Notice ID: 230250
CMS, and specifically, CCIIO, is broadly responsible for Marketplace implementation. CCIIO has promulgated regulations for the establishment and practices of Marketplaces in the States, District of Columbia, as well as for various programs associated with the Marketplaces. Section 1311 of the Affordable Care Act (ACA) sets minimum standards for the Marketplace covering key areas of consumer protection.
The plan management function that includes, but is not limited to, evaluation, certification, management, and oversight of Qualified Health Plans (QHP) is a critical activity for all Marketplaces. In all Marketplaces, the plan management function is performed by CCIIO or by a state; however, the specific roles and responsibilities for CCIIO and states vary by type of Marketplace.
The following knowledge and experience are required:
- Thorough understanding of the ACA as well as related regulations, sub-regulatory guidance, and related CMS policies
- Understanding of the current CMS Health Insurance Marketplaces and the attributes of the different types of marketplaces
- Thorough understanding of Public Health Information (PHI) rules and regulations
- Experience in effective project management that includes a proven track record of keeping to a schedule and managing multiple tasks
- Knowledge of and experience with plan procurement and rate and benefit analysis in State and/or Federal programs. This may include, but is not limited to, Massachusetts Connector, California Public Employees’ Retirement System (CalPERS), Medicare Parts C and D, the Federal Employee Health Benefits Program (FEHBP) or Medicaid Managed Care
- Thorough understanding of the private individual and small group insurance markets with a national scope.
- Experience in preparing Paperwork Reduction Act (PRA) packages and knowledge of 508 accessibility standards
