Plan Management Compliance Review (PMCR)

Plan Management Compliance Review (PMCR): The purpose of this procurement is to obtain services to conduct various types of compliance reviews of health insurance issuers who operate Qualified Health Plans (QHHP)/Stand-Alone Dental Plans (SADP) in the Federally-Facilitated Exchange (FFE). These reviews are being procured by the Centers for Medicare & Medicaid Services' (CMS) Center for Consumer Information and Insurance Oversight's (CCIIO), in support of the health insurance Exchanges (Exchanges), as required under the Patient Protection and Affordable Care Act (PPACA). Compliance reviews serve as one of the primary mechanisms that CMS will use for ensuring and documenting QHP issuers' compliance with Affordable Care Act (ACA) requirements. Compliance reviews are necessary to identify irregularities, validate self-reported data, and to ensure that CCIIO is managing the FFE programs effectively.