SSN - 240197 - MATS - FINAL.pdf

Sources Sought Notice (SSN) 240197 Marketplace Assister Technical Support

THIS IS NOT A FORMAL REQUEST FOR QUOTE (RFQ) AND DOES NOT

COMMIT THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

TO AWARD A CONTRACT NOW OR IN THE FUTURE

Purpose of Notice

This is a SOURCES SOUGHT NOTICE (SSN) issued for the purpose of planning and performing market research. The purpose of this Notice is to determine the availability of small businesses (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) on the General Services Administration (GSA) Multiple Award Schedule (MAS) that have the capability to support CMS in all activities associated with providing technical support services that will enhance assisters’ knowledge and skills to facilitate enrollment in insurance coverage through the Affordable Care Act (ACA).

The information gathered from this market research will help the Government determine an appropriate acquisition strategy, including whether a small business set-aside is possible. Interested contractors must submit a capability statement to demonstrate their ability to perform the requirements stated below. No reimbursement will be made for any costs associated with providing information in response to this announcement and any follow-up information requests. Respondents will not be notified of the results of the capability assessment. All information submitted in response to this announcement must arrive on or before the closing date. CMS reserves the right to contact respondents as necessary.

Background

On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act (P.L. 111-148). On March 30, 2010, the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) was signed into law. The two laws are collectively referred to as the Affordable Care Act. The ACA creates new competitive private health insurance markets, or Federally-Facilitated Marketplaces – FFMs that have given millions of Americans and small businesses access to affordable coverage.

Marketplaces help individuals and small employers shop for, select, and enroll in high quality, private health plans that fit their needs at competitive prices. By providing a place for one-stop shopping, Marketplaces make purchasing health insurance easier and put greater control and more choice in the hands of individuals in the Marketplaces.

As with the ACA, Congress also recognized the need for stronger consumer and stakeholder protections related to pricing and billing in health care and passed Title I (No Surprises Act) and Title II (Transparency) of Division BB of the Consolidated Appropriations Act, 2021, collectively referred to throughout as the No Surprises Act

(NSA). The NSA was signed into law on December 27, 2020, and established new protections for consumers related to price transparency and surprise billing in health care.

For example, plans and issuers are required to provide an Advance Explanation of Benefits prior to scheduled services to include, among other things, a good-faith estimate of the cost of the service. They must also offer price comparison information to allow enrollees to compare the cost sharing for items and services furnished by any participating provider. And, it introduces new requirements on providers to ask about the individual’s insurance coverage status and provide a good-faith estimate of the expected charges when an individual schedules an item or service. As a result, CMS is developing a patient-provider dispute resolution (PPDR) process for uninsured individuals who are billed substantially more than estimated charges.

The NSA also takes significant steps to end surprise billing by building on existing provisions that require group health plans and issuers of group and individual health insurance coverage to cover emergency services without prior authorization, and at the same cost sharing for out-of-network services that applies to in-network services. The legislation also sets forth methodologies for determining the out-of-network rate that plans and issuers must pay providers, including air ambulance providers, for claims subject to surprise billing protections. If the plan or issuer and provider cannot agree on an amount during a 30-day negotiation period, the parties may choose to enter an independent dispute resolution (IDR) process.

Consumers applying for coverage through the Marketplace are able to receive application assistance from in-person assisters. In-person assisters help consumers obtain eligibility determinations and help them through plan selection, thus increasing the number of consumers with health insurance coverage. One of the primary functions of in-person assisters is to facilitate enrollment into healthcare coverage by obtaining a determination for advanced payment of premium tax credit, cost-sharing reductions, Medicaid, CHIP, and the Basic Health Program from the Marketplace. In order to facilitate these processes, in-person assisters require training that provides a basic set of knowledge of health insurance and various forms of coverage as well as an introduction into the mechanics of obtaining Marketplace Eligibility and Enrollment determinations.

Additionally, assisters need an array of resources to rely upon to ensure that they are adequately prepared to support consumers as quickly as possible.

Enrollment assistance helps ensure that as many consumers as possible have the understanding needed to apply and enroll in health coverage. For the purposes of this SSN, “in-person assisters” may include Navigators, Certified Application Counselors (CACs), and Agents and Brokers. This work would focus on in-person assisters in FFMs and the CMS IT systems that support them and the new PPDR and IDR processes.

Much of the in-person assister support content is developed by this task order then automated, stored and made accessible for them on the MATS Salesforce instance. The MATS Salesforce instance provides automated Certified Application Counselor (CAC) application processing, inquiry response and tracking, assister WBT ID generation and storage, and supplemental interactive Micro learning trainings. This work will also support in-person assister help desk support, the development and provision of assister continuing education programs, and the maintenance of assister email inbox operations.

The MATS Salesforce instance is also currently under development to include a module for an automated assister community tool called the Marketplace Assister Community (MAC) module. This module supports in-person assister consumer efforts with the Public Health Emergency (PHE) unwinding of Medicaid eligibility expansion by enabling assisters to leverage enrollment data and automate enrollment assistance reporting to

CMS.

Another essential support service provided to FFM assisters by this task order is the annual delivery of an estimated twenty hours of interactive, mobile-compatible, Web Based Training (WBT) curricula to another CCIIO IT system called the Marketplace Learning Management System (MLMS). The MLMS system is hosted and made securely and publicly available on CMS’ enterprise-wide Identity Management (IDM) portal.

MLMS verifies the in-person assister IDs that are generated and stored on the MATS Salesforce system and connected with MLMS though an Application Programming Interface (API). The MATS Salesforce instance is one of many CCIIO Salesforce instances that must maintain its compliance with the CCIIO-wide Customer Relationship Management System (CCRMS) Salesforce system security protocol boundary. In order to maximize efficiencies for CCIIO, this task order also enhances and maintains the Marketplace Plan Management Group’s (MPMG) System for Plan and Issuer Data and Reporting (SPIDR) Salesforce instance and the Marketplace Eligibility & Enrollment Group (MEEG) Salesforce Community Portal instance in compliance with CCIIO’s CCRMS Salesforce system security protocol boundary. Along with the MATS, SPIDR, and MEEG Community Salesforce instances, this work will also continue to support development, system integration, implementation and maintenance across multiple CMS IT systems to create stronger consumer NSA protections related to health care pricing and billing in the newly created IDR and PPDR processes.

The No Surprises Act directed CCIIO to implement a federal Independent Dispute Resolution (IDR) process to protect against surprise medical bills. This task order will work with CMS and other stakeholders, including the Departments of the Treasury and Labor, to design, develop, and implement an automated federal independent dispute resolution (IDR) process; collect data on user fees from individuals who use the federal IDR process and pass that data to the CCIIO RARI Salesforce instance; certify IDR entities (IDREs), organizations charged with carrying out disputes; and collect quarterly data on group health plans or health insurance issuers offering group or individual health insurance coverage or types of such plans or coverage that have a pattern or practice of routine denial, low payment, or down-coding of claims, or otherwise abuse the 90-day period.

In conjunction with the IDR process, Congress passed a critical mandate for CCIIO to stand up a No Surprises Help Desk (NSHD) for consumers and providers to submit complaints to CMS called the Patient-Provider Dispute Resolution (PPDR) process. This task order will continue the development and maintenance of a complaints helpdesk platform to intake consumer, provider, and issuer complaints and information that includes an email-to-case inquiry resolution (IR) solution and APIs to CMS stakeholders for inquiry review and resolution; and the implementation of the NSHD with an inContact call center solution that connects to the MATS Salesforce instance, which serves as the Department of Health and Human Services (HHS) complaints system of record.

Requirements

The work would be to aid the Center for Consumer Information and Insurance Oversight (CCIIO) to provide ongoing technical assistance to the in-person assister community and Salesforce system IT development, system integration, and support across multiple CMS components and their IT systems, including the new IDR and Patient-Provider Dispute Resolution system development. At a minimum, the following knowledge and experience are required:

• Extensive knowledge and experience in the ACA and Marketplaces, commercial individual and small group health insurance markets, Medicaid, CHIP, other relevant insurance programs in States across the country.

• Extensive knowledge of best practices in outreach, education and enrollment, including hard to enroll or vulnerable populations. Comprehensive familiarity with the Affordable Care Act and the No Surprises Act as well as related regulations and sub-regulatory guidance relating to the FFM.

• Development of in-person technical support materials

• Development of interactive, mobile compatible WBT material

• Development of mobile compatible simulation based microlearning modules

Development and maintenance of centralized electronic email inbox operations

• Development and maintenance of electronic program application processing

• Development and maintenance of inquiry response and tracking automation

• Development and maintenance of secure, 508-compliant, custom Salesforce community portal designed with Salesforce Lightning web components for 10,000+ users under the CMS Salesforce Enterprise Integration Portal

• Integrate Salesforce assister community portal with multiple systems and vendors to receive intake, and process large volumes of data consisting of up to 250,000 records per intake using SOAP (Simple Object Access Protocol) and REST (Representational State Transfer) APIs application programming interface and Electronic File Transfers (EFT)

• Integrate the MAC Salesforce portal with data processing that involves running advanced custom algorithms that leverage geocoding to assign consumers losing health coverage to the nearest assister organization for direct outreach and enrollment assistance through the Marketplace

• Coordination of program management teams

• Implement and distribute standard operating procedures (SOPs) to appropriate parties

• Implement project management

• Develop operational improvement recommendations

Skills required of the contractor will include:

• Experience in developing, adapting or updating large, interactive, mobile compatible WBTs and securely and effectively transferring them to another CMS contractor

• Expertise or experience regarding healthcare laws, policies and regulations

• Expertise or experience with in-person assister activities and needs

• Expertise or experience developing SOPs

• Expertise or experience developing internal control plans

• Expertise or experience developing or updating multiple automated Salesforce applications simultaneously

• Expertise or experience developing or updating automated multiple Salesforce inquiry response systems simultaneously

Capability Statements

In response to this Notice, CMS is seeking capability statements. Capability statements are NOT quotes and do not address price/cost. Industry is merely asked to provide information, which may demonstrate that they have expertise and capacity to meet the requirements of this work as a prime contractor, with subcontractors, as they deem necessary.

No marketing literature should be submitted in response to this SSN. When responding to this SSN, contractors must demonstrate their experience in meeting and performing capabilities listed below. A mere statement that the contractor has a required capability is not sufficient.

For the purposes of responding to this notice, contractors should address their capability.

When answering the following questions, contractors must provide specific and detailed examples of work that was performed that demonstrate required capabilities and the attendant level of effort that was involved:

1. Do you have a thorough understanding of Health Insurance Portability and Accountability Act (HIPAA) requirements and rules and regulations related to Personally Identifiable Information (PII), Protected Health information (PHI), and Federal Tax Information (FTI)?

2. Do you have a thorough understanding of the Affordable Care Act and the No Surprises Act as well as related regulations and sub-regulatory guidance involving the in-person assisters?

3. Do you have prior experience in responding quickly to ad hoc requests that require immediate attention?

4. Do you have prior experience working collaboratively with multiple entities, including Federal agencies, States, and other contractors, to accomplish program objectives on a nationwide scale?

5. Do you have prior experience in effective project management that includes a proven track record of keeping to a schedule and managing multiple tasks and multiple development teams?

6. Do you have prior experience working with in-person assisters?

7. Do you have prior experience updating existing, large WBT materials compatible with a third-party LMS?

8. Do you have prior experience developing or updating SOPs?

9. Do you have prior knowledge, and experience of updating and developing internal control plans?

10. Do you have prior experience in developing project management plans as well as creating and updating detailed project reports?

11. Do you have prior experience in managing multiple automated application and inquiry response Salesforce systems?

Responses Requested

Please submit your responses no later than 11:00am on June 9, 2023 to Megan.Famodu@cms.hhs.gov and Matthew.Waskiewicz@cms.hhs.gov in the following format:

• Microsoft Word (or PDF) document with page size 8.5 by 11 inches, with a minimum of 1" margins.

• Times New Roman Font Size 11 with no less than single spacing between lines.

• Submissions shall not exceed 6 pages. Cover Page is included in the total page count.

Cover Page

Vendors shall include the following Business information on the Cover Page:

a) SSN number, title, and date of issuance

b) UEI

c) Company Name

d) Company Address

e) Company Point of Contact, Phone and Email address mailto:Megan.Famodu@cms.hhs.gov mailto:Matthew.Waskiewicz@cms.hhs.gov

f) Current GSA Schedules/Categories appropriate to this effort

g) NAICS code under which the company conducts business as a small business and socio-economic status of the small business as validated via the System for Award Management (SAM). All potential offerors must be registered in SAM located https://sam.gov/content/home

h) Number of full-time employees

Confidentiality

No proprietary, classified, confidential, or sensitive information should be included in your response. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s).

Disclaimer and Important Notes

This notice does not obligate the Government to award a task order or otherwise pay for the information provided in response. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted.

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.

Similar Situated Entities

Description of how the respondent will provide at least 50% of the cost of labor (including indirect charges) required to perform the services. 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.

https://sam.gov/content/home