Agent Broker Sources Sought Notice - Final.docx

SSN 200673

Sources Sought Notice (SSN) 200673 Federally Facilitated Marketplace (FFM) Agent and Broker (A&B) Program Support and Training

THIS IS NOT A FORMAL REQUEST FOR PROPOSAL (RFP) AND DOES NOT COMMIT THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) TO AWARD A CONTRACT NOW OR IN THE FUTURE

This is a SOURCES SOUGHT NOTICE (SSN) to determine the availability and capability of qualified small businesses (e.g., 8(a), service-disabled veteran owned small business, HUB Zone small business, small disadvantaged business, veteran-owned small business, and women-owned small business) that have the capability to support CMS in supporting and training the Agents and Brokers operating within the Federally-Facilitated Marketplace (FFM) established under the Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) (collectively, the Affordable Care Act). This contract supports the help desk, outreach and technical guidance, education, annual training (through CMS and HHS-approved vendors), registration, enrollment technical support, data analytics, oversight, and development of manuals and other operational guidance and technical assistance for the agent and broker program.

The information gathered from this market research will assist the Government in determining the appropriate acquisition strategy, including whether a set-aside is possible. Interested contractors must submit a capability statement to demonstrate their ability to perform the requirements stated below.

A. Background

The Patient Protection and Affordable Care Act (ACA) was enacted to assist millions of Americans in obtaining affordable health insurance and to allow more employers to offer insurance coverage in a cost-effective manner to their employees. CMS is responsible for management and oversight of the coverage provisions of the Affordable Care Act. Within CMS, the Center for Consumer Information and Insurance Oversight (CCIIO) was created to ensure successful implementation, and adherence to, the specific provisions of the legislation related to private health insurance.

Marketplaces are a cornerstone of the Affordable Care Act and include State-Based Marketplaces (SBMs), Federally-facilitated Marketplaces (FFMs), and State-Based Marketplaces operating on the Federal Platform (SBM-FPs). Marketplaces are competitive exchanges where eligible individuals are able to purchase affordable private health insurance. States have the opportunity to tailor their Marketplace or SBM to meet their needs and perform all the marketplace functions. For states that do not establish a Marketplace, CMS develops and implements one on their behalf, known as a Federally-Facilitated Marketplace (FFM). Other states may have SBM-FPs, which operate similarly to regular SBMs, except that they rely on the federal Healthcare.gov website for eligibility and enrollment functions. Consumers in FFM and SBM-FP states apply and enroll for coverage through Healthcare.gov, while consumers in SBM states apply and enroll for coverage through marketplace websites implemented and maintained by states. Marketplaces serve as a one-stop shop where individuals get information about their options, and submit a single, streamlined application for enrollment in a qualified health plan (QHP), and for advance payments of the premium tax credit (APTC), cost-sharing reductions (CSR), Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP), where applicable, which are collectively known as insurance affordability programs. Initial open enrollment began on October 1, 2013 and after seven open enrollment seasons, total enrollment has reached over 12 million individuals. Open Enrollment seasons now run each year from November 1st to December 15th.

CCIIO’s Marketplace Plan Management Group (MPMG) has promulgated regulations for the establishment and operation of Marketplaces in the District of Columbia, and States, as well as for the various programs associated with the Marketplaces. CMS recognizes the long-standing role that agents and brokers have played in connecting individuals and small businesses with health insurance products. Both section 1312(e) of the ACA and 45 CFR §155.220 permit States to allow agents and brokers to enroll individuals, employers, and employees in qualified health plans (QHP), including through the Marketplace; and assist individuals in applying for advance payments of the premium tax credit and cost-sharing reductions. The FFM leverages the market presence of agents and brokers to bring both individuals and small businesses to QHPs offered through the Marketplace. As of January 2019, licensed agents and brokers were responsible for an average of 44% of all FFM enrollments.

Requirements related to the participation of agents and brokers in Marketplace enrollment activities are described at 45 C.F.R. 155.220. Specifically, agents/brokers may assist consumers through the followings pathways to obtain coverage through Marketplaces:

· Marketplace Pathway for Individuals: Using HealthCare.gov, agents and brokers are able to help individuals complete the application process, enroll in a QHP, and apply for advance payment of premium tax credits and cost-sharing reductions for QHPs.

· Direct Enrollment/Enhanced Direct Enrollment (DE/EDE) Pathway for Individuals: The FFM collaborates with web brokers and insurance companies to reach consumers, allow those individuals to receive an eligibility determination through the FFM, and help them compare and select a QHP on the web broker or insurance company website.

· Small Business Health Options Program (SHOP) Marketplace for Employers and Employees: Agents and brokers serve as a key distribution channel for SHOP in the FFM, helping employers understand and participate in SHOP and assisting employees in enrolling in QHPs offered through SHOP.

As health reform implementation continues, consumers will need to understand new programs, avail themselves of new protections, and navigate the system to find the most affordable, high quality coverage that meets their needs. Marketplace agents and brokers are intended to assist consumers in those areas.

All agents and brokers are required to complete training and registration with the FFMs for the current plan year, prior to interacting with consumers or employers. Registration renewal training and testing is also required for agents and brokers. Training and registration is currently offered through CMS’s Marketplace Learning Management System (MLMS) for FFM agents and brokers, and through CMS-approved vendors. The contractor will support CCIIO’s evolving needs related to training, registration, and related data needs for agents and brokers.

B. Required Knowledge and Experience

At a minimum, the following knowledge and experience are required:

· Thorough understanding of the Affordable Care Act as well as related regulations and sub-regulatory guidance.

· Thorough understanding of HIPAA requirements, PHI rules and regulations, Marketplace privacy and security requirements.

· Understanding of the function of and experience providing services to agents and brokers.

· Prior experience supporting IT systems, which includes assistance with IT build, technical improvements, change requests, and security monitoring. (Preferred but not required experience working with CMS IT systems).

· IT support system experience. (Preferred but not required experience related to FFM IT).

· Experience providing technical assistance (email/phone).

· Experience operating help desks serving a minimum customer base of 70,000.

· Experience using incident management systems to track and manage high volume of help desk inquiries.

· Experience developing and providing web-based training.

· Stakeholder outreach experience.

· Experience providing data analytics support.

· Experience providing oversight/compliance support services, including monitoring and enforcement of user activity on IT systems, tracking incidents, preparation and distribution of non-compliance notices.

· Prior experience in responding quickly to ad hoc requests that require immediate attention, in many instances less than 24-48 hours for turnaround.

· Prior experience working collaboratively with multiple entities, including Federal agencies, States, and other contractors, to accomplish program objectives on a nationwide scale.

· Prior experience in effective project management that includes a proven track record of keeping to a schedule and managing multiple tasks.

C. Capability Statement Requirements

CMS requests that the respondent specifically address the requirements listed below. Respondents should provide enough information for CMS to make an informed determination of their capability to perform each capability identified below. It is acceptable for certified small business potential offerors to concentrate on a subset of the capabilities identified below. A certified small business potential offerors as prime contractors should describe how the respondent will provide at least 60% of the cost of labor (including indirect charges) required to perform the services. Rough workload estimates for each capability have been provided below for the purpose of estimating the proportion of labor covered by the prime contractor (assume and an estimated 5-15% of the total contract work will be project management and ad hoc tasking). In the event of conflict between FAR clause 52.219-14 and 15 U.S.C. § 657s, for purposes of the limitations on subcontracting, CMS will follow 15 U.S.C. § 657s. Also, please provide a list of contract numbers that your organization has had (if applicable) and your role on the contract (prime contractor or subcontractor). If you were a subcontractor on a particular contract, please clarify the work that you did on that contract.

Teaming Arrangements

Firms seeking to respond to this notice as a team or to rely on subcontractors to perform any portion of the work must include the above-requested information and certifications for each entity on the proposed team or each proposed subcontractor. Responses must clearly indicate the nature of the teaming arrangement.

The contractor and any subcontractors must not have any relationships or arrangements through business operations or its employees that could be considered as possibly lessening the company’s objectivity concerning any aspect of the proposed tasks. If such relationships or arrangements exist, contractors or subcontractors shall be required, during the procurement process (if one occurs), to identify potential conflicts of interest and discuss how the conflicts will be addressed and mitigated.

Please describe your capabilities and detailed experience performing similar activities as those described below. Your responses should demonstrate your understanding of the requirements to:

1. Provide a multi-tiered help desk to receive and respond to up to 15,000 agent and broker e-mails annually. The agent and broker e-mail help desk is an existing resource for assisters to submit Marketplace agent/broker related questions to CMS. (estimated 15% of total contract work). Support shall be provided by the contractor as follows:

a. Conducting end-to-end issue tracking using an incident management system.

b. Managing inquiries across multiple escalation pathways and support resolution of inquiries.

c. Maintaining a help desk knowledge base, including over 300 scripts that require annual review.

d. Providing outbound messaging and/or call back support to those who require additional technical assistance.

e. Supporting manual identity verification requests.

2. Lead ongoing communication, education, technical assistance, and outreach efforts to assist and encourage participation of agents and brokers in the Marketplaces (estimated 15% of total contract work), including:

a. Developing and supporting live webinars and computer-based trainings, including creating slide decks, drafting speaker’s notes, reviewing and drafting post-webinar responses to participant questions, and facilitating posting of materials to a website.

b. Redesigning the Agents and Brokers resource web page, conducting quarterly audits of website content, and supporting ad hoc updates.

c. Drafting and disseminating promotional messaging (e.g., tweets, email blasts, web page posts, and newsletters). Emails may be sent to as many as 150,000 agents/brokers, and number of emails sent per year may be up to 14.5 million.

d. Creating videos, podcasts, and trainings.

e. Providing content development support and logistics support for an annual full-day Summit.

f. Managing clearance/approval process of all communication materials.

3. Develop and maintain a formal training curriculum and certification program (estimated 10-15% of total contract work), including:

a. Providing annual updates to the training, agreements, and exam content to reflect program and policy changes.

b. Preparing test and training content for entry into the training software system.

c. Maintaining live training content and implementing ad hoc revisions or corrections to the training and exam content, as needed.

d. Providing mobile responsive training (i.e. tablet, smart phone).

4. Manage a vendor model for training and registration of agents and brokers. (An agent or broker may complete training through CMS’s MLMS or through a CMS-approved vendor. Training through vendor(s) is offered as an alternative for agents and brokers seeking CEU credits. Vendors who wish to offer training must apply and be approved by CMS). Support activities (estimated 3-5% of total contract work) include:

a. Developing and maintaining the vendor training project schedule.

b. Updating the application and associated guidance documents for vendors (e.g., FAQs, webinar).

c. Updating an Application Review Tool and scoring criteria, conducting intake and reviewing applications from prospective vendors. Preparing a summary of vendor applicants recommended for conditional approval or denial.

d. Updating content submission guidance, conducting preliminary reviews of vendor’s training content, and facilitating reviews by SMEs as needed for supplemental training content developed by the vendors.

e. Conducting onboarding and testing activities to promote an on-time go-live for conditionally approved vendors.

f. Performing oversight of conditionally approved vendors’ marketing activities and continuing education unit credits and, once approved, performing oversight of marketing and operational activities.

g. Tracking vendor inquiries and draft responses as appropriate.

5. Support the registration process for agents and brokers seeking to participate in the FFMs by maintaining data on training and registration status for over fifty thousand registered users (estimated 15% of total contract work), including:

a. Maintaining the user registry.

b. Compiling user registration completion and termination lists and posting on a website.

c. Removing suspended and terminated users from the registration completion list.

d. Developing registration reporting metrics.

e. Assisting with business requirements, architecture, and testing of registration associated systems.

f. Assisting with technical inquiries that come through the help desk.

g. Identifying, prioritizing, and triaging system issues, when appropriate, and drafting change requests.

h. Supporting oversight and monitoring of enrollment pathway systems.

6. Conduct analytics of agent/broker program operations, web-based data metrics, and Marketplace data to develop program metrics, strategy, and business requirements for new capabilities. Provide regular data analytics reports to brief program management and stakeholders on highlighted activity and metrics (estimated 5% of total contract work).

7. Provide general oversight support services in the monitoring and enforcement of user activities on a network or web service (estimated 3-5% of total contract work), including:

a. Developing and documenting processes to identify and respond to confirmed or suspected incidents of noncompliance.

b. Assisting with documenting, archiving, and tracking new incidents and existing cases of noncompliance, including timelines associated with terminations and suspensions of users.

c. Assisting with preparation of information or notifications to support referrals and response actions.

d. Supporting distribution of formal notices and other outgoing communications; monitoring and triaging incoming communications.

8. Research and draft SOPs and other operational guidance primarily in the form of workflows, manuals, and other operational guidance (estimated 1-2% of total contract work), including:

a. Finalizing SOPs and other guidance/manuals based on program feedback, suggestions, and recommendations.

b. Providing quarterly updates to existing SOPs to reflect any policy updates or new/revised program policies.

c. Maintaining an SOP Index, which includes all current SOPs and provides the identification number, date last updated, title, file name, status, and task number.

9. Implement and support a consumer assistance web-based solution that allows consumers to request and receive enrollment help from an available Marketplace registered agent or broker within minutes of the request (estimated 15-20% of total contract work). Support shall be provided by the contractor as follows:

a. Performing service and producing a technical solution and associated processes that provide all requisite solution features that can be configured as defined by CMS, and fully hosted, operated, and maintained outside of CMS firewalls.

b. At minimum, solution must:

- Have a configuration that will assign consumer requests to agents and brokers based on factors such as preferred language, proximity to consumer, agent or broker availability, and other factors to be determined by Contractor and CMS.

- Support a maximum of 75,000 concurrent consumers, 10,000 concurrent agents and brokers, and five concurrent administrative users.

- Be fully compatible with CMS information security and privacy requirements.

c. Supporting user acceptance testing and conducting system performance testing.

d. Conducting training and technical support for administrative users and all interested agents and brokers.

10. Staffing for cyclical or seasonal workloads that require a level of year-round employees and surge staffing for short periods of time.

11. Maintain strict data confidentiality standards including all requirements for use

D. Instructions for Submitting Responses to CMS

The following specific information is requested: (a) company descriptive literature; (b) specific related corporate experience; (c) experience with the type of capability expectations mentioned above; (d) references, to include points of contact, email addresses, and phone numbers; and (e) Business information outlined below.

a. DUNS

b. Company Name

c. Company Address

d. Validation of small business status under NAICS Code 541611 - (size standard of $15 million)

e. Current GSA Schedules appropriate to this Sources Sought Notice

Please limit your documentation to the following Page Size, Font Type and Size, Spacing and Page Numbering. Responses shall be submitted using a Microsoft Word document with page size 8.5 by 11 inches. Font type shall be Times New Roman, size 10-12 using standard tabs and indent software features with no less than single spacing between lines. Responses are limited to a total of no more than ten (10) pages for the entire capability statement. Cover Page is not included in the total page count.

All transmitted information marked proprietary shall be treated as such. Therefore, businesses should identify any proprietary information in their responses. Proprietary materials will neither be distributed, nor discussed with, any other organization. Information submitted in response to this will be used at the discretion of the Government. Further, the information submitted will remain confidential insofar as permitted by law, including the Freedom of Information and Privacy Acts.

Respondents should be aware that this SSN is for marketing purposes only and any responses thereto, or lack thereof, will not constitute a commitment by CMS to treat any potential offeror more or less favorably in an anticipated forthcoming solicitation and/or ultimate award. Please be advised that CMS will not respond directly to organizations submitting information in response to this SSN.

All capability statements can be submitted via e-mail to Hind.Kanine@cms.hhs.gov. Responses must be submitted no later than close of business, January 13, 2020.