Solicitation Number: 200358
The Center for Consumer Information and Insurance Oversight (CCIIO) within CMS promulgated regulations for the establishment and practices of Health Insurance Exchanges and related programs established by the Act CCIIO focuses on operational program support and related activities for the financial programs associated with the Patient Protection and Affordable Care Act of 2010. These financial programs include all tasks related to the permanent risk adjustment program within CMS’ CCIIO Payment Policy and Financial Management Group (PPFMG).
In order to perform the federal functions required by the Act, CMS has employed contractors to build elements of the Exchange operational system. The various components of the operational system are responsible for determining eligibility, storing information about enrollment, transmitting this information to issuers, receiving information from issuers, storing current and historical data, calculating payments due or charges owed, and transmitting data to other government systems. The operational system requires complex processing of large volumes of data, interaction between many different entities (including multiple federal agencies, contractors, insurance companies, and enrollees), and accountability to individual enrollees. As such, high-quality analysis of operational data is necessary for the continued success of the Act.
The purpose of this program is to perform operational analytics to support these CMS priorities. Operational analytics consist of data analysis, reporting, root cause analysis, and surveillance functions related to CMS’s ongoing operations under the Act. CMS requires substantial analytic resources to monitor operational processes, proactively investigate problems or anomalies, validate information, maintain records of analytical work, inform stakeholders both inside and outside the federal government, and otherwise support program operations. Sophisticated analytical functions are necessary to ensure that CMS eligibility, enrollment, and data collection processes are working correctly, payments and charges associated with the Act’s programs are being calculated and assessed properly, and regulated entities regulated are complying with the law. The Operational Analytics Contractor is required to have a deep understanding of CMS’s regulations and business processes, the CMS operational system, and relevant outside operational systems…
