ATTACHMENT I_S-DASOBO-00010624 Current and Future FDSH Integration.pdf
PDF 221 KB Posted
- Attached to
- Oregon State Based Insurance Marketplace Solution State and local contract opportunity
- Solicitation number
- S-DASOBO-00010624
- Issued by
- Marion County, Oregon
About this file
This document is a context diagram that illustrates the current and future integration between Oregon's Eligibility System (ONE) and the Federal Data Services Hub (FDSH) as well as Oregon's State-Based Marketplace (SBM) and FDSH. The document outlines the available business services and data verification functions between these systems, including initial eligibility determination, verifying lawful presence, income and family size, employer-sponsored insurance, and periodic eligibility verification.
The related state and local contract opportunity is for the procurement of a State-Based Insurance Marketplace (SBM) Solution Platform and related Customer Assistance Center on behalf of the Oregon Health Authority. DAS PS is issuing this RFP, and they anticipate awarding one contract from this solicitation. The contract term and any renewal options are not specified in the information provided.
View the file
Other files for this state and local contract opportunity
Show all 17
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Office of Information Services Strategy & Digital Transformation
Current Oregon Eligibility Integration with FDSH Federally Facilitated Marketplace (FFM) - Oregon Eligibility (ONE) - Federal Data Services Hub (FDSH) Eligibility Verification CONTEXT
DIAGRAM
(ONE and FFM Requesting Eligibility Determination with FDSH Independently)
OREGON ELIGIBILITYFEDERALLY FACILITATED MARKETPLACE FEDERAL SYSTEMS
EN
R
O
LL
M
EN
T M
A N
A G
EM
EN
T
EL
IG
IB
IL
IT
Y M
A N
A G
EM
EN
T
Available Business Services
a. Initial Eligibility
Determination
b. Verify Lawful Presence
c. Verify Annual Income and
Family Size (Currently not used by ONE)
d. Verify Current Income from other sources
e. Verify Employer-Sponsored Insurance (ESI) Minimum Essential Coverage (MEC) (Currently not used by ONE)
f. Verify Non-ESI MEC
g. Periodic Eligibility
Verification
h. Redetermination & Renewal
Verification
Created: 03/25/2024 – Reference: process Flow Version: v0.5 – Updated: 04/08/2024 Version: v0.9 – Updated: 04/12/2024 Version: v1.0 – Updated: 04/25/2024
LEGEND
File transfer or real time data exchange via integration
Manual data entry or manual process via Document Mgmt.
Eligibility changes:
Report a Change (RAC) Household, change in residence, residence / citizenship / tribal status, income Client info updates: Name, Address, Contact
FDSH Verification Data:
a. Validation of SSN
b. Verification of Citizenship or Immigration Status
c. Incarceration status
d. Eligibility and/or enrollment in certain types of minimum essential coverage
e. Income, based on Federal Tax Information, Title II benefits, and current income sources
f. Quarters of Coverage
g. Death Indicator
OHP Eligibility Eligibility Engine
Request Verification Data for OHP Eligibility
Request Verification Data for FFM Eligibility
FFM2ONE
Service
Current Functions:
• Refer to OHP
Current Functions:
• Refer to SBM
• Communicate final
OHP Determination
Account Transfer (AT) Service
Federal Data Services Hub
(FDSH)
Eligibility changes:
Qualifying Life Events
(QLE)
Household, change in residence, residence / citizenship / tribal status, income Client info updates:
Name, Address, Contact https://healthcare.gov
Customer Service Portal
Assister / Navigator Portal
Broker Portal
Issuer Portal
SBM
broker
New Applicant
Existing subscriber
SBM
admin
SBM
navigator
SBM
issuer
FFM
Eligibility Service
Eligibility Engine
FFM2ONE
Service
Current Functions:
• Refer to OHP
Current Functions:
• Refer to FFM
• Communicate final
OHP Determination
Eligibility changes:
Qualifying Life Events
(QLE)
Household, change in residence, residence / citizenship / tribal status, income Client info updates:
Name, Address, Contact https://healthcare.gov
Customer Service Portal
Assister / Navigator Portal
Broker Portal
Issuer Portal
SBM
broker
New Applicant
Existing subscriber
SBM
admin
SBM
navigator
SBM
issuer
FFM
Eligibility Service
Eligibility Engine
Dept. Of Homeland Security
(DSH)
Centers for Medicare & Medicaid Services
(CMS)
Social Security Administration
(SSA)
Internal Revenue Service
(IRS)
Applicant Portal
Worker Portal
OHP, CHIP, SNAP TANF,
ERDC
admin
New Applicant
Existing subscriber
Applicant Portal
Worker Portal
OHP, CHIP, SNAP TANF,
ERDC
admin
New Applicant
Existing subscriber
Office of Information Services Strategy & Digital Transformation
Future SBM Integration with FDSH Oregon State Based Marketplace (SBM) - Oregon Eligibility (ONE) - Federal Data Services Hub (FDSH) Eligibility Verification
CONTEXT DIAGRAM
(ONE and SBM Requesting Eligibility Determination with FDSH Independently)
OREGON ELIGIBILITYOREGON STATE BASED MARKETPLACE FEDERAL SYSTEMS
EN
R
O
LL
M
EN
T M
A N
A G
EM
EN
T
EL
IG
IB
IL
IT
Y M
A N
A G
EM
EN
T
Eligibility changes:
Qualifying Life Events
(QLE)
Household, change in residence, residence / citizenship / tribal status, income Client info updates:
Name, Address, Contact
Applicant Portal
Created: 03/25/2024 – Reference: process Flow Version: v0.5 – Updated: 04/08/2024 Version: v0.9 – Updated: 04/12/2024 Version: v1.0 – Updated: 04/25/2024
LEGEND
File transfer or real time data exchange via integration
Manual data entry or manual process via Document Mgmt.
Client Portal
Customer Service Portal
Assister / Navigator Portal
Broker Portal
Issuer Portal
SBM
broker
Worker Portal
OHP, CHIP, SNAP TANF,
ERDC
admin
SBM2ONE
Service
Eligibility changes:
Report a Change (RAC) Household, change in residence, residence / citizenship / tribal status, income Client info updates: Name, Address, Contact
Oregon SBM Eligibility Service
Eligibility Engine
Request Verification Data for SBM Eligibility
OHP Eligibility Eligibility Engine
Request Verification Data for OHP Eligibility
Current Functions:
• Refer to OHP Desired Functions:
• Confirm Existing
OHP Eligibility
• Communicate final QHP Enrollment
• Communicate End of Coverage
Current Functions:
• Refer to SBM
• Communicate final OHP Determination
Desired Functions:
• Communicate
End of Coverage
Federal Data Services Hub
(FDSH)
Account Transfer (AT) Service
Current Functions:
• Refer to OHP Desired Functions:
• Confirm Existing OHP
Eligibility
• Communicate final
QHP Enrollment
• Communicate final
APTC/CSR eligibility outcome
• Communicate End of Coverage
Current Functions:
• Refer to SBM
• Communicate final OHP Determination
Desired Functions:
• Communicate
End of Coverage Account Transfer
(AT) Service
New Applicant
Existing subscriber
SBM
admin
SBM
navigator
SBM
issuer
New Applicant
Existing subscriber
Business Services
a. Initial Eligibility
Determination
b. Verify Lawful Presence
c. Verify Annual Income and
Family Size (Currently not used by ONE)
d. Verify Current Income from other sources
e. Verify Employer-Sponsored Insurance (ESI) Minimum Essential Coverage (MEC)
f. Verify Non-ESI MEC
g. Periodic Eligibility
Verification
h. Redetermination &
Renewal Verification
FDSH Verification Data:
a. Validation of SSN
b. Verification of Citizenship or Immigration Status
c. Incarceration status
d. Eligibility and/or enrollment in certain types of minimum essential coverage
e. Income, based on Federal Tax Information, Title II benefits, and current income sources
f. Quarters of Coverage
g. Death Indicator
Dept. Of Homeland Security
(DSH)
Centers for Medicare & Medicaid Services
(CMS)
Social Security Administration
(SSA)
Internal Revenue Service
(IRS)
New Applicant
Existing subscriber
Available Business Services
a. Initial Eligibility Determination
b. Verify Lawful Presence
c. Verify Annual Income and
Family Size (Currently not used by ONE)
d. Verify Current Income from other sources
e. Verify Employer-Sponsored Insurance (ESI) Minimum Essential Coverage (MEC) (Currently not used by ONE)
f. Verify Non-ESI MEC
g. Periodic Eligibility Verification
h. Redetermination & Renewal
Verification
FDSH Verification Data:
a. Validation of SSN
b. Verification of Citizenship or Immigration Status
c. Incarceration status
d. Eligibility and/or enrollment in certain types of minimum essential coverage
e. Income, based on Federal Tax Information, Title II benefits, and current income sources
f. Quarters of Coverage
g. Death Indicator
Dept. Of Homeland Security
(DSH)
Centers for Medicare & Medicaid Services
(CMS)
Social Security Administration
(SSA)
Internal Revenue Service
(IRS)
| Slide 1: Current Oregon Eligibility Integration with FDSH |
| Slide 2: Future SBM Integration with FDSH |
File details come from the government source that posted it. Updated .