Survey. See Task B7. Conducted in
2000, the survey estimated the numbers and characteristics of employers/employees,
examined recent cost increases, and documented coverage differences. It was conducted
by a university department.

Update KID’s 2005 Uninsured Report for the State of Kansas (purchased from Mercer
Government Humans Services Consulting). See Task B8. The report noted that 80% of
70,000 small businesses in Kansas have fewer than 100 lives. Information was provided
on benefit design, cost sharing, utilization, cost trends, and income.
o Create a plan to mine data from the Kansas Health Insurance Information System
(KHIIS). See Task B5. This all payer database for large groups, Medicaid, and the state
health plan has a wealth of baseline data on utilization, claims, pricing, and benefits
design. We need to make determinations about the quality and validity of extracted data.
Subsequent Tasks – We will coordinate data acquisition and information analysis with staff to
KID’s Premium Rate Review Award team. Our Exchange planning team and the Rate Review
team are likely to have overlapping assignments requiring data feeds from NAIC, KHIIS, and
other sources to support analysis and reporting.
7
STAKEHOLDER INVOLVEMENT: KID will be responsible for coordinating a vibrant,
inclusive statewide planning process with an effective steering function that ensures buy-in and
maximizes participation. Leadership will spell out the preferred process for working together to
make decisions, implement actions, and effectively operate an exchange function. Our planned
outreach process will include input from the following stakeholders – legislators, regulatory
staff, consumers and consumer advocacy groups, small businesses and chambers of commerce,
healthcare providers (physician groups, hospitals, long-term care), insurers, agents and brokers,
health underwriters, state and federal agencies, and influencing organizations across the state.
Involvement with legislative bodies and regulatory agencies is covered below.
Outreach Methodology and Partnership Development – KID leadership will make its best initial
judgments on candidate organizations and groups to engage as stakeholders and prospective
partners. A list of contact names and organizations will be developed, maintained, enhanced
over time, and reported out. The outreach lists will span each of the groups mentioned above.
The lists will be made representative to include all entities pertinent to developing an exchange
or meeting more immediate developmental objectives. The extent of ongoing communications
and effective working relations among the candidate partner groups will be assessed as part of an
effort to tailor a communications plan and work regimen maximizing chances for success. See
Task C1, C2, C3, C4, and C5.
Designation of Exchange Planning Leadership Groups – KID will recruit for an advisory panel
to serve the critical role of steering, policy setting, and decision making during the planning and
implementation process. This temporary, transitional governing body appointed by the
8
Commissioner will work in alignment with KID’s project leader. The advisory panel will be
supported by KID dedicated staff, other staff supported by the grant, and potentially dedicated
staff at other partner agencies in Kansas. Leadership groups and their representation may change
over time to accommodate differences in ensuing phases of work. The Advisory Panel may task
out and fund several temporary groups empowered to meet defined assignments in key areas.
The proposed leadership and steering structure will be as follows:

The Advisory Panel, responsible for the project steering function including coordination,
research questions, outreach, and policy decisions with KID. See Task C10.

The Legislative and Regulatory Work Group, responsible for effective working relations
with elected officials and staff on statutory and regulatory issues affecting the exchange
mechanism; included is interaction with NAIC staff for input on model language and best
practices. See Task C11.

The Insurance and Finance Work Group, responsible for macro issues like the availability
of government funding for subsidies and losses. The group will aid in developing the
organizational model, business rules, required actuarial analyses, and benefits design. See
Task C12.

The Organization and Operations Work Group, responsible for overseeing discussions on
functional integration, information technology, capacity analysis, other infrastructure
elements and systems, and ultimately operational issues; this will include interaction with
NAIC staff to synchronize system design and shared services functions. See Task C13.
Deliverables from Outreach Efforts – There are four byproducts of our grant-funded outreach
efforts over Year-one. First, we will have established a balanced set of leadership groups with
9
the listening mechanisms to benefit from multiple inputs. These groups will have a defined
purpose, scheduled activities, and due dates for specific topics. See Task C14. Second, a clear
picture will have emerged of the parties involved in the development and success of a health
benefits exchange. Individual organizations’ roles will have been identified and prospective
Participation Agreements under discussion. See Task C9. Third, consumer groups and small
businesses in Kansas will have been segmented and an outreach plan formulated and activated
for education and listening purposes. See Task C8. A communications firm may be engaged to
carve out specific channels for public awareness and direct participation from Kansans. See
Task C6 and C7. Fourth, working from the broader list of organizations with some bearing or
interest in the Kansas Health Benefits Exchange, we will devise a media plan for web-based,
traditional media, and in-person involvement in the planning and decision-making processes.
Overall, we will have a solid inter-personal foundation for moving forward.
GOVERNANCE MODEL FOR THE KANSAS EXCHANGE: KID and the advisory panel
will be responsible for conducting discussions related to the design and governance of the
Kansas Health Benefits Exchange. The two topics for detailed evaluation and discussion relate
to the Exchange’s organizational model and its functions and responsibilities.
Design Issues – KID staff, the advisory panel, selected legislative committee members, and
representative from the Governor’s Office will convene a series of information sessions and
discussions on the features and benefits of various organizational forms. See Task D1. After
reviewing all options, in-depth design discussion will likely revolve around a government agency
or authority model versus an independent organization with government oversight. Also, the
10
feasibility of a bi-state exchange operating in the Kansas City metropolitan area will be
considered. This would involve population on the Kansas and Missouri sides of the region.
Three initial tasks will be to evaluate the following:

Evaluate currently-working models in Kansas state government. These include the
Kansas Health Policy Authority (KHPA), the state high risk pool (Kansas Health
Insurance Association), and the State Attorney General/Kansas Bureau of Investigation
structures. See Task D2.

Review features, functions, and the business model for exchanges in Massachusetts,
Utah, and those planned in other states. See Task D2.

Review the statutory basis underlying the Kansas Business Health Partnership for its
authority and relevance in developing a Kansas exchange. Are there aspects of the
Business Health Partnership act that could empower the exchange in Kansas (Task D3).
Underpinnings for an Effectively Designed State Exchange – Irrespective of the organizational
form assumed by the Exchange, the actual operating entity must have a solid basis for carrying
out its mission. See Task D4, D5, and D6. Elements to be detailed in the planning grant process
include:

Beginning to define the entity’s ‘charter’, governing structure, by-laws, roles and
responsibilities; see Task D7.

Securing the needed statutory and regulatory basis for financing, resources, and
sustainability;

Identifying the entity’s ‘touch points’ and accountability with specific agencies,
departments or officials; See Task D8.
11

Ironing out policies on the appointment process, audit, conflict of interest rules, and other
organizational matters;

Establishing policies for licensure, qualifying plans, eligibility, cost sharing, grievancehandling procedures, transparency, and consumer protections. See Task D9.
REGULATORY / POLICY ACTIONS: KID will recruit and designate a small group, the
Legislative and Regulatory Work Group, to be responsible for conducting discussions with
members of legislative bodies and staff with regulatory agencies on the Kansas Health Benefits
Exchange. This work group will provide bi-directional communications to inform KID’s
exchange planning functions and that of other groups. See Task E1. Some initial actions for the
KID staff and this work group include:

Establish an interface with selected committees and agency staff; set an agenda for
educational purposes; build statutory and regulatory flexibility into the planning process;
see Task E2.

Canvas the committees and officials for specific ideas on enabling legislation and
clarifying State regulations; understand their time lines and decision points for
accommodating change requests; see Task E3.

Synchronize planning and development efforts between state-specific initiatives and
those sponsored by NAIC; KID will review and may adopt model laws and statutory
templates to assist in introducing legislation supporting the Exchange.
12

Identify and address specific topics relating to transparency policies, disincentives to
adverse selection, risk adjustment, achieving affordability, and other pertinent issues as
they arise.
An important element in the planning and development process will be for KID and its partner
organizations to begin crafting a ‘political strategy’ to achieve longer-term development
objectives and ensure the ongoing viability of a health benefits exchange. See Task E4. This
will be especially important in Kansas in 2011.
FINANCE: KID will recruit and designate a small group, the Insurance and Finance Work
Group, to be responsible for conducting discussions on the economic and financial
underpinnings of a Kansas Health Benefits Exchange.
Benefits, Plan Design, and Pricing – At the broadest level, KID and the work group will identify
options for the number and types of plans to be offered in the Kansas marketplace. See Task F1.
Actuarial input will be required to model relationships between benefits and competitive pricing
in consideration of adverse selection, risk adjustment, and customer demand. See Task F2.
Finding ways to making decision-support tools more widely available to applicants and enrollees
(e.g., see grants.gov and ehealth.com) will be explored. See Task F3.
Analyzing Revenues and Costs – The work group will also acquire information and develop a
financial summary of the sources of revenue affecting benefits subsidization, cost drivers,
resource constraints of partner organizations, and all major factors impacting the financial
13
viability of a state health benefits exchange. This summary will help staff create the best
business model for the proposed exchange. See Task F4.
Developing the Business Model – Modeling fixed and variable expenses with varying levels of
take-up and claims activity will be overseen by the Insurance and Finance Task Force. These
financial estimates will drive plans for staffing and procurement. Discussions on covering
operating losses given different break-even points and product offerings will require pro forma
development. See Task F5 and F6.
Financial Management of the State Exchange – Plans will need to be sketched for developing the
various financial policies, practices, and standards necessary to operate an exchange. See Task
F7. The work group will have the opportunity to specify features of an accounting system, the
audit function, banking relations, and other related functions. The group will be mindful of
reporting requirements to HHS, the public and other stakeholders. See Task F8. Attention will
be paid to develop performance measures and dashboards that best support decision-making and
inform stakeholders.
PROGRAM INTEGRATION: KID will recruit and designate a group to be responsible for
deliberating on a host of organizational, technical, and operational issues. This is the
responsibility of members of the Organization and Operations Work Group. Their mission spans
four of the nine topical areas cited in the Program Announcement – program integration,
resources and capabilities, technical infrastructure, and business operations. The composition
and representativeness of the group could be altered through phases of the planning cycle. See
14
Task G1. There could be subgroups or offshoots formed to handle specific operational features
(e.g., IT, eligibility systems, compliance). However, for KID’s proposed planning exercise the
topics of integration, ‘capacity’, technology, and operations are viewed from more of a holistic
perspective.
Sharing, Streamlining, or Consolidating – Decisions or recommendations on inter-agency
functional integration will stem from an inventory of overlapping boundaries and redundancy in
selected Exchange functions. These could relate to eligibility determination, enrollment,
consumer assistance, and other customer-facing roles. The group will strive to identify barriers
that may prevent a state health benefits exchange from coordinating, combining, or sharing
functionality to benefit consumers. See Task G2, G3, G4, and G5.
Year-one Deliverables on Integration – A systems analysis will be conducted by a multi-agency
work group to examine the benefits and barriers of shared functions or integrating systems as
part of the state health benefits exchange. See Task G6. The Kansas Health Policy Authority
(associated with Medicaid, HealthWave (CHIP), and the state employees’ health plan) will be
represented along with the Kansas Department of Health and Environment, Department of
Revenue, the Department of Social and Rehabilitative Services (SRS), and others to be named
(see attached systems integration Illustration). The analysis will encompass statutory,
technological and political issues affecting or promoting functional integration or alterations to
agency work flows. Models of redesigned systems will be contemplated along with scenarios for
realigning responsibilities and improving coordination among multiple programs. See Task G7.
15
RESOURCES AND CAPABILITIES: The Organization and Operations Work Group will first
determine the extent to which shared services or integration will affect the Exchange’s
operational model. A determination of start-up and ongoing resource requirements will be
itemized for the Exchange as an entity and for its principal partners. The organizational ‘foot
print’, both enterprise-wide and as an accountable unit will be described in terms of capabilities,
staffing numbers, skill sets, location requirements, systems, and technologies. See Task G8 and
G9. A picture will emerge of the exchange as a unit connected to a broader regional enterprise
in hub and spoke fashion with certain shared and integrated services. Given this depiction, KID
and the advisory panel will be able to budget for contracting requirements, technology
specifications, and contemplate build/buy approaches to meet program objectives.
TECHNICAL INFRASTRUCTURE: The Organization and Operations Work Group will
strive to plan in greater detail and specificity with regards to the technical and technological
underpinnings of the state health benefits exchange. Emerging from discussions on cross-agency
integration, plans will be needed for specific systems and functions. Some proposed activities
for the work group are the following:

Inventory current systems assets with a focus on (a) customer-facing functions (webbased portals, call centers, other educational), (b) operational systems (eligibility,
enrollment, reporting), and (c) possible NAIC interfaces; see Task G10.

Determine the gaps between current capacity and required system capacity for a state
health benefits exchange; see Task G11.
16

Specify solutions and tasks required to meet expected demands, coordinating with
Medicaid, HealthWave (CHIP), and other partners; see Task G12 and.

Draft time lines, budget allocation, outsourcing requirements, and other work needed to
replace, install, upgrade or modify IT and other infrastructure elements that will support a
state exchange; see Task G13.
BUSINESS OPERATIONS: KID along with the Organization and Operations Work Group will
take into consideration the assembled data, opinions on barriers and features, business rules, and
other inputs to specify the operations and practices of a state health benefits exchange (Task 15).
Plans and policies will be needed for the following areas:

Qualifying features of basic benefits (‘essential benefits package’ options), pricing, costsharing, and other coverage issues;

Eligibility determination, enrollment coordination (open enrollment, special enrollments),
and organizational interfaces;

Reporting to stakeholders and the public on quality, cost, and efficiency; fulfilling basic
reporting features like claims payment policies, enrollee rights, rating policies, periodic
financial information, and selected operating statistics (e.g., enrollment, disenrollment,
claims denials); see Task G18.

TPA-like administration of premium collection, subsidies, and cost-sharing assistance;
see Task 16.

Customer service processes (e.g., call centers, tracking) and consumer decision tools; see
Task G17

Data security, privacy, and compliance responsibilities; see Task G14.
17
CONCLUDING REMARKS: HHS grant funding will facilitate efforts on the part of Kansas to
design and implement a Health Benefits Exchange. After completing the one year planning
cycle outlined above, KID will have derived an executable plan with a time line and sets of roles
and responsibilities for commencing work. This will have been the result of an evidence-based
and inclusive process for systematically exploring all options. Legislative flexibility,
governance, organizational structure, financial elements, inter-agency coordination, information
technology, capacity, and operations will have been included in the planning phase. A clear
picture, direction, and momentum for implementation steps will capstone this effort.
18
BUDGET NARRATIVE
KID is requesting $1,000,000 in grant funding from HHS. No indirect charges are negotiated
between HHS and KID. Details and assumptions of proposed budget expenses are outlined here:
Personnel and Fringe Benefits: No direct personnel costs or dedicated staff is budgeted at KID
for this project.
Contractual Costs. Given the specialized nature of this planning process and the short time line
for accomplishing proposed work, $750,000 is allocated to contacted services. These services
are divided into four categories addressing specific grant related activities. These activities
include (a) research studies, (b) outreach to consumers, small businesses, and other
organizations, (c) support for work groups and facilitation services, and (d) other awarded work
as arises during the planning cycle. Quarterly budgeted spending projections for contractual
services range from $172,000 to $207,500.
o Research Studies - $200,000 total to support data mining and 3 to 4 study updates;
o Outreach Activities - $175,000 total for assistance with media relations and outreach;
o Work Groups - $325,000 total for work group budgets and facilitation work to
synchronize efforts and expedite progress;
o Other Awards -$50,000 for additional studies and assistance as identified during the
planning process.
19
Equipment and Computers. Expenses to upgrade desktop computers, laptop computers,
servers, printers, PC software, and related items are budgeted at $15,000. Amounts are allocated
to Quarters 2 through 4 at $5,000 per quarter.
Supplies. $10,000 is budgeted for supplies, printing costs for consumer information
(pamphlets/leaflets), postage, and related costs for program support and outreach efforts.
Travel. $40,000 is budgeted for travel. This includes travel for KID staff ($20,000) along with
$20,000 budgeted to work groups and other involved parties to travel to meetings and conduct
planning grant business. KID staff may use funds to travel to HHS meetings, conferences, NAIC
workgroup meetings, training sessions, and other outreach efforts. The sum of $10,000 is
allocated per quarter for travel.
Other Expenses. All other expenses subtotal $185,000. Of this amount, the budget will allow
for meeting expenses, outreach activities, A/V products, and other required items.
o Meeting Expenses – $35,000 is allocated to support public meetings, work group
sessions, and other related interactions. These expenses will be allocated evenly across
the period.
o Outreach and Education – $75,000 is budgeted for KID to host outreach efforts
(including several town hall meetings) and other policy-directed education.
o A/V from Meetings – The amount of $25,000 is allocated for services related to capturing
visual and written content from planning and outreach meetings and packaging products
for future use. This is spread evenly across the planning period.
20
o Miscellaneous – $50,000 is budgeted evenly over the year for other unanticipated
expenses in support of program efforts.
Indirect Expenses – There are no indirect charges assigned to this project.
21
KANSAS EXCHANGE PLANNING GRANT BUDGET FOR 2010/2011
Total
$0
$0
Quarter 1
$25,000
$7,500
Quarter 2
$25,000
$7,500
Quarter 3
$25,000
$7,500
Quarter 4
$25,000
$7,500
Contracts
Research Studies
Consumer/Sml Business Outreach
Work Groups & Facilitation
Other awarded work
Contracts Subtotal
$200,000
$175,000
$325,000
$50,000
$750,000
$37,500
$50,000
$72,500
$12,500
$172,500
$62,500
$50,000
$82,500
$12,500
$207,500
$50,000
$50,000
$82,500
$12,500
$205,000
$50,000
$25,000
$87,500
$12,500
$172,000
Equipment / computers
Supplies
Travel – Staff
Workgroups & other
$15,000
$10,000
$20,000
$20,000
$0
$2,500
$5,000
$5,000
$5,000
$2,500
$5,000
$5,000
$5,000
$2,500
$5,000
$5,000
$5,000
$2,500
$5,000
$5,000
Other Expenses
Meetings
Outreach
AV Products
Miscellaneous
$35,000
$75,000
$25,000
$50,000
$5,000
$12,500
$5,000
$12,500
$10,000
$12,500
$5,000
$12,500
$10,000
$25,000
$10,000
$12,500
$10,000
$25,000
$5,000
$12,500
$185,000
$35,000
$40,000
$57,500
$52,500
$0
$1,000,000
$0
$220,000
$0
$265,000
$0
$270,000
$0
$245,000
Personnel
Fringe Benefits
Other Expenses Subtotal
Indirect Charges
Total
22
TIME LINE AND WORK PLAN
TASK
Description
A
Create and organize KID HBE team
A1
A2
A3
A4
A5
A6
Assign internal staff; work with HR and Finance for
enablement
Define project scope of work and budget allocation
Coordinate event scheduling, time line reporting, directories
Contractor procurement – identify work, candidates, means
Scheduling and attendance for staff training and education
Document and draft implementation plan for 2011-2012
TASK
Description
B
Background Research
B1
B2
B3
B4
B5
B6
B7
B8
B9
Q1
23
Q3
Q4
X
X
X
X
X
X
X
X
X
X
X
Q1
Identify information requirements for design phase &
operational phase
Design prototype tables and charts / formulate study design
Submit Requests for Information
Commission external research and information services
Acquire benchmark and comparative measures
Telephone interview survey for KS Health Insurance Survey
Survey of Small Business Health Insurance
Update KS Uninsured Report
Preliminary assessment of potential demand for KS HBE
Q2
Q2
Q3
Q4
X
X
X
X
X
X
X
X
X
TASK
Description
C
Create stakeholder involvement
C1
C2
C3
C4
C5
C6
C7
C8
C9
C10
C11
C12
C13
C14
Formulate / implement outreach for legislative and regulatory
Formulate / implement outreach for partners & participants
Formulate / implement outreach for consumers, small business
Formulate / implement outreach for influencing organizations
Assemble contact information
Develop outreach and media plan (web, traditional, in-person)
Engage communications firm to assist
Schedule statewide outreach meetings
Discuss / secure participation agreements with partners
Designate Advisory Panel (steering, research, outreach)
Designate Legislative, Regulatory work group
Designate Insurance & Finance work group
Designate Organization/Operations work group
Schedule activities and due dates for deliverables
TASK
D
Governance Model
D1
D2
D3
D4
D5
D6
D7
D8
D9
D10
Description
Discuss features and benefits of various organizational forms
Evaluate currently-working models
Review underlying statutes
Contractor procurement – identify work, candidates, means
Scheduling and attendance for staff training and education
Document and draft implementation plan for 2011-2012
Defining charter, governing structure, by-laws, roles and
responsibilities
Secure statutory and regulatory changes for financing,
resources
Identify accountabilities with specific agencies and public
Convene discussions on HBE policies & operating practices
24
Q1
Q2
X
X
X
X
X
X
X
X
X
Q3
Q4
X
X
X
X
X
X
X
X
X
X
X
X
Q1
Q2
X
X
X
X
X
Q3
Q4
X
X
X
X
X
X
X
X
TASK
Description
E
Regulatory / Policy Actions
E1
E2
E3
E4
Group initiates discussion with legislature & staff
Establish calendar for discussion / briefings
Acquire time lines and decision points for ongoing legislative
or regulatory changes
Convene discussion on political strategy for success
TASK
Description
F
Insurance and Finance
F1
F2
F3
F4
F5
F6
F7
F8
Q1
Q2
X
X
X
Q1
Convene discussion on number, types of plan options
Seek actuarial input on pricing, risk adjustment, other issues
Identify types of decision support aids for consumers / groups
Summarize major financial factors affecting HBE viability
Develop options for business model
Pro forma modeling of cash flow, losses, break even
Outline and document operating principles & practices
Begin outreach for implementation (banking, admin functions)
25
Q3
Q4
X
X
X
X
X
Q2
Q3
Q4
X
X
X
X
X
X
X
X
X
X
X
TASK
Description
G
Integration / Capacity / Systems / Operations
G1
G2
G3
G4
G5
G6
G7
G8
G9
G10
G11
G12
G13
G14
G15
G16
G17
G18
Designate group on streamlining/consolidating or inter-agency
functional integration
Inventory overlap in boundaries and redundant functions
Eligibility determination
Enrollment
Customer service and other
Conduct systems analysis of technical, organizational issues
affecting integration
Create scenarios for better coordination & redefined roles
Determine start-up & ongoing resource requirements for
accountable units
Budget for contracting requirements
Inventory current system assets and interfaces
Determine gaps between current and required
Specify technology requirements & decide on build/buy
approaches
Draft time lines, budget to replace, install, upgrade or modify
IT and other infrastructure elements
Specify data security, privacy, and compliance responsibilities
Itemize other operations policies and practices TPA-like administration of premium collection, subsidies
Customer service processes (e.g., call centers, tracking)
Specify reporting requirement for HHS, public, other
26
Q1
Q2
Q3
X
X
X
X
X
X
Q4
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
APPLICANT ATTESTATION
Check as many items that apply, as appropriate. States are not required to accomplish all
activities nor should this list be considered exhaustive.
1.
With the Planning and Establishment Grant, the State intends to:
_x_ Determine needed and available staff and hire key staff
_x_ Determine resource needs
_x_ Develop a work plan and timeline for first year activities
_x_ Determine needed statutory, regulatory, and other administrative changes (including
statutory changes that may be necessary to set up the governance structure, facilitate health
plan contracting, consumer outreach, etc.)
_x_ Conduct an initial assessment of IT systems and modifications/new systems needed to
facilitate eligibility and enrollment and other Exchange functions
_x_ Plan the coordination of eligibility and enrollment across Medicaid, CHIP, and the
Exchanges
_x_ Provide public notice and other stakeholder engagement activities
_x_ Develop a budget justification and implementation plan
_x_ Develop performance metrics and planned milestones
_x_ Plan for customer services processes, including a call center
2. The State attests that it has submitted a budget narrative and justification that fully supports
the activities the State intends to pursue with Planning and Establishment Grant funds:
YES___x____ NO_________
3. The State has adhered to the required Format, Standard Form (SF), and Content Requirements
contained in Section IV.
YES___x____ NO_________
4. The State commits to submitting a draft detailed implementation plan with the final report
within 90 days of the end of the project period.
YES___x____ NO_________
27
Linda J. Sheppard, JD
State Planning and Establishment Grants for the Affordable Care Act’s Exchanges, CFDA:
93.525
Project Director
EDUCATION
University of Kansas School of Law
Juris Doctorate awarded in 1995
Lawrence, Kansas
University of Kansas
Bachelor of Science, Business Administration awarded in 1992
Lawrence, Kansas
WORK EXPERIENCE
2008-present Kansas Insurance Department
Director, Accident & Health Division
Topeka, Kansas
2007-2008
Office of Kansas Attorney General
Deputy Attorney General, Consumer Protection Division
Topeka, Kansas
1999-2007
Kansas Insurance Department
Assistant General Counsel
Topeka, Kansas
1995-1999
Shughart Thomson & Kilroy, P.C.
Attorney
Kansas City, Missouri
PROFESSIONAL ACTIVITIES
 Kansas Licensed Attorney
 Missouri Licensed Attorney
 Member, Missouri Bar Association
28
Cindy Hermes, AAPA
State Planning and Establishment Grants for the Affordable Care Act’s Exchanges, CFDA:
93.525
Key Personnel
EDUCATION
University of Oklahoma
Master of Public Administration
University of Arkansas
Bachelor of Arts, Psychology
Fayetteville, Arkansas
WORK EXPERIENCE
2003-present Kansas Insurance Department
Government and Public Affairs/Public Liaison
Consumer Assistance Representative
Topeka, Kansas
1999-2003
Kansas House of Representatives
State Representative, District 51 (Western Shawnee County)
Topeka, Kansas
1991-1997
Kansas Governmental Ethics Commission
Auditor
Topeka, Kansas
1989-1991
State of Kansas – Division of the Budget
Budget Analyst II
Topeka, Kansas
PROFESSIONAL DESIGNATION
 Associate, Annuity Products & Administration (AAPA)
LOMA
29
Neil A. Woerman
State Planning and Establishment Grants for the Affordable Care Act’s Exchanges, CFDA:
93.525
Key Personnel
EDUCATION
Kansas State University
Master of Science, Journalism & Mass Communications awarded in 1982
Manhattan, Kansas
Kansas State University
Bachelor of Science, Journalism & Mass Communications awarded in 1974
Manhattan, Kansas
WORK EXPERIENCE
2003-present Kansas Insurance Department
Director, Information Technology
Topeka, Kansas
1995-2003
Office of Kansas Attorney General Carla J. Stovall
Director, Budget & Special Projects
Topeka, Kansas
1987-1995
Office of Kansas Attorney General Robert T. Stephan
Chief of Staff
Topeka, Kansas
1979-1987
Office of Kansas Attorney General Robert T. Stephan
Special Assistant
Topeka, Kansas
PROFESSIONAL ACTIVITIES
 Chair, NAIC Information Systems (IS) Task Force
30
DIRECTOR, ACCIDENT AND HEALTH DIVISION
Kansas Insurance Department
HHS State Planning and Establishment Grants for the Affordable Care Act's Exchanges,
CFDA: 93.525
Project Director – Linda J. Sheppard
This is an executive-level position reporting directly to the Commissioner of Insurance and will perform
highly diverse and complex managerial work, exercising authority and control over the resources
necessary to operate and maintain activities of the Accident and Health Division of the Kansas Insurance
Department within overarching policy parameters provided by the Commissioner.
Work involves coordinating the activities and setting the priorities necessary to ensure the division meets
the overall mission and goals of the agency, and managing the resources to meet those goals.
Primary Job Duties:
Division Oversight Responsibilities – 20%
 Plans, develops, manages and leads the Division in performing the following functions to ensure
actions are consistent with Kansas laws and regulations:
o rate, rule and form review for all lines of accident and health insurance
o issuance of Certificates of Authority and amendment of existing certificates

Supervises and directs activities of division staff. This includes scheduling, performance
management, work distribution and project assignment.

Ensures accident and health insurance industry plans and insurance programs are consistent with
Kansas laws and regulations.

Leverages the use of existing and new technologies in responding to business needs and regulatory
requirements.
Grant Implementation/Oversight Responsibilities – 60%
 Oversees day-to-day operations of the grant implementation to ensure the activities, goals, objectives
and timelines outlined in the grant application are being met. Will be responsible for record keeping,
reviewing financial expenditures, maintaining a project file, preparing required reports, evaluating
implementation progress, initiating requests for proposal(s) for consultants and vendors.

Coordinate work of KID staff responsible for grant implementation and works with various work
groups assigned to various aspects of planning for state exchange.

Collaborates with contracted consultants to ensure clear understanding of goals and expected
outcomes.

Works closely with staff of Kansas Health Policy Authority (KHPA), state agency responsible for
administration of Kansas Medicaid and Healthwave, the Kansas CHIP program, to ensure open
discussion and exchange of information related to need for integration of Medicaid and Healthwave
as part of Kansas exchange.

Participates in and attends conferences and meetings sponsored by the NAIC and other organizations
related to implementation of the Affordable Care Act in order to gain additional information
regarding the requirements and desirable components of a state exchange.
31

Directs responsibility to coordinate work of Assistant Project Directors, outside consultants, work
group participants, and any new temporary staff required to assist with this grant project.
Policy Formation/Industry Regulation Monitoring Responsibilities – 20%
 Reviews, analyzes and drafts proposed legislation that may impact the accident and health insurance
industry. Promulgates new or amended accident and health insurance regulations.

Makes recommendations to the Commissioner as to appropriate policy direction consistent with the
mission of the agency.

Represents the agency on various National Association of Insurance Commissioners (NAIC)
committees and working groups relating to accident and health insurance regulation.

Communicates with insurance industry representatives, insurance producers, peer regulators and
others about accident and health insurance regulation and other industry-related issues.
32
GOVERNMENT AND PUBLIC AFFAIRS
Kansas Insurance Department
HHS State Planning and Establishment Grants for the Affordable Care Act's Exchanges,
CFDA: 93.525
Assistant Project Director – Cindy Hermes
Primary Job Duties:
Education and Outreach Responsibilities - 30%

Coordinates and participates in consumer education and outreach activities or delivers public
presentations. These efforts are designed to provide the public and other stakeholder groups with
information about the Kansas Insurance Department’s activities, operations or initiatives or address
topics relating to a specific line of insurance regulation.
Governmental Affairs Responsibilities – 10%

Researches legislative issues pertaining to health insurance. Utilizes research to develop
recommendations for the Commissioner legislative agenda.

Analyzes proposed health insurance legislation to determine its potential impact on the agency.
Monitors legislative activities that directly impact the health insurance regulatory operations of the
agency. Collaborates with other agency staff members to develop Departmental positions on
legislative and/or regulatory issues.
Facilitation Responsibilities – 10%

Provides dedicated support to the State of Kansas’ Long-Term Care Task Force and the Kansas
Interagency Coordinating Council on Early Childhood Developmental Services
Grant Implementation Responsibilities – 50%

Will provide dedicated support to the health benefits exchange advisory panel and to work groups
assigned to various aspects of planning for state exchange.

Will work with business and technical consultants to collect, organize and compile information as
needed.

Will provide support to external partners assisting in the update of KID’s Kansas Health Insurance
Study, Small Business Health Insurance Survey, and Uninsured Report for the State of Kansas.
33
DIRECTOR, INFORMATION TECHNOLOGY
Kansas Insurance Department
HHS State Planning and Establishment Grants for the Affordable Care Act's Exchanges,
CFDA: 93.525
Assistant Project Director – Neil Woerman
This is an executive-level position reporting directly to the Commissioner of Insurance and will perform
highly diverse and complex managerial work, exercising authority and control over the resources
necessary to operate and maintain activities of the agency’s information technology systems and
infrastructure within overarching policy parameters provided by the Commissioner. Work involves
providing vision, leadership, planning and management for the development, acquisition, implementation
and support of information technology systems that will maximize the effectiveness of data collection,
processing and reporting. The position defines and solves user requirements and develops and
implements computer applications and solutions that will integrate with existing systems and/or
infrastructure.
Primary Job Duties:
Information Technology (IT) System Development and Project Management – 40%

Establishes Department IT Vision in Consultation with Commissioner, Staff and Other Stakeholders.
Communicates with the Commissioner, other directors and Department staff to develop and articulate
the IT vision of the department. It also includes communicating with staff of the National
Association of Insurance Commissioners and other stakeholders external to the department.

Selects, schedules and budgets projects to support vision and maintain infrastructure. To carry out the
department vision and maintain a secure and reliable infrastructure, this position scopes and schedules
IT projects within available resources. The occupant makes appropriate purchases and enters into
contracts.

Represents Commissioner on National Association of Insurance Commissioners (NAIC) and state ITrelated groups. Plans, leads and attends meetings and helps coordinate projects on behalf of the
Commissioner at the NAIC and state level in collaborate on IT issues with other state insurance
departments and other state agencies. In this role, the position helps to monitor and oversee use of
NAIC IT resources.

Plans and manages department E-Regulation projects. A primary goal involved in attaining the
department’s IT vision is to make possible conducting virtually all business with department
stakeholders online. This position schedules, budgets, plans and monitors iterative projects to carry
out this goal, directing use of staff and out-sourced resources.
Division Oversight Responsibilities – 40%

Directs staff involved in web, database, regulatory application and regulatory application interfaces.
The position is the primary supervisor of the Senior Systems Analyst/Assistant Director, Web
Developer, and Database Administrator, and the IT supervisor of the Technical Business Analyst. The
position advises and directs them in their work as necessary, assists them in planning, and monitors
projects and work in which they are involved.
34

Collaborates with and backs up the Assistant Director in responsibilities including those involving the
network, security, email, servers, desktops, software and service.

Responds to questions and serves as an advisor and resource to the Commissioner and Department
staff on a wide range of technology issues.

Performs and directs computer system research. Safe, efficient and effective use of computer systems
requires constant learning and research to ensure that best practices are being used. It requires
frequent research and testing to thoroughly evaluate the interaction of hardware and software systems
with one another before introducing them into a production environment. The occupant both
performs and directs the performance of such research.

Designs core hardware and software systems used in the network for their intended purposes. Directs
hardware, software and network support issues, particularly for systems involved in ongoing projects,
and as necessary to backup other staff in performance of their duties.
Supervises and directs activities of division staff. This includes scheduling, performance
management, work distribution and project assignment.

Grant Implementation/Oversight Responsibilities – 20%

Will oversee planning for information systems and interfaces required to support the exchange. Will
initiate requests for proposal(s) for technology consultant(s) or other vendors. Will evaluate
information system planning progress. Will be responsible for record keeping, reviewing financial
expenditures and preparing required reports as it pertains to the exchange information systems plan.

Will work with team leads in partner agencies as well as business and technology consultants to
develop information systems plan to support exchange implementation.
35