CMS Eligibility Appeals Operations Service Information Technology (EAOS IT)
Investment ID: 009-000333912
Overview
Program Title
CMS Eligibility Appeals Operations Service Information Technology (EAOS IT)
Description
Case Management System for Federally Facilitated Marketplace Hearing and Appeals.
Type of Program
Major IT Investments
Multi-Agency Category
Not Applicable
Investment Detail
The ultimate goal of this system is to provide eligibility appeals data to consumers, federal hearing officers, and the EAOS contractor in adjudicating Marketplace appeals and various eligibility determinations and/or subsidy calculations. To that end, the EACMS contractor will be provide Program Management (PM) resources to oversee various aspects of the appeal lifecycle. This includes the EAOS Call Center, Eligibility Appeals (EA) case coordinators, EA Informal Resolution (IR) specialists, and other program management/oversight resources. All of the external contractor support resources provide direct and indirect support to the Federal Hearing Officers (FHO) that make all final decisions on valid appeals submitted to the Eligibility Appeals Support Center (EASC).
The EAOS contractor will provide end-to-end accessibility for the appellant, CMS staff, and any third parties who may be involved with the appeal as required by Sections 508 and Section 504. Such access may include ensuring the provision of hearing accommodations for individuals with disabilities and language translation services for limited English proficient appellants.
CMS will incorporate several methods of oversight to ensure the contractor performs at a high level and has the necessary quality assurance measures in place. CMS has provided an initial set of Service Level Agreements (SLAs) and will be providing associated Key Performance Indicators (KPls) that include quantitative benchmarks with the contract. The Contractor shall develop additional quantitative and qualitative benchmarks and SLAs for areas not addressed by CMS. The Contractor shall ensure that the KPls are specific, measurable and reliable. These KPls developed by the Contractor shall focus on enhancing, evaluating and improving the efficiency of EAOS services for the Marketplace.
The setup and execution of an Eligibility Appeals Case Management System (EACMS), in support of EAOS, is required to collect, organize, access, and respond to various data sources that include, but are not limited to, incoming mail/fax correspondence, consumer calls, external requests for information (RFI), and other appeal related data.
The EAOS contractor will provide end-to-end accessibility for the appellant, CMS staff, and any third parties who may be involved with the appeal as required by Sections 508 and Section 504. Such access may include ensuring the provision of hearing accommodations for individuals with disabilities and language translation services for limited English proficient appellants.
CMS will incorporate several methods of oversight to ensure the contractor performs at a high level and has the necessary quality assurance measures in place. CMS has provided an initial set of Service Level Agreements (SLAs) and will be providing associated Key Performance Indicators (KPls) that include quantitative benchmarks with the contract. The Contractor shall develop additional quantitative and qualitative benchmarks and SLAs for areas not addressed by CMS. The Contractor shall ensure that the KPls are specific, measurable and reliable. These KPls developed by the Contractor shall focus on enhancing, evaluating and improving the efficiency of EAOS services for the Marketplace.
The setup and execution of an Eligibility Appeals Case Management System (EACMS), in support of EAOS, is required to collect, organize, access, and respond to various data sources that include, but are not limited to, incoming mail/fax correspondence, consumer calls, external requests for information (RFI), and other appeal related data.