Sources_Sought_Notice_190737.docx

Sources Sought Notice 190737 Insurance Market Reform Enforcement

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 of small businesses on the GSA Professional Services Schedule (e.g., 8(a), service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business, and women-owned small business) that have the capability to support CMS with examining Issuers (i.e health insurance issuers) and non-federal governmental plans to assess compliance with the Market reform and other provisions under title XXVII of the PHSA, including provisions added by Title I of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Newborns’ and Mothers’ Health Protection Act of 1996 (NMHPA), the Women’s Health and Cancer Rights Act of 1998 (WHCRA), the Genetic Information Nondiscrimination Act of 2008 (GINA), Michelle’s Law the Paul Wellstone and Pete Domenici Mental Health Parity and Addition Equity Act of 2008 (MHPAEA) as well as any ancillary statues, regulations and sub-regulatory guidance related to the laws listed here. This work includes supporting CMS with reviewing insurance policies and contracts, conducting Market Conduct examinations and investigations, and performing ongoing research and trend analysis of changing industry, states and federal regulatory guidelines.

A. Background

The Centers for Medicare & Medicaid Services (CMS) is responsible for providing national leadership in setting and enforcing standards for health insurance that promote fair and reasonable practices to ensure affordable, quality health coverage is available to all Americans. CMS also provides consumers with comprehensive information on coverage options currently available so they may make informed choices on the best health insurance for their family.

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA), as amended by the Health Care and Education Reconciliation Act of 2010 (HCA) (the ACA and HCA are referred to herein together as the “Act”). The Act, in part, amended the Public Health Service Act (PHSA) by adding the Market Reforms, which became effective on September 23, 2010. CMS started implementing the Market Reforms on September 24, 2010. The goal under this task order is for the Contractor to conduct agreed-upon activities relating to ongoing policy form review and market conduct examinations of licensed health insurance Issuers (as identified by CMS) offering fully insured health benefit plans in the individual, small group, and large group markets (collectively, the Issuers); plans or policies seeking recognition as minimum essential coverage (hereafter referred to as MEC); and non-Federal governmental plans (as identified by CMS), documenting the level of compliance with the Market Reforms and any other provisions under title XXVII of the PHSA as may be identified by CMS. Another goal under this task order is for the Contractor to perform ongoing monitoring of changing industry, states and federal regulatory guidelines for CMS.

CMS is responsible for directly enforcing provisions under title XXVII of the PHSA, with respect to Issuers, when it has been notified by a state that the state lacks authority to enforce or is otherwise not enforcing such federal requirements, or when it has been determined that the state is not substantially enforcing those requirements. In addition, CMS has primary enforcement authority over non-federal governmental plans and the authority to recognize plans or policies as MEC.

B. Required Knowledge and Experience

Offerors shall demonstrate in their quote that the work performed under this contract will not present any potential or actual conflict of interest. Offerors also performing services for the insurance industry and/or any of its trade associations must be able to perform examinations without the appearance of or actual/potential conflicts of interest.

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

· Title XXVII of the PHSA, as well as other federal and state laws, regulations and guidance pertaining to private health insurance necessary to perform this work

· How to conduct plan document reviews

· Market conduct examination procedures consistent with the guidelines set by the NAIC Market Regulation Handbook

· Investigation procedures

· How to perform ongoing research on industry, and state and federal regulatory requirements, such as statutes, regulations, and bulletins

· TeamMate™ system and ability to demonstrate use of the system

· System for Electronic Rate and Form Filing (SERFF™) for form filing submissions

· Performing multiple form reviews, market conduct examinations, and investigations under tight timeframes

· Federal IT security procedures and systems and ability to observe all federal regulations concerning the integrity and security of all paper and electronic information In addition, the Offerors must:

· Have the ability to accept assignments on short notice as well as a track record of managing multiple project deadlines at one time and completing deliverables on-time

· Provide technical assistance and training to internal and external stakeholders

· Have the ability to produce progress and summary reports with analysis of trends

· Have the ability to prepare agendas, facilitate status calls, and record minutes

· Track record of effective project management

· Track record of managing and staying within budgets

· Track record of quality assurance for deliverables

· Track record of effective communication and customer relations

With regards to staffing, the Offeror must:

· Employ examiners and analysts with appropriate insurance regulatory education, experience, and certifications.

· Employ a prescription drug benefit specialist with appropriate education and experience, who understands the fundamentals of pharmacoeconomics and balancing clinical, regulatory, pharmaceutical industry and consumer access issuers to formulary system development.

· Employ or have access to an actuary with appropriate education and experience in analyzing health insurance rates and premium changes, and demonstrate knowledge of the requirements for rate filings with the state departments of insurance, and rate templates for On-Marketplace plan certification.

· Employ or have access to a statistician with appropriate education and experience, who understands the fundamentals of health insurance including topics such as policy forms, underwriting, terminations, rescissions and denials, and claims data.

· Employ or have access to a clinical medical doctor with appropriate education and experience.

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 the work as identified below. Please remember that the potential offeror or prime contractor must be able to perform at least 50% of the labor associated with this effort. 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.

Please describe your capabilities and detailed experience performing similar activities as those described below:

· Extensive knowledge title XXVII of the PHSA, as well as other federal and state laws, regulations and guidance pertaining to private health insurance necessary to perform this work

· Prior experience and knowledge of how to conduct plan document reviews, market conduct examination procedures consistent with the guidelines set by the NAIC Market Regulation Handbook, and investigations

· Prior experience and knowledge of how to perform ongoing research on industry, and state and federal regulatory guidelines.

· Extensive knowledge of TeamMate™ system and ability to demonstrate use of the system

· Prior experience and knowledge of System for Electronic Rate and Form Filing (SERFF™) for form filing submissions

· Ability to accept assignments on short notice as well as a track record of managing multiple project deadlines at one time and completing deliverables on-time

· Prior experience performing multiple form reviews, market conduct examinations, and investigations under tight timeframes

· Provide technical assistance and training to internal and external stakeholders

· Ability to produce progress and summary reports with analysis of trends

· Ability to prepare agendas, facilitate status calls, and record minutes

· Track record of effective project management

· Track record of managing and staying within budgets

· Track record of quality assurance for deliverables

· Track record of effective communication and customer relations

· Knowledge of federal IT security procedures and systems and ability to observe all federal regulations concerning the integrity and security of all paper and electronic information

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 Mailing Address and Website 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 via email using a Microsoft Word or Adobe PDF 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 including any appendices or supplemental information.

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 Malissa.Shin@cms.hhs.gov and Geane.Chatman@cms.hhs.gov. Responses must be submitted no later than close of business, by 11:00am January 31, 2019.