Call Center Operations

09/03/2021The purpose of this Amendment 00006 is to incorporate the following changes: See page of the SF30 for a summary of changes. 08/24/2021 Update: See attachment Amendment 00006The purpose of this Amendment 00006 is to incorporate the following changes: See page 2 of the SF30 for a summary of changes. 08/20/2021 Update: See attachment Amendment 00005The purpose of this Amendment 00005 is to incorporate the following changes: See page 2 of the SF30 for a summary of changes.08/11/2021 Update: See attachment Amendment 00004The purpose of this Amendment 00004 is to update Attachment J-12, Pricing Template. See page 2 of the SF30 for a summary of changes.07/30/2021 Update: See attachment Amendment 00003The purpose of this Amendment 00003 is to extend the due date for Phase 1: Volume I - (Corporate Experience Only) to 11:00 AM EST on 08/03/21 and to incorporate the following changes: See page 2 of the SF 30.07/26/2021 Update: See attachment Amendment 00002.Also, the solicitation does

not commit the Government to pay any cost for the preparation and submission of a proposal. In addition, the Contracting Officer is the only individual who can legally commit the Government to the expenditures of public funds in connection with the proposed procurement. NOTE: This procurement is currently subject to the availability of funds.07/16/2021 Update: CMS has utilized the comments and questions received from the initial solicitation to make revisions to the solicitation (see attached Amendment 00001).   Additionally, CMS has attached questions and answers generated as a result of the original solicitation posting.CMS is the largest purchaser of health insurance in the United States.   CMS works to ensure high quality health care at a reasonable price and to provide information about benefits, health promotion, and choices. CMS is responsible for accurate, timely, relevant, understandable, and easily accessible information that will help individuals evaluate health plan options, nursing home options, and make decisions on their individual health care needs.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 Affordable Care Act creates new competitive private health insurance markets – called Marketplaces– that give millions of Americans and small businesses access to affordable healthcare. Marketplaces help individuals shop for, select, and enroll in high quality, affordable private health plans that fit their needs at competitive prices.CMS is working with States (including the District of Columbia and the territories) to establish Marketplaces in every State.  The law gives States the opportunity to establish State-based Marketplaces, subject to certification that the State-based Marketplace meets federal standards and will be ready to offer health care coverage. In a State that does not achieve certification, the law directs the Secretary of Health and Human Services to facilitate the establishment of a Marketplace in that State.CMS’s Contact Center Customer Service (CCCS) objective is to establish a Contact Center Operations (CCO) environment that will provide customer service functions which are able to efficiently handle and answer inquiries with a high level of service across the United States and its territories. The operations include offering the same range of services and quality across multiple contact channels, such as telephone, mail, email, TDD/TTY, fax, and web chat, enabling multi-channel access.In order to meet national program missions and strategies as well as legislative mandates (Balanced Budget Act of 1997 and Medicare Modernization Act of 2003), CMS operates a toll-free, nation-wide, 24 x 7 contact center with multiple sites to provide customer service and address inquiries, which includes 1-800 MEDICARE. In addition to this, with new reform and regulations and with the advent of the Affordable Care Act (ACA), calls and inquiries may also include issues regarding the Affordable Care Act (ACA), consumer health choices or other Federal programs and Department of Health and Human Services (DHHS) initiatives including the operation of a Federal Marketplace.The inquiries that CCO will be responsible for generally align with the different traditional benefits and programs, as well as questions about general policies, referrals for assistance in decision-making or other individual healthcare needs.Annually, CMS experiences a “peak” inquiry volume from October through the January time frame. This peak period is driven by high call volumes due to mass mailing of the Medicare & You handbook; annual enrollment in prescription drug plans, Marketplace plans or other health plans; managed care non-renewal notices; managed care enrollment period; and, information sent by the Social Security Administration (SSA) each Fall concerning cost of living adjustments and Medicare premiums for the next calendar year.CMS may also experience unforeseen peak periods at other times in the year, based on changes in Medicare, Marketplace or other federal health program policy, tax season, legislation, media and outreach activities, etc.The complexity and various factors of the CMS programs will drive many of the inquiries to the CCO environment.  It is important that the CCO contractor understands the magnitude and complexity of the program and the scope of information that Customer Service Representatives (CSRs) will provide in response to inquiries. The contact center serves as one of the primary outreach channels for a significant population of individuals and therefore requires high performance standards, disaster planning (business continuity), and other important oversight and monitoring functions.