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Home My WebLink AboutC15-426 Connect for Health Grant AgreementCONNECT�MEALTH . COLORADO Connect for Health Assistance Network Grant Agreement This Connect for Health Assistance Network Grant Agreement (Agreement), entered into between the Colorado Health Benefit Exchange doing business as Connect for Health Colorado® (C4HCO) and Eagle County, Colorado (Grantee), is part of C4HCO's "Connect for Health Assistance Network" to fund and certify Assistance Sites who supervise Health Coverage Guides (HCGs) as part of C4HCO's efforts to serve Coloradans by providing impartial information and assistance with the application and enrollment experience. 1. Scope of Work: The grant shall be used exclusively for the scope of work described herein, and as approved for revision during the grant term: • Support C4HCO's mission to increase access, affordability, and choice for individuals and small employers purchasing health insurance in Colorado • Work with C4HCO to complete and revise work plans to be implemented by the grantee including target areas or populations and enrollment goals • Provide in- person assistance to customers (by appointment, or walk -in). In- person assistance includes but is not limited to: • providing education about insurance terms and essential health benefits, the full range of public and private health coverage options, premium tax credits, cost - sharing reductions, AI /AN benefits, shared responsibility for health coverage, distinguishing plan benefits and choices, appeals and complaints process, exemption process, and the importance of timely premium payment • helping customers complete the application and enroll in health coverage through C4HCO • providing referrals for technical assistance and follow up after technical assistance o providing post - enrollment support including education about 1095A forms and referral for reconciliation at the time of tax filing • Provide appropriate referrals and facilitate appropriate connections with other members of C4HCO's customer service system including contractors, customer service center, certified brokers who provide impartial and objective consumer assistance, and other Assistance Network participants • Provide phone assistance to customers with simple, referral, or follow up needs and phone access for setting appointments with a maximum call response time of 2 (two) business day • Conduct outreach and public education that helps inform Colorado organizations that have contact with potential C4HCO enrollees about topics including but not limited to: enrollment periods for Marketplace coverage, insurance affordability programs, essential health benefits, and getting help with enrollment • Conduct or participate in Open Enrollment Period enrollment events in cooperation with C4HCO • Provide administrative support services related to Assistance Site and Health Coverage Guide duties such as scheduling, supervision, and budget management • Respond to internet or email inquiries within 2 (two) business days • Provide direction to HCGs and associated support personnel to use C4HCO Customer Relationship Management programs and training programs /tools • Provide the infrastructure that allows Health Coverage Guides to conduct their business (Infrastructure requirements include ADA accessible space, telephone and fax, high -speed internet access with compatible browser, computer, scanner, and printer) • Recruit, employ, manage, and monitor individual Health Coverage Guides. Prepare for turnover of key staff with hire /replacement within 30 days. Notify C4HCO Assistance Network Administration of staffing gaps that will not be filled within 30 days • Complete and maintain requirements for Assistance Site Certification (Attachment 2) • Ensure Health Coverage Guides complete and maintain C4HCO training and certification (Attachment 3) • Provide monthly, quarterly, and /or annual reporting in the format requested by C4HCO • Submit to third -party evaluation • Be prepared to deliver services at start of contract term 2. Use of Grant Funds: A. Approved Budget: Funds paid shall not exceed $128,299. Funds paid shall be used to supplement, and not supplant, grantee federal, state, local, organizational and private funds. Expenditure of grant funds shall match the amounts in the Grantee's Approved Budget (Attachment 1). The budget must cover all allowable expenses for the duration of the grant. Grant funds are for approved expenditures incurred during the grant period July 1, 2015 through June 30, 2016. The budget is considered to be a reimbursement of actual costs incurred. Upon award, grantees will be expected to track their actual expenditures against their budget. To the extent program resources are shared across other programs of the grantee, costs must be allocated proportionatelyto each program. The written justification must show how expenses will support accomplishment of program objectives. Grantees may submit requests for prospective funding disbursements with prior approval and examination of need. Financial reporting to justify advance disbursements must be submitted in accordance with COCO instructions. B. Budget Revisions: Transfers between budget categories may be completed by the grantee if they do not exceed 25 percent of the total budget. Transfers between budget categories that exceed 25 percent of the total budget must receive prior written approval from C4HCO. Grantees must provide a budget that agrees with funding amounts in reimbursement request budget categories. Grantees must track cumulative transfer of funds between categories. C. Unexpended Funds: Grantees receiving advance disbursements shall return to C4HCO any unexpended funds within 60 days after the close of the grant period or the termination of the grant. C4HCC, at its sole discretion, may extend the original time limit for expenditure of grant award funds following approval of an extended project timeline. This will be an extension with no additional funds 3. Term: This Agreement is effective upon its execution by the parties and remains in force for twelve months, July 1, 2015 -June 30, 2016 or until such time as the obligations and conditions imposed by or otherwise associated with the Grant expire. C4HCO may terminate this Agreement for Grantee's failure to meet any requirement of the Connect for Health Assistance Network or should it at any time determine that such termination is in C4HCC's best interest, provided that such termination shall be in writing and be provided to Grantee at leastthirty (30) days in advance of the effective date of termination. In the event of such termination, C4HCO will pay Grantee for all services rendered, up to the effective date of termination, it being acknowledged that during the notice period, Grantee will wind -down its responsibilities under the Grantee's project proposal, and in consultation with C4HCC, determine which specific activities should be terminated as soon as possible and which should be continued until the effective date of termination. 4. Unapproved Expenditures. Any expenditure of grant funds not in accordance with the approved budget submitted or not consistent with the purposes stated in the Grantee proposal are subject to prior approval by the C4HCO, in its sole discretion. Should any expenditure be disallowed or should the Grantee violate any of the terms of this Agreement, C4HCO may require repayment, an offset from this Grant to the Grantee in the current or succeeding fiscal year, or other appropriate action. S. Liability and Insurance: The Grantee will be liable, to the extent provided by the Colorado Governmental Immunity Act, for the conduct of individuals serving as Health Coverage Guides under its supervision, whether employed or volunteer, including (but not limited to) compliance with the roles and responsibilities set out in this Connect for Health Assistance Network Grant Agreement, and processes and procedures developed by Connect for Health Colorado, The Grantee is a "public entity" within the meaning of the Colorado Governmental Immunity Act, 24 -10 -101, et seq., C.R.S., as amended ( "Act "). The Grantee will maintain insurance, by commercial policy or self- insurance, as is necessary to meet the Grantee's liabilities under the Act. With respect to general liability, the Grantor recognizes that the County is self- insured for general liability in accordance with the provisions of the Colorado Governmental Immunity Act, as amended. Grantee will be required to show proof of insurance prior to disbursement of grant funding and provide C4HCO with satisfactory evidence of its compliance with this requirement during the term of this agreement upon request. Failure to comply with the insurance requirements may result in termination of this Grant Agreement. 6. ProiectAdministration: A. The Grantee agrees to assign a program manager to be accountable forthe grant work, reporting, and achievement of goals. B. The Grantee will directly administer the project supported by the Grant and agrees that no Grant funds shall be disbursed to any organization or entity, whether or not formed by the Grantee, other than as specifically set forth in the budget and approved work plan. C. Subcontracts: The Grantee must ensure that all subcontracts and consulting or partnership agreements are deliverables -based and in compliance with the terms of C4HCO's award and follow the Grantee's procurement policies. The Grantee is accountable for the deliverables of its subcontractors. D. Project Revisions: Any material changes in the project goals, work plan, timetable, deliverables, budget, or corrective action plan must receive prior written approval from C4HCO E. When Grantee identifies a problem or barrier to meeting project timelines or work plan deliverables, Grantee shall notify C4HCO Assistance Network Administration immediately. Notification shall include specific strategies to deal with or overcome the problem or barrier and shall include any required revisions to the timeline, budget or deliverables. Upon approval by C4HCC, the proposed revisions shall be incorporated as an update to Grantee's work plan or grant agreement for its project. Until approval by C4HCO of any proposed revisions to the grant agreement or work plan in operation, the Grantee shall be responsible for completing all timeline requirements and objectives, as provided in that agreement, in a timelyfashion. F. Certification: The Grantee must meet certification requirements as defined by C4HCO (Attachment 2). Grantee must ensure all Health Coverage Guides under its supervision, meet the requirements for certification as defined by C4HCO (Attachment 3), and obtain certification prior to assisting customers. G. Grantee agrees to retain customer authorization forms for 6 (six) years and provide same to C4HCO on request for audit, complaint, or quality review. 7. Reporting Requirements and Payment Schedule: The Grantee shall submit required reports on or before the date due, per the instructions provided by C4HCO, following C4HCO's guidelines and formats. Upon receipt, review, and approval of Grantee reports, C4HCO shall issue grant payments. 8. Grant Monitoring and Evaluation: A. The Grantee agrees to attend meetings, participate in site visits, and give reports on progress and accomplishments to the Board of Directors of C4HCO, C4HCO staff and advisors, and other grantees as requested by C4HCO. B. The Grantee agrees to participate in an evaluation of C4HCO's grants program, including assisting with any data collection and information gathering, such as participation in surveys, site visits, meetings, and interviews with evaluators. C. The Grantee agrees to provide reports as requested with information including but not limited to characteristics of the population served, numbers served, numbers enrolled, and outreach and enrollment strategies and outcomes. D. The Grantee agrees to produce all documents and reporting required for monitoring of Federal grant sub - recipients, as determined and directed by C4HCO. E. The Grantee agrees to comply with the federal rules and requirements related to C4HCO's grant including but not limited to circulars A -87, A -122, and A -133, issued by the United States Office of Management and Budget, as applicable. If Grantee receives federal funds in excess of $500,000 in the Grantee's fiscal year, Grantee will be subject to a federal A -133 Audit. Grantee is responsible for notifying C4HCO in the event that federal grant funds will exceed the $500,000 threshold for the Grantee fiscal year. 9. Financial Reporting Requirements: A. On a monthly basis, for reimbursement the Grantee shall use the reimbursement form provided by C4HCO to provide to C4HCO an itemized statement of expenditures, and submit documentation of expenses showing how the funds were expended for the preceding month. For prospective disbursement of funds, requests must be submitted by the 15" of the month preceding the month for which funding is requested and documentation of expenditures must be provided on the 15" of the month following the month for which funding was disbursed. B. The Grantee must provide C4HCO with any audited financial statements including qualified /unqualified opinion with comments for any year in which C4HCO Grant funds are received C. Audit: C4HCO reserves the right to audit Grantee's use of funds upon reasonable notice to Grantee for the purpose of identifying potential overpayments and non - compliance with Grant requirements. In the event of overpayment C4HCO reserves the right to recover Grant funds from Grantee, or otherwise off -set future provision of funds as may be appropriate, or required by application of law. D. Continued funding for an awarded project is contingent on the Grantee meeting the goals and objectives stated in the approved original or revised work plan and budget. 10. Failure to perform and corrective action: If it is apparent that the Grantee is failing to meet its obligations under this Agreement, C4HCO will provide notice of the identified failure to the Grantee, an opportunity to establish a corrective action plan approved by C4HCO, and at least thirty (30) days to cure. Failure to cure will result in suspension or cancellation of unpaid disbursements 11. Reversion of Grant: C4HCO may suspend or cancel unpaid disbursements if Grantee becomes unable to carry out the purposes of the Grant or ceases to be an appropriate means for accomplishing the purposes of the Grant based on, by way of non - exclusive example, the Grantee's insolvency, receivership, bankruptcy, assignment for the benefit of creditors, or cessation of business on a regular basis. In any such case, the Grantee shall, at a minimum, within thirty days after written request by C4HCO, repay the portions of the Grant received but not disbursed, and all portions of the Grant, which although disbursed, are within the Grantee's control. 12. Non- Discrimination: The Grantee may not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin, sexual orientation, or any other characteristic forbidden as a basis for discrimination by applicable laws, and certifies that its Constitution or by -laws contains a non - discrimination clause consistent with all applicable law. 13. Title VI and ADA Compliance. Pursuant to 45 CFR 155.210(5), the Grantee and its Health Coverage Guides shall at all times provide information in a culturally and linguistically appropriate manner in compliance with Title VI of the Civil Rights Act of 1964 and shall ensure accessibility and usability for individuals with disabilities in accordance with the Americans with Disabilities Act of 1990, Section 504 of the Rehabilitation Act and 45 CFR 155.205(c). 14. Collusion or Other offenses A. Neither the Grantee, nor any of its officers or directors, has engaged in collusion with respect to the grantee's application for the Grant or this Agreement or has been convicted of bribery, attempted bribery, or conspiracy to bribe under the laws of any state or of the United States; B. The Grantee has not employed or retained any person, partnership, corporation, or other entity, other than a bona fide employee or agent working for the Grantee, to solicit or secure the Grant or this Agreement, and the Grantee has not paid or agreed to pay any such entity any fee or other consideration contingent on the making of the Grant or this Agreement: C. The Grantee, if incorporated, is registered or qualified in accordance with the Colorado Secretary of State's Office, and is in good standing, has filed all required annual reports and filing fees with all applicable State, County, and /or other local governmental jurisdictional bodies; D. No money has been paid to or promised to be paid to any legislative agent, attorney, or lobbyist for any services rendered in securing the passage of legislation establishing or appropriating funds for the Grant; E. Neither the Grantee, nor any of its officers or directors, nor any person substantially involved in the contracting or fundraising activities of the Grantee, is currently suspended or debarred from contracting with the State or any other public entity; and F. Neither the Grantee, nor any of its officers, directors, employees nor any other person substantially involved in the contracting or fundraising activities of the Grantee is currently on the "List of Excluded Individuals /Entities" (LEIE) maintained by the Office of Inspector General of the United States Department of Health and Human Services. 15. Conflict of Interest A. Grantee affirms that Grantee and all of its employees are not any of the prohibited entities and will not engage in any of the prohibited conduct specified in the Conflict of Interest and Conduct policy (Attachment 4). B. Grantee will remain free of conflicts during the term of this Agreement. Grantee agrees that if an actual or potential conflict of interest arises after the date of this Agreement, the Grantee shall immediately make a full disclosure in writing to C4HCO of all relevant facts and circumstances. This disclosure shall include a description of actions which the Grantee has taken and proposes to take to avoid, mitigate, or neutralize the actual or potential conflict of interest. If the contract has been awarded and performance of the contract has begun, the Grantee shall continue performance until notified by C4HCO per the terms articulated in the Grant Agreement of any further action to be taken. C. Grantee will not participate in lobbying activities related to the business of C4HCO. 16. Conduct, Roles and Responsibilities A. Grantee agrees to ensure that the employees and volunteers under its supervision pursuant to this Agreement will adhere to requirements as set forth at 45 CFR § 155.210 (d) and (e) and the role as agreed upon by C4HCO in work plans and as specified in the Conflict of Interest and Conduct policy. B. Grantee will ensure that employees and volunteers under its supervision pursuant to this Agreement will not represent or conduct themselves in such a way that violates State of Colorado law governing the licensing and appointment of insurance producers, C.R.S. 10.2 -401 et. seq. 17. General Requirements: A. The Grantee shall comply with the Scope of Work description within this agreement. B. The Grantee shall conduct background investigations of its employees and volunteers performing work related to this Agreement as stated in the certification requirements (Attachment 3). Grantee will ensure all staff interacting clients or accessing the personal information of clients have completed a criminal background check and are, at a minimum, free of conviction of financial crimes, crimes against children or vulnerable adults, and violent offenses. C. Grantee understands and acknowledges that under 45 CFR 92.34, the Department of Health & Human Services (HHS) retains a royalty -free, nonexclusive, and irrevocable license to reproduce, publish or otherwise use and authorize others to use, for Federal Government purposes, the copyright in any work developed under a Federal grant, or a subgrant or subcontract, and in any rights to a copyright purchased with grant support. D. Confidentiality. Grantee may use confidential client and C4HCO information to carry out its requirements under this Agreement or as required by applicable law. Grantee agrees to comply with applicable law including the Colorado Insurance Code, ACA, HIPAA, and Colorado State law regarding the confidentiality of personal health information. E. C4HCO Privacy and Security Standards. The Grantee shall comply with C4HCO's privacy and security standards as set forth and incorporated by reference in Attachment 5 of the Agreement. F. Grantee acknowledges and agrees to comply with any C4HCO advertising, marketing, and branding requirements, as determined by C4HCO and communicated to grantee from time to time. Grantee may advertise or refer to itself as a "Connect for Health Colorado Assistance Site;' but shall not represent itself as an agent or other representative of C4HCO- C4HCO reserves the right to terminate a grantee of this Agreement for acts of misrepresentation orfalse and misleading advertising, as solely determined by C4HCO. G. The laws of Colorado shall govern the interpretation and enforcement of this Agreement. Any claim, action, suit or proceeding relating to this Agreement shall be brought in the applicable State or Federal courts for the City and County of Denver, Colorado. H. The Grantee may not sell, transfer, or otherwise assign any of its obligations under this Agreement, or its rights, title, or interest in this Agreement, without the prior written consent of C4HC0. This Agreement shall bind any respective successors and assigns of the parties. The grantee will notify C4HCO of any changes to key personnel involved in the grant work within 7 business days of such a change. I. No amendment to this Agreement is binding unless it is in writing and signed by both parties. J. The following items are incorporated by reference and made a part of this Agreement. Attachment 1: Approved Budget. Attachment 2: Assistance Site Certification Requirements Attachment 3: Health Coverage Guide Certification Requirements Attachment 4: Conflict of interest and conduct policy Attachment 5: Privacy and Security Standards 18 Non - availability of Funds: If third parties fail to make expected funds available (including funds which may be received from the federal government) for the continued performance for any fiscal period of C4HCO operations, this Agreement shall be canceled automatically as of the beginning of the fiscal year for which funds were not appropriated or otherwise made available; provided, however, that this will not affect either C4HCC's rights or the Grantee's rights under any termination clause in this Agreement. The effect of termination of the Agreement hereunder will be to discharge both the Grantee and the C4HCO from future performance of the Agreement, but not from their rights and obligations existing at the time of termination. C4HCO shall notify the Grantee as soon as it has knowledge that funds may not be available for the continuation of this Agreement 19. Acceptance of Terms and Conditions: This document shall be signed by an individual legally authorized to execute contracts on behalf of the Grantee, signifying agreement to comply with all the terms and conditions specified above. The above terms and conditions of the grant are hereby accepted and agreed to as of the date specified: For: Colorado Health Sene i change By: Printed Name and Title: Kevin Patterson, Chief Executive Officer, Interim Date: For By: Prir Date: huG6.SR 7,S 20tS ca \ / E- - -- - - ®® -----®--®---,..----®- !� ;! ; ;� - • l =�.� | .- § ■ ...7 || ...... | ]| - _ �Z..� \/\ !f■k .�� 5 /, ■■ )\/ § | 99 ! /■ ■; § d" § ...agg ®k� " - - -- - - - - - -- - - - - ® -- . [ §!! §§§ | | •99d • • • § ! - ,.- ' -- - -. - ® -- - - - - - -- \! § §® '787 222�a :�G • \ //\ - I[s, !§§ ■ ■ ' 999 ' § K ; § \k® k�� k \ / \� §k / / /■ / \@ |k | § f `2. 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Attachment 2 CONNECT FOR HEALTH COLORADO ASSISTANCE SITE CERTIFICATION REQUIREMENTS For Connect for Health Colorado certification as an Assistance Site, the Site must meet the following requirements at least annually: • Approved Budget and Work Plan • Assignment of Program Manager /Supervisor to receive Connect for Health Colorado Supervisor /Administrative training • Submission of W9 for named site • Must not be on the DIG List of Excluded Individuals /Entities • Signed Connect for Health Colorado Privacy and Security statement • Signed Connect for Health Colorado Conflict of Interest statement and any disclosures TERMS AND CONDITIONS OF ASSISTANCE SITE CERTIFICATION Once an Assistance Site has been certified, certification shall remain in effect with the following conditions: • Changes to W9 must be reported to Connect for Health Colorado on a new W9 • Legal actions against the Site or individuals supported by Connect for Health Colorado that could result in inclusion on the DIG List of Excluded Individuals /Entities must be reported to Connect for Health Colorado and may result in termination of certification • The Site must attest to compliance with Privacy and Security standards • Breeches in security or instances of compromise of privacy must be reported to Connect for Health Colorado and may result in termination of certification • Connect for Health Colorado reserves the right to inspect, assess, and audit the Site's security and privacy practices. Inadequate security and privacy practices may result in termination of certification • Annually, the Site must complete the Conflict of Interest statement. New disclosures of Conflicts of Interest must be reported to Connect for Health Colorado and may result in termination of certification • Changes in demographics or personnel, when such changes result in Assistance Site application form or agreement must be reported to Connect for Health Colorado • Program Manager /Supervisor assigned by the Site must complete Connect for Health Colorado Administration training within 120 days and at least annually thereafter as required by Connect for Health Colorado to maintain skills • If a site does not meet performance goals, or quality audits show trends of concern about a Site's ability to remain impartial or otherwise fulfill duties, Connect for Health Colorado may ask for a plan of action to improve performance, ask for an amended application, or terminate certification Attachment 3 CONNECT FOR HEALTH COLORADO HEALTH COVERAGE GUIDE CERTIFICATION REQUIREMENTS For Connect for Health Colorado certification as Health Coverage Guide, an individual must meet the following requirements on at least an annual basis: • Assignment by a Certified Assistance Site. Assignment from a Site includes: • Attestation that individual is not on the OIG List of Excluded Individuals /Entities • Attestation that Privacy and Security statement has been signed • Attestation that background check was completed with satisfactory results within the previous 5 years • Attestation that Conflict of Interest statement has been signed and Connect for Health Colorado has been given any disclosures • Completion of Connect for Health Colorado Health Coverage Guide training program TERMS AND CONDITIONS OF HEALTH COVERAGE GUIDE CERTIFICATION Once a Health Coverage Guide is certified, certification shall remain in effect with the following conditions: • Loss of assignment by Certified Assistance Site will result in termination of certification • Legal actions against a Health Coverage Guide that could result in inclusion on the OIG List of Excluded Individuals /Entities or would result in an unsatisfactory background check must be reported to Connect for Health Colorado and may result in termination of certification • Changes in relationships that constitute a Conflict of Interest disclosure must be reported to Connect for Health Colorado and may result in termination of certification • Breeches in security or instances of compromise of privacy must be reported to Connect for Health Colorado and may result in termination of certification • Connect for Health Colorado reserves the right to inspect, assess, and audit a Health Coverage Guide's security and privacy practices. Inadequate security and privacy practices may result in termination of certification • Health Coverage Guide must complete update trainings to maintain expertise at least annually If quality audits show trends of concern about a Health Coverage Guide's ability to remain impartial or otherwise fulfill Health Coverage Guide duties, Connect for Health Colorado may ask for a plan of action for improvement or may terminate certification Attachment 4 Connect for Health Colorado Assistance Network Conflict of Interest and Conduct Policy for Assistance Sites and Health Coverage Guides Revised July 1, 2015 It is Connect for Health Colorado's intent that the Connect for Health Assistance Network Program provides Connect for Health Colorado customers with impartial, high - quality, community -based education and information, and in- person assistance. In order to assure the delivery of high - quality services, to minimize or eliminate the existence of conflicts of interest and ensure the integrity of the program Connect for Health Colorado will: 1. Monitor for potential conflicts of interest during the Assistance Site selection process and throughout the term of engagement with the Assistance Sites 2. Provide robust initial and ongoing training that includes instruction on providing impartial education and in- person assistance with customer selection of a qualified health plan 3. Require from Assistance Sites and Health Coverage Guides disclosures of affiliations that may present a direct or indirect conflict of interest 4. Require Health Coverage Guides to disclose to customers any relationships within the last five years with a health insurance issuer or issuer of stop loss insurance, or those relationships of a spouse /partner may have or have had within the last five years with a health insurance issuer or issuer of stop loss insurance, and any anticipated relationships S. Monitor Health Coverage Guide enrollment practices for trends that could point to steering 6. Monitor customer feedback on their experience in working with Health Coverage Guides 7. As circumstances command where a conflict of interest arises, require mitigation, revocation of certification, or termination of the grant B. Not, except as otherwise provided under § 155.705(d), require that Health Coverage Guides refer customers to others who are not required to provide fair, accurate, and impartial information 1. Prohibition on conduct 1.1. As required by 45 CFR 155.210 (d) a Navigator (Health Coverage Guide] or Navigator entity (Assistance Site] must not: 1.1.1.1le a health insurance issuer or issuer of stop loss insurance 1.1.2.Be a subsidiary of a health insurance issuer or issuer of stop loss insurance 1.1.3.Be an association that includes members of, or lobbies on behalf of, the insurance industry; or 1.1.4.Receive any consideration directly or indirectly from any health insurance issuer or issuer of stop loss insurance in connection with the enrollment of any individuals or employees in a QHP (qualified health plan] or non -QHP [qualified health plan]' ' The comments in the final federal regulations state, ""consideration," as used in § 155.230(d)(4) of the final rule, should be interpreted to both mean financial compensation — including monetary or In -kind of any type, including grants —as well as any other type of influence a health Insurance issuer could use, including but not limited to things such as gifts and free travel, which may result in steering individuals to particular QHPs offered in the Exchange or plans outside of the Exchange. "" Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers; Final Rule and Interim Final Rule," Federal Register 77:59 (March 27, 2012) 18333. Connect for Health Colorado thus Interprets the words "indirect consideration" to mean in -kind compensation and other types of influence as stated above. Connect for Health 1.S.S.Charge an applicant or enrollee, or request or receive any form of remuneration from or on behalf of an individual applicant or enrollee, for application or other assistance related to Health Coverage Guide duties 1.1.6.Provide gifts, including gift cards or cash, unless they are of nominal value, or provide promotional items that market or promote the products or services of a third party, to any applicant or potential enrollee as an inducement for enrollment = 1.1.7.Use Marketplace funds to purchase gifts or gift cards, or promotional items that market or promote the products or services of a third party, that would be provided to any applicant or potential enrollee 1.1.8.5olicit any customer for application or enrollment assistance by going door -to -door or through other unsolicited means of direct contact, including calling a customer to provide application or enrollment assistance without the customer initiating the contact, unless the individual has a pre - existing relationship with the individual Health Coverage Guide or Assistance Site and other applicable State and Federal laws are otherwise complied with' 1.1.9.Initiate any telephone call to a customer using an automatic telephone dialing system or an artificial or prerecorded voice, except in cases where the individual Health Coverage Guide or Assistance Site has a relationship with the customer and so long as other applicable State and Federal laws are otherwise complied with 1.2. A Health Coverage Guide or Assistance Site must not: 1.2.1.Be a provider entity (including, but not limited to, hospitals, clinics, and physician practices) that is directly owned by, a subsidiary of, or exclusively contracts with, a single insurer or its subsidiaries, except in cases where the provider can demonstrate that due to geography or other factors, there are significant limitations on available insurers with whom to contract 1.2.2.Receive any consideration directly or indirectly from any health insurance producer in connection with the enrollment of any individuals or employees in a QHP [qualified health plan] or non -QHP [qualified health plan] 2. Health Coverage Guide conflict of interest and conduct 2.1. A Health Coverage Guide shall not allow any philosophical, professional or personal financial or non - financial interests to influence or appear to influence the ability of the Health Coverage Guide to perform his /her duties impartially 2.2. Health Coverage Guides shall disclose to Conned for Health Colorado and to customers personal and professional financial and non - financial Interests that may present a conflict of interest 2.3. Health Coverage Guides shall obtain authorization from their customers, prior to accessing any Personally Identifiable Information. This authorization must inform the customer of the Health Coverage Guide's responsibilities and disclose potential conflicts of interest to the customer. The authorization must disclose any relationships within the last five years with a health insurance Colorado further interprets this provision to say that Health Coverage Guides and Assistance Sites cannot receive compensation (cash or in -kind) for enrollment. 2 Because the definition of 'nominal value' is debatable, Connect for Health Colorado believes Assistance Sites and Health Coverage Guides should avoid the use of gift cards or gifts, despite value. Connect for Health Colorado interprets the prohibition on gifts to include gifts given in consideration of an appointment, as people who meet with Health Coverage Guides are inherently potential enrollees. Connect for Health Colorado interprets gifts to Include non - tangible gifts such as the relief of bad debt. ' Outreach and education activities may be conducted by going door -to -door or through other unsolicited means of direct contact. "Solicit' means attempting to sell insurance, asking or urging a person to apply for a particular kind of insurance from a particular company, or asking or urging a person to use the services of, or services in connection with activities as, a public adjuster. CRS 10.2 -103 (11) issuer or issuer of stop loss insurance, or those relationships of a spouse /partner may have or have had within the last five years with a health insurance issuer or issuer of stop loss insurance, and any anticipated relationships The form will also advise the customer of the right to revoke the authorization at any time. These forms shall be kept no less than 6 years. 2.4. Health Coverage Guides shall attest that they are not a prohibited entity or employed by a prohibited entity as described in Paragraph 1. 2.5. Health Coverage Guides shall not receive direct or indirect consideration from any health insurance issuer in connection with enrollment of individuals or employees. 2.6. Health Coverage Guides shall not charge for their services. 2.7. Health Coverage Guides shall provide to customers impartial information about all plans for which customers are eligible and shall not allow personal or professional interests to influence the customers' decisions. In an effort to maintain impartiality in providing assistance: 2.7.1.Health Coverage Guides must not in any way solicit or persuade customers to enroll in any specific health insurance plan. 2.7.2.Health Coverage Guides must not in any way solicit or persuade customers to switch from one health insurance issuer to another. 2.7.3-Health Coverage Guides must not in any way persuade or compel customers to select a particular provider, but may assist a customer in locating or selecting a provider. 2.7.4.Health Coverage Guides must not in any way solicit or persuade customers to engage a particular agent or broker, but may assist a customer in locating or selecting a broker. 2.8. Health Coverage Guides shall not use their role as a Health Coverage Guide for lead generation or profit. 2.9. Health Coverage Guides shall adhere to Connect for Health Colorado reporting, monitoring, and evaluation requirements. 3. Assistance Site conflict of interest and conduct 3.1. An Assistance Site shall not allow any philosophical, financial or non - financial interests or affiliations to influence or appear to influence the ability of the Assistance Site to impartially deliver Health Coverage Guide services or assure that the Health Coverage Guides employed, contracted or otherwise supervised by the Assistance Site are able to impartially perform their duties as Health Coverage Guides, 3.2. Assistance Sites shall disclose to Connect for Health Colorado and to Connect for Health Colorado customers all philosophical, financial and non - financial interests or affiliations that may present a conflict of Interest, including professional relationships between the entity and any health insurance issuer. 3.3. Assistance Sites shall not be any of the prohibited entities described in Paragraph 1. 3.3.1. Assistance Sites shall disclose to Connect for Health Colorado and customers all relationships with prohibited entities as described in paragraph 1. 3.3.2.Assistance Sites receiving any cash or in -kind compensation from health insurance issuers shall disclose to Connect for Health Colorado and customers the nature of the compensation, what the compensation is intended to support, and from whom it is received. 3.4. Assistance Sites shall not direct or permit Health Coverage Guides to solicit or persuade customers to enroll in any specific health insurance plan, switch from one carrier to another, or select a particular provider. 3.5. Assistance Sites shall not direct or permit Health Coverage Guides to use gifts to induce customers to apply or enroll in health coverage. 3.6. Assistance Sites shall not charge for Health Coverage Guide services or otherwise utilize the Assistance Program, or their association with the Assistance Program for lead generation or profit. 3.7. Assistance Sites shall not direct or permit Health Coverage Guides to solicit any customer for application or enrollment assistance by going door -to -door or through other unsolicited means of direct contact, including calling a customer to provide application or enrollment assistance without the customer initiating the contact, unless the individual has a preexisting relationship with the individual Health Coverage Guide or the Assistance Site and other applicable State and Federal laws are otherwise complied with. Outreach and education activities may be conducted by going door -to -door or through other unsolicited means of direct contact, including calling a customer. 3.8. Assistance Sites shall not direct or permit Health Coverage Guides to initiate any telephone call to a customer using an automatic telephone dialing system or an artificial or prerecorded voice, except in cases where the individual Health Coverage Guide or Assistance Site has a relationship with the customer and so long as other applicable State and Federal laws are otherwise complied with 3.9. Assistance Sites shall not utilize interests or affiliations for purposes of soliciting or persuading customers to enroll in a specific health insurance plan, switch-from one plan to another, or to select a particular provider or broker 3.10. Assistance Sites shall monitor Health Coverage Guides they employ, contract with or otherwise supervise for fair and impartial performance of Health Coverage Guide duties. 3.11. Assistance Sites and shall adhere to Connect for Health Colorado reporting, monitoring, and evaluation requirements. Attachment 5 Privacy and Security Standards Grantee shall: (a) Not use or disclose C4HCO information other than as permitted or required by the Agreement or as required by law; (b) Use appropriate safeguards, and comply with or exceed C4HCO supplied policies and guidance with respect to C41HICO information, to prevent use or disclosure of information other than as provided for by the Agreement; (c) Report to C4HCO any use or disclosure of C4HCO information not provided for by the Agreement of which it becomes aware, Including breaches of unsecured C4HCO information, and any security incident of which it becomes aware; (d) If applicable, ensure that any subcontractors that create, receive, maintain, or transmit C4HCO information on behalf of the Grantee agree to the same restrictions, conditions, and requirements that apply to the [Partner] with respect to such information; (e) Maintain and make available the information regarding accounting of disclosures; and (f) Make its internal practices, books, and records available to C4HCO for purposes of determining compliance with the C4HCO Polices and Guidance.