Health Plan Management System (HPMS)-Website Maintenance and Enhancement Services

The purpose of the work is to obtain system development and support services for the Agency's Health Plan Management System (HPMS). HPMS is a full service website where health and drug plans, plan consultants, third party vendors, and pharmaceutical manufacturers can work with CMS to fulfill the plan enrollment and compliance requirements of the Medicare Advantage (MA) and Prescription Drug (Part D) programs.

HPMS manages the plan enrollment and compliance business processes for more than 800 private health and drug plans participating in the MA and Part D programs. In total, there are approximately 70 software modules, of varying sizes and complexity, which support MA and Part D functions, including, but not limited to: application submission, automated network adequacy review, formulary submission, bid and benefit package submissions, marketing material reviews, Part D drug pricing and pharmacy network submission, program audits and compliance oversight, performance monitoring, fraud, waste, and abuse tracking and reporting, improper payments, plan surveys, financial reporting, beneficiary complaint tracking, and data support for the Medicare & You handbook, Medicare Plan Finder, and Online Enrollment Center. HPMS also houses the Plan Management Dashboard, a visual platform that organizes HPMS data and presents key performance indicators for plan compliance, fiscal soundness, marketing, contract performance, enrollment operations, and account management.

As the system of record for contract and plan data, HPMS is responsible for the data that serves as the backbone for the MA and Part D programs. Downstream systems are dependent upon HPMS data to carry out mission critical agency operations such as beneficiary enrollment, plan payment, appeals processing, payment reconciliation, and premium withhold.

Because of its crosscutting nature, HPMS systems development requires interaction with numerous entities both inside and outside of CMS. In addition to a wide array of internal partners, CMS works closely with MA, Prescription Drug Plan (PDP), cost-based, Program for All-Inclusive Care (PACE), and demonstration organizations and affiliated industry and trade groups. HPMS has a broad user base comprised of over 13,900 users, including internal CMS staff, private health and drug plans, pharmaceutical manufacturers, States, consultants and third party vendors, external federal agencies, and CMS contractors.

Support requires, but is not limited to, full-lifecycle software development and maintenance; DevSecOps; application development in .Net 4.0/4.5 (C# language) and Node.js; testing in CMS' test and implementation environments: performance, integration and load testing; cloud hosting; analyzing and refactoring existing code and database structures to optimize performance; and technical expertise in project management, website usability, Section 508 compliance, Internet security, information architecture, customer relationship management, service-oriented architectures, application performance, operational efficiencies, web services. and e-Government best practices.

Please note that this notice includes support for only a subset of HPMS software modules. Table 1 provides the list of modules under the purview of this notice, while Table 2 depicts the corresponding system development lifecycle (SDLC) for each module. Potential contractors shall be required to work closely, collaboratively, and cooperatively with other HPMS support contractors.