Health Industry Collaboration Effort

Health plans, Providers, Associations

Simplifying Healthcare Administration

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HICE Volunteer Organizational Guidelines and Participation Policy Statement

HICE PURPOSE STATEMENT

To establish, coordinate and oversee a voluntary multi-disciplinary team that works collaboratively to implement and improve compliance with the requirements of CMS, DMHC, DHS, NCQA and other regulatory agencies or accreditation organizations;
To seek a standardized implementation interpretation and relay standardized requirements to providers regarding those requirements;
To seek clarification from regulating agencies, collaboratively working to resolve issues surrounding operations and compliance;
To seek ways to simplify implementation(s) and improve compliance through standardized reporting mechanisms, provider communications, and training;
To realize cost savings for agencies, health plans, providers and associations through the above.

RESPONSIBILITIES

Establish Teams
Establish & Maintain "Participation Guidelines"
Make Decisions Regarding Projects
Develop Simplified / Standardized Tools
Develop Provider Communications
Develop Training Material & Workshops
Seek Clarification from Agencies

ORGANIZATION
The intent of the HICE organization configuration is to support the HICE purpose of voluntary health care industry collaboration to streamline implementation of regulatory and accreditation standards for health plans, provider organizations and their respective associations. The configuration is developed to address multiple topics with minimal formalities and broad representation. The meetings are held primarily by conference call.

HICE Leadership

Team Leads
The Team Leads Group is the decision-making group that consists of the Leads or Co-Leads of each HICE Team, and other key organizational stakeholders. The Team Leads is the principal leadership group of HICE and as much as possible there is equal representation of the provider community and health plan community. The configuration is designed to respond quickly to issues raised and allow input from affected stakeholders, while ensuring that HICE work products receive attention and are reviewed by the major industry stakeholders in a timely manner. Team Leads also make decisions on HICE configuration and process, team modifications, new projects, and controversial issues where a team is unable to come to consensus. Team Lead participants are voluntarily accountable for sharing in the responsibility of HICE Team Lead decision-making, as well as for communicating within their respective organizations any HICE requests for document review and approval of HICE work products.

Participation on the Team Leads Group will be automatic for any HICE Team Lead or Co-Lead. The Team Leads Group, with a majority vote, will also be able to appoint representatives annually from the below list of "Specific Stakeholder Entities" to serve on the HICE Team Leads Group. In general, these appointments will fulfill the following criteria: 1) Enhance the representation on HICE from all Health Plans; 2) Enhance the representation on HICE from a broad cross-section of regions within California; 3) Enhance the representation on HICE from a broad cross-section of provider organization types (i.e. medical groups, IPAs, foundations, mixed models); and, 4) Enhance the representation on HICE from trade associations representing HICE Stakeholders.

Team Leads Co-Chairs
Team Leads Co-Chairs include one health plan and one provider organization representative who generally hold a Vice President or Management level position within their organization. Change in the positions of Team Leads Co-Chairs is decided by the Team Leads group itself through an election. Team Leads participants who represent health plan organizations nominate candidates for one health plan Co-Chair position; Team Leads participants who represent provider group organizations nominate candidates for one provider organization Co-Chair position. The nomination of at least two candidates per Co-Chair position is preferred. Each Co-Chair position's term is two years. There is no term limit. All Team Leads participants are eligible to participate in the election of Co-Chair positions. Elections are to occur at a period of time approved by Team Leads via an electronic method (e.g., via email or HICE website). Elected Co-Chairs are to be announced at the HICE Annual Conference. The function of HICE Team Leads Co-Chairs is to facilitate and coordinate the HICE Team Leads bi-monthly meeting. The HICE Team Leads Co-Chairs will have nonvoting positions on the HICE Board of Directors (unless the position is held by a current member of the Board of Directors) and will have a responsibility to report to the HICE Board of Directors at each regularly scheduled Board meeting.

Director of Agency Relations
The HICE Team Leads elects one representative of its group to perform the role of Director of Agency Relations. The Director of Agency Relations may be a representative from either a health plan or provider group organization, who generally holds a Vice President or Management level position within their organization. Team Leads participants nominate candidates. The nomination of at least two candidates is preferred. The term of the Director of Agency Relations is two years. There is no term limit. All Team Leads participants are eligible to participate in the election of the position. The election is to occur at a period of time approved by Team Leads via an electronic method (e.g., via email or HICE website). The elected Director of Agency Relations is to be announced at the HICE Annual Conference. The function of the Director of Agency Relations is to facilitate, develop, and maintain relationships with regulatory agencies and industry associations for the purpose of ensuring ongoing participation of agencies and associations in HICE. The Director of Agency Relations will have a nonvoting position on the HICE Board of Directors (unless the position is held by a current member of the Board of Directors) and will have a responsibility to report to the HICE Board of Directors at each regularly scheduled Board meeting.

The Industry Leadership Team includes both Team Leads and governmental/other entity representatives who provide guidance to interpret federal and California state regulations and requirements affecting the health care delivery system. This group is led by the Director of Agency Relations.

HICE Teams
HICE Teams are established when industry leaders express concern about a particular topic related to state or federal regulation(s), and accreditation requirements. As much as possible, an HICE Team is led by Co-Leads representing one health plan and one provider organization. HICE Team participants, including Co-Leads, are volunteers who should have subject matter expertise, project management experience, and be a stakeholder within the participant's organization. Each HICE Team develops its own charter, which is submitted to the Team Leads for review and posted to the HICE website. The charter is used to guide the team in accomplishing goals. A monthly report is made to the Team Leads. There is an annual review of the charter and goals by each team for planning purposes the following year. Leadership changes in teams or sub-teams are made by the team.

Decision Making Process
Consensus is the mode of operation in each HICE Team. If consensus is unable to be reached, the issue is raised up to the Team Leads. See the Section below titled "Issue Resolution: Ad Hoc Resolution Panel". Once an issue is resolved, the Ad-Hoc Resolution Panel is disbanded.

Issue Resolution: Ad-Hoc Resolution Panel
If consensus is unable to be reached at the HICE Team, an Ad-Hoc Resolution Panel will be designated to develop a recommended resolution.

Objective: To create a forum to assist in resolving disputes that arise within teams surrounding issues that affect one stakeholder significantly more than others, result in high risk or resource intensive outcomes, or relate to leadership changes. Once an issue is resolved, the Ad-Hoc Resolution Panel is disbanded.

Composition:

Team Leads Co-Chairs,
the specific HICE Team Co-Chairs who own the issue, and
others as relevant to a particular issue and approved by the Team Leads (e.g. for clinical issues - a physician or nurse may be invited).

Process: A request to initiate an Ad Hoc Resolution Panel is decided by the Team Leads either at the request of HICE Team Co-Leads or through Team Leads Co-Chairs.

Meeting criteria:

Equal representation of concerned stakeholders relevant to the issue
Neutral facilitator as determined by the HICE Team Co-Leads and Team Leads Co-Chairs
Forum can be conference call or face-to-face
Recommended resolution will be determined by consensus of the Ad-Hoc Resolution Panel.

VOLUNTEERS
The goal of participation is to support the HICE purpose of voluntary industry collaboration to develop strategies to coordinate and simplify implementation of regulations and agreements between health plans, provider organizations ("Stakeholders") and their respective associations through active participation in project teams. Participation is accomplished by volunteers from these Stakeholder entities. Designees of Stakeholder entities are also welcomed as participants. Participation is not limited by state boundary. Government Agencies, Associations, Consultants and Vendors are not participants but function as resources invited to participate in all phases of HICE at the invitation of Team Leads and under a defined scope.

Participation Criteria
All the following criteria are required to participate as a Stakeholder entity on an HICE team.
Be employed or engaged by one of the qualifying Stakeholder entities (see list below)
Be responsible for and/or perform a specific function related to compliance with health care statute or
regulation
Be authorized by a Stakeholder entity to represent the entity and contribute on its behalf at various meetings

Specific Stakeholder Entities
Health Plans, Whole - Full Benefit Licensees (e.g. California - Health Care Service Plans offering Full Service Health Benefits under the Knox-Keene License)

Health Plans, Partial - Limited or Partial Licensees (e.g. California - Health Care Service Plans offering Limited Service Health Benefits under Knox-Keene - Dental)

Provider Organizations - IPAs and medical groups, medical foundations, and other legally organized physician organizations or other provider entities supplying administrative functions

Hospital and Health Systems - Licensed hospitals, integrated delivery systems and/or hospital related business system entities.

Resources
Government Agencies - Both federal and state agencies are invited to participate in HICE to clarify regulations, obtain input from the industry about implementation issues and to assist in developing solutions to regulatory issues and problems raised in the various forums of HICE.

Associations - Professional associations representing health plans, provider organizations, providers and employers.

Private Accrediting Agencies - Accrediting organizations are invited to participate to coordinate their expectations with others in the health care industry to reduce duplication and administrative
inconsistencies.

Practitioners - Hands-on providers of health care (e.g. MDs, Dentists, Optometrists, Chiropractors, Nurse Practitioners, etc.) are invited to participate to address issues relevant to their field of practice.

Consultants - By invitation of Team Leads, consultants may participate in HICE as a resource to address specific issues in their sphere of expertise to provide HICE teams with alternatives to solving problems or addressing issues related to implementation of regulations or agreements. These are usually short-term relationships with HICE teams with a specific scope. An invitation to participate on an HICE team is in no way an endorsement of a particular consultant.

Consultants may participate in HICE, when a letter from the HICE Stakeholder entity clarifying this role is received by the Team Leads in advance of a scheduled HICE Team meeting. When received, the consultant will be listed on the HICE Contact List as if s/he were an employee of that organization.

Vendors - Vendors are invited to participate in HICE by invitation only to address specific products or services available to the health care industry. An invitation to participate on an HICE team in no way means endorsement of a vendor's products or services. These are usually short-term relationships with HICE teams with a specific goal and timeframe.

VOLUNTARY ANNUAL FUNDING PARTNER CONTRIBUTIONS

HICE relies on annual tax-deductible charitable contributions from industry organizations to finance the annual operating budget and further its educational objectives. Without this funding, and the volunteer efforts from so many in the industry, the valuable collaboration between health plans and their provider partners that allows HICE to develop educational and "best practice" materials would not be possible.

Annual Guidelines For Partner Contributions

Partner contributions comprise the funding that HICE uses to finance the day-to-day operations of the organization (meetings, website development, work product, staffing, etc.):

Health Plan State-Based Partners (if your plan is participating in HICE on a state level, the following are the suggested annual contributions):

Plan Size (by State)	Suggested Annual Contribution
Small Health Plans (membership of 10,000 or less)	$5,000
Medium Health Plans (membership of 20,000 or less)	$10,000 - $15,000
Larger Health Plans (membership over 20,000)	$20,000

Health Plan National Partners (if your organization participates in multiple states, you can choose to contribute by each state using the state-based guidelines or by using the national participation level outlined below):

National	Suggested Annual Contribution
For Health Plans With a Presence in Multiple States that Participate in HICE	$40,000

Provider Partners

Provider Organization Size	Suggested Annual Contribution
Less than 60,000 covered lives	$1,000 - $5,000
Up to 60,000 covered lives	$5,500
60,001 - 180,000 covered lives	$9,750
180,000 - 600,000 covered lives	$14,500
600,000 - 1,200,000 covered lives	$19,000
More than 1,200,000 covered lives	$25,000

Project-Based Contributions

Please note that for special projects outside of the normal scope/operating budget, there can be separate funding requests beyond the annual contribution for those organizations that want to participate in any of those projects.

Annual Contribution Acknowledgements

HICE greatly appreciates the consideration of participating organizations in making an annual contribution to support the educational and collaborative activities of HICE. Annual contributions from industry organizations are acknowledged on the HICE website at https://www.iceforhealth.org/partners.asp and in the following ways:

CEO Leadership Circle - those organizations that give the maximum amount requested AND have staff either participating on the HICE Board of Directors and/or leading/co-leading a HICE Team or Workgroup will receive this special designation. CEO Leadership Circle members will have their logo prominently displayed at the top of the HICE website "Partners" page, and the logo will be linked to the organization's website. Logos will also display on the HICE website home page in a scrolling manner and be included in any broadcast messages that are sent to HICE membership.
Other contributing organizations are listed below the CEO Leadership Circle members on the "Partners" page with a website link.
CEO Leadership Circle member organization logos are included on the back of the HICE Annual Conference tote bag or portfolio and on conference slides shown at the opening of the conference (when conducted in person).
Contributing organizations receive discounts on HICE Annual Conference attendee registration. CEO Leadership Circle member organizations receive the largest discount, and the level of discount varies based on conference format (virtual vs. in-person) and if a registration fee is charged for the event.

Any questions regarding annual contributions to HICE can be directed to admin@iceforhealth.org