JA LSJ EAP OP addition Redacted.pdf

the Final Exchange regulations at 45 CFR 155.205(d) and (e). CMS labeled its Marketplace in-person assistance program the “Enrollment Assistance Program” (EAP). A version of the EAP existed under contract GS-10F-0579N/HHSM-500-2013-00295G through August 29, 2017. The program ended at the conclusion of Option Period 3. The final option period was not exercised due to changes in budgetary priorities, as funding was no longer allocated for this program.

Cognosante’s successful performance for the 4 years they served as an EAP contractor made them uniquely situated to provide consumers in CMS-designated Marketplace locations in-person enrollment assistance services. CMS believes these services are necessary to help facilitate eligible consumers’ enrollment into Marketplace plans and transition from the expiring expanded health coverage eligibility that resulted from the declaration of the Covid-19 pandemic PHE.

The PHE related to the COVID-19 pandemic was issued on January 31, 2020, by Secretary Alex M. Azar II of the U.S Dept of Health and Human Services using the authority vested in him in section 319 of the Public Health Service Act. On March 18, 2020, the Families First Coronavirus Response Act (FFCRA) was signed into law and one of its many provisions stated that the PHE period expires after 90 days, unless further extended by the Secretary. The Secretary extended the PHE every 90 days, with the last extension occurring on January 16, 2023, and the PHE expired on May 11, 2023. The FFCRA also contained several provisions related to Medicaid, with two of them being pertinent for the creation of this contract. The FFCRA provides states with a temporary 6.2% payment increase in Federal Medical Assistance Percentage (FMAP) funding that expires a quarter after the PHE ends. The FMAP payment increase led to historically large increases of temporarily eligible Medicaid and Children’s’ Health Insurance Programs (CHIP) beneficiaries. It also prohibited increased FMAP funded states from disenrolling beneficiaries during the PHE except at the beneficiary’s own request. This prohibition on disenrollment is referred to as the “continuous coverage requirement.” However, when the PHE expired both the FMAP payment increases, and the resulting continuous coverage requirement expired shortly soon after. This also effectively meant that the roughly 22 million additional Medicaid/CHIP PHE-created beneficiaries did not have to reapply for or have their eligibility status annually determined by the states to maintain their coverage. Federal law generally states that eligibility of Medicaid beneficiaries whose financial eligibility is determined using MAGI-based income must be renewed (applied for or automatically determined by some states based on their pertinent financial databases like SNAP) once every 12 months. CMS observed that the expiration of the PHE and the resulting sunsetting of the increased FMAP state funding resulted in millions of current Medicaid and CHIP beneficiaries losing their eligibility and healthcare coverage and that most would have no prior experience or knowledge of the federal requirement that this coverage must be annually determined eligible in order to maintain their coverage. Since Medicaid is a joint federal and state program that gives states significant control, CMS observed that the States’ approach to notifying potentially affected beneficiaries varied widely.

CMS also observed that many States in Federal Health Insurance Marketplaces are not able to sufficiently process the eligibility renewals of the historically large increases of temporarily eligible Medicaid and Children’s’ Health Insurance Programs (CHIP) beneficiaries to meet its initial 12-month return to normal eligibility and enrollment operation’s March 31, 2024, deadline. As a result, CMS extended the deadline to July 31, 2024, and then on March 28, 2024, announced a further extension to November 30, 2024.

As a result, CMS identified that a new iteration of the EAP program is an efficient and effective means to quickly facilitate potentially affected consumers’ FFM enrollment support during PHE unwinding efforts.

Specifically, CMS utilizes the EAP program to support existing FFM outreach and enrollment efforts and provide additional in-person assistance. CMS believes that the EAP program’s additional support, outreach, education, and in-person assistance to consumers during the wind-down period helps further reduce erroneous enrollment terminations and gaps in coverage. However, EAP operations were delayed a year because the PHE did not expire a year longer than CMS initially thought it would when it re-created the EAP program. This led to many programmatic adjustments, including tying the end of the program’s operation to dovetail with CMS’ July 2024 Medicaid/CHIP return to normal eligibility and enrollment operation’s deadline.

CMS’ recent November 30, 2024, extension announcement means the EAP program will expire well before the new deadline.

In late 2022, CMS transitioned the ability for consumers to find local Marketplace enrollment assistance from its Healthcare.gov Find Local Help (FLH) platform to the Customer Support Group’s (CSG) Salesforce Customer Relationship Management (CRM) automated instance. This coincided with the development and deployment of a new Salesforce module for an automated assister community tool called the Marketplace Assister Community (MAC) module. This module supports in-person assister consumer efforts (including the EAP) with the Public Health Emergency (PHE) unwinding of Medicaid eligibility expansion by enabling assisters to leverage local health coverage enrollment data provided by the States to directly contact affected beneficiaries and automate enrollment assistance reporting to CMS. Ther current total number of unique households (cases) in the MAC exceeds 1.8 million, with more than 790,000 of those cases still in a new (unworked) or in progress status. CMS believes there will be an estimated backlog of 1.2 million MAC cases because of its March 28, 2024, announcement extending the temporary special enrollment period (Unwinding SEP) for people who are no longer eligible for Medicaid or CHIP to transition to Marketplace coverage in states using HealthCare.gov. CMS believes additional time for the EAP task order is necessary for the continued processing of MAC backlog, current, and future cases. This is especially critical because Navigators will shift their focus and expertise away from the MAC backlog cases that requires many attempts to directly contact affected beneficiaries and focus on their traditional facilitation of Marketplace enrollments and community outreach events during the annual Marketplace Open Enrollment this fall, potentially leaving only EAP MAC caseload support. CMS also believes over a million households will potentially become future MAC cases because of losing coverage from the annual Medicaid/CHIP redeterminations in FFM States at various times throughout the year as part of the return to normal eligibility and enrollment operations when the Unwinding SEP ends (also known as the Medicaid churn). CMS believes it is critical for 2 additional Option Periods for the EAP to continue to work the current and future MAC backlog cases and then shift their efforts to direct outreach of consumers experiencing lost coverage because of the annual Medicaid/CHIP redeterminations, while also providing additional “surge” enrollment support during Open Enrollment when the Navigators are not able to meet the demand.

3. Authority:

ORDER AGAINST FSS: Authority of the Multiple Award Schedule Program, Title III of the Federal Property and Administrative Services Act of 1949 (41 U.S.C. 251, et seq.); Title 40 U.S.C. 501, Services for Executive Agencies; and Section 803 of the National Defense Authorization Act of 2002 (PL 107-107) and implemented by FAR 8.405-6. Mark the applicable exception and for each discuss how the cited authority applies in accordance with FAR 8.405-6(c)(2)(iv).

An urgent and compelling need exists, and following the procedures would result in unacceptable delays (FAR 8.405-6(a)(1)(i)(A));

On March 18, 2020, the Families First Coronavirus Response Act (FFCRA) was passed and provided for the dramatic increase of Medicaid and CHIP beneficiaries with increased Federal Medical Assistance Percentage (FMAP) funding for states’ Medicaid and CHIP funding. However, Congress conditioned states’ continuous receipt of the increased FMAP funding increase on the state’s providing continuous coverage of these benefits for the duration of the PHE. Congress conditioned states’ continuous receipt of the increased FMAP funding increase on the state’s providing continuous coverage of these benefits for the duration of the PHE.

On January 16, 2022, HHS Secretary Xavier Becerra renewed the declaration of an ongoing Public Health Emergency (PHE). and provided for the dramatic increase of Medicaid and CHIP beneficiaries with increased Federal Medical Assistance Percentage (FMAP) funding for states’ Medicaid and CHIP funding.

At the time of award of this task order in 2022, the PHE was set to expire on April 16, 2022, and CMS expected millions of Medicaid and CHIP beneficiaries tolose their health care coverage in a very short amount of time when the PHE and FMAP state funding increase expired. This created an urgent and compelling need to allow CMS to appropriately prepare for this surge in required support to assist enrollment support for CMS identified Marketplace locations. The additional requested option periods are necessary as this contractor must continue to support CMS to effectuate and clear the current significant backlog that has resulted from the unwinding of Medicaid. It has been determined that with this unwinding effort, there is larger than anticipated amount of Medicaid enrollees who are routinely dropped by the States with vastly varying notice from the States. These beneficiaries will need to be contacted and potentially enrolled into a Marketplace plan, even when the existing backlog is resolved. CMS believes the MAC tool it recently created is an efficient and consistent method to ensure that all potentially affected beneficiaries are contacted in a consistent federal approach. However, there is no staff currently in place to make these direct consumer contacts when the EAP program expires. The Navigators, under this task order, possess the unique skill set to best reach these beneficiaries through their traditional community outreach approach, On February 6, 2023, President Biden announced to Congress that Department of Health and Human Services (HHS) Secretary Xavier Becerra would renew the federal public health emergency (PHE) one final time as of February 11, 2023, with an expiration date of May 11, 2023. This final extension was the thirteenth of such extensions and therefore the expected date for the anticipated loss in health coverage for Medicaid enrollees that will require Marketplace plan options has been fluid.

However, the “Unwinding SEP” now extended until November 30, 2024, there is a backlog of over a million Medicaid and CHIP beneficiaries that lost their health care coverage that need direct consumer outreach to ensure their opportunity to enroll into Marketplace plans. Navigators will no longer be able to provide this support and this creates an urgent and compelling need for a Limited Source Justification to allow CMS to quickly surge contracted in-person enrollment support and direct consumer outreach in Marketplace locations CMS determines. The anticipated resolution of this backlog is early 2027. Recompeting this work before the resolution of this backlog will potentially jeopardize the efficient resolution of the Medicaid backlog and the identification and aid to other beneficiaries that will lose coverage. The addition of two option periods and 3 month transition period will allow sufficient time for the resolution of the backlog and the new contract will focus on contacting and enrollment scheduling for the regular Medicaid enrollees who lose coverage and need a Marketplace plan option.

4. Market Research:

Prior to award of this task order to Cognosante in FY22, CMS considered previous Marketplace contracts/task orders with similar requirements to identify a contractor for this effort. In 2013, CMS awarded two (2) task orders from solicitation RFQ 130122 to Cognosante, LLC and Systems Research and Applications Corporation (SRA) for the previous version of its EAP program to provide in-person enrollment services in support of the ACA. Cognosante and SRA performed under their respective task orders until 2017. The contractors had unique technical approaches and operated in different geographic locations. Both contractors performed well under very challenging and rapidly evolving circumstances. CMS believes that this prior experience is invaluable to quickly implement another version of the EAP contract. Of the two (2) contractors who previously performed similar services, the in-person assister hiring model was the main difference between SRA and Cognosante. SRA used hiring agencies to hire and employ its assisters while Cognosante directly hired their EAP assisters. CMS believed its need for rapid in-person enrollment services during the wind-down period following the end of the PHE will require Cognosante’s prior experience directly employing their EAP assisters instead of SRA’s previous delegated approach. Therefore, the task order was awarded to Cognosante as ot was identified as the only federal contractor with the experience to continue to rapidly implement the EAP contract.

5. Actions to Increase Competition:

If there is a need to continue this work after the period of performance ends, this work will be competed. At the completion of the period of performance, it is anticipated that the need to assist consumers transitioning between different healthcare coverages resulting from the end “Unwinding SEP” will no longer be necessary. As a result, any subsequent procurements will be competitive and can be conducted without risk to CMS’ compliance with the Final Exchange regulations at 45 CFR 155.205(d) and (e).

6. Any other facts supporting the justification:

N/A

3. CMS Competition Advocate (CA) Approval

I hereby confirm the circumstances described above apply and approve the Limited Source Justification.

Donald Knode - CA / Date

4. Head of Contracting Activity (HCA) Approval

I hereby confirm the circumstances described above apply and approve the Limited Source Justification.

Derrick Heard - HCA / Date

5. Office of Small and Disadvantaged Business Utilization

N/A – contract action is < $75 million Name / Date

6. OGC Legal Review

N/A – contract action is < $75 million Name / Date

7. HHS Competition Advocate Approval

N/A – contract action is < $75 million Name / Date

8. Senior Procurement Executive (SPE) Approval

Based on the foregoing justification, I hereby approve the procurement of (state supplies/services being procured) on an other than full and open competition basis pursuant to the authority of (state the full statutory authority and FAR cite and title, consistent with paragraph 4, e.g. 41 U.S.C. 253(c)(1)), as implemented by FAR 6.302-1), subject to the availability of funds, and provided that the services herein described have otherwise been authorized for acquisition.

Digitally signed by Donald Knode -S Date: 2024.05.15 11:32:56 -04'00'

Douglas D.

Bergevin -S

Digitally signed by Douglas D.

Bergevin -S Date: 2024.05.16 18:12:24 -04'00'

N/A – contract action is < $75 million Name / Date