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GAO sees exchange helper program delays

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Builders of individual Patient Protection and Affordable Care Act (PPACA) health insurance exchanges are having trouble setting up navigator and in-person assister programs on schedule.

Builders of the PPACA small-group exchanges — the Small Business Health Options Program (SHOP) exchanges — reported in May that they had fallen behind on 44 percent of the key activities that were supposed to be completed in May.

John Dicken, a director at the U.S. Government Accountability Office (GAO director), included those findings in reports on PPACA exchange implementation progress prepared for congressional Republicans.

Dicken made no recommendations and came to no firm conclusions about whether the individual exchanges or SHOP exchanges will open on time.

On the individual side, for example, the states that are setting up their own exchanges and the government workers that are setting up the “federally facilitated exchanges” (FFEs) that will be wholly or partly run by the U.S. Department of Health and Human Services (HHS) have made “much progress” at creating a regulatory framework for the exchanges and develop, test and implement a central HHS data hub that is supposed to handle program eligibility determination processes.

But the development of the program “has been a complex undertaking, involving the coordinated actions of multiple federal, state,  and private stakeholders, and the creation of an information system to  support connectivity and near real-time data sharing between health  insurance exchanges and multiple federal and state agencies,” Dicken said.

“Certain factors, such as the still-unknown and evolving scope of the  exchange activities CMS will be required to perform in each state, and the  large numbers of activities remaining to be performed—some close to the  start of enrollment—suggest a potential for implementation challenges  going forward,” Dicken said.

Similarly, on the SHOP side, state agencies and the Centers for Medicare & Medicaid Services (CMS), the HHS arm in charge of exchange construction, have made much progress, but they still face implementation challenges, Dicken said.

“Whether CMS’s contingency planning will assure the timely and smooth  implementation of the exchanges by October 2013 cannot yet be  determined,” Dicken concluded in each report.

Dicken said FFE efforts to set up navigator programs, or exchange ombudsman programs, were about two months behind schedule in May because of CMS delays in issuing a funding announcement. CMS was going to offer two rounds of awards, but now it expects to offer just one round, with an Aug. 15 award date, Dicken said.

CMS expects to use at least two different types of navigators in each of the 34 FFE states, Dicken said.

CMS expects navigator employee training to be based on the same training content being developed for FFE agents and brokers, Dicken said.

In two states that had hoped to pick in-person assisters by the time the GAO was working on the exchange implementation reports, one was about six weeks behind the schedule it had set and another was two weeks behind, Dicken said.

In the individual report, Dicken has included a table breaking CMS FFE contract obligations by expense type. The information technology contracts for the central data hub will cost about $84 million, and the consumer call center contracts are costing about $25 million.

The SHOP program efforts are costing about $22 million.

The list of top contracts is topped by CGI Federal Inc., which is getting about $88 million for FFE information technology and Web support.

The company on track to get the third highest amount of money, Booz Allen Hamilton, is supposed to collect about $38 million for work on enrollment and eligibility planning and state grant technical assistance. Booz Allen has made headlines recently for being the employer of Edward Snowden, who has been objecting to the National Security Agency’s approach to monitoring telephone and Internet communications.

An appendix gives a longer list of exchange program contractors.

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