Notice ID: 230207
“The purpose of this SSN is to determine the availability and capability of potential small businesses (e.g., 8(a), service-disabled veteran-owned and veteran-owned small business, HUBZone small business, small disadvantaged business, and women-owned small business) that capability of supporting can support the eligibility support processes for the Federally-Facilitated Exchange (FFE) and State-based Exchanges (SBEs) 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 includes associated paper intake, document review, data matching inconsistency reconciliation, customer support call center, casework, and related support requirements…”
The main functions of an Exchange, laid out in the Affordable Care Act, include:
- Certifying, recertifying, and decertifying QHPs
- Assigning ratings to each plan offered through the Exchange on the basis of relative quality and price
- Providing consumer information on QHPs in a standardized format
- Creating an electronic calculator to allow consumers to assess the cost of coverage after application of any advance payments of the premium tax credit and cost-sharing reductions
- Operating an internet website and toll-free telephone hotline offering comparative information on QHPs and allowing consumers to apply for and purchase coverage if eligible
- Determining eligibility for enrollment in a QHP through the Exchange and for insurance affordability programs, and facilitating enrollment of eligible individuals in those programs
- Granting certifications of exemption from the individual tax penalty for the failure to maintain minimum essential coverage, in accordance with section 5000A of the Internal Revenue Code, subject to applicable law
- Establishing a Navigator Program to assist consumers in making choices about their health care options and accessing their new health care coverage.
The Eligibility Support program, within CCIIO, provides support services related to the above function’s numbers six and seven. Successful execution of the tasks requires a comprehensive familiarity with the Affordable Care Act, as well as related regulations and sub-regulatory guidance. The tasks include the intake and review of paper applications and documentation, operation of a consumer support call center, and complex case work. The tasks do not include the provision of in-person assistance. The Contractor would not make eligibility determinations; rather, the contractor would follow CMS-defined Standard Operating Procedures (SOPs) to ensure that the FEPS has the necessary information to make eligibility determinations and provide other support services.”
“The Eligibility Support program has developed a database and multiple software tools to support production tasks. The Contractor shall be responsible for maintaining and enhancing the current IT solution portfolio…”
