HHS CMS - Part D Transaction Facilitator - MRAS

The Department of Health and Human Services (HHS), in collaboration with the General Services Administration (GSA), is conducting market research to support the modernization efforts of the Medicare Enrollment and Premium Billing Systems (MEPBS). This initiative involves migrating critical systems to the Amazon Web Services (AWS) Cloud platform, enhancing data accessibility and security. As part of this transition, the Beneficiary Information on the Cloud (BIC) Data Services and Application Programming Interface (API) are being developed. These services aim to streamline interactions with Medicare beneficiary data, allowing authorized partners to retrieve, update, and receive notifications regarding beneficiary-related events such as entitlement changes or death.

The core component of this effort is the MEPBS Transaction Facilitation (TRF) process. This process ensures a seamless daily data exchange between MEPBS and the TRF Contractor. The system transmits comprehensive beneficiary data including Parts A, B, C, D enrollment details, and Part D payer information via a batch file format using CMS Enterprise File Transfer (EFT). This data is crucial for pharmacies participating in Part D drug programs as it enables them to verify active enrollments accurately. The interface specifications document provides detailed guidelines on how BIC interacts with the TRF system through JSON-formatted batch files comprising header, detail, and trailer records.

Additionally, this solicitation outlines requirements under Section 1860D-2(b)(4)(D) of the Social Security Act for determining reimbursement responsibilities when Medicare Part D beneficiaries have other prescription drug coverage. The contract seeks expertise in managing coordination of benefits processes to prevent duplicate payments by ensuring Medicare pays secondary when necessary. Furthermore, it emphasizes tracking beneficiaries' true out-of-pocket expenditures (TrOOP) through a facilitation process that captures relevant data from various sources.

Technical constraints include baseline security requirements that ensure contractors maintain secure access to government information or operate federal systems containing sensitive data. The selected contractor must demonstrate proficiency in relevant chapters of the Medicare Prescription Drug Benefit Manual and compliance with Office of Inspector General studies on Part D eligibility processes. This project may involve additional work or modifications as new standards are implemented under CMS directives.