Kuster, DeGette Lead Letter Urging Department of Health and Human Services for Transparency, Best Practices In Medicare and ACA Contract Proposals

December 22, 2020

Contact: Jen Fox, (202) 597-1894 (Kuster)

Ryan Brown, (202) 515-1804 (DeGette)

Kuster, DeGette Lead Letter Urging Department of Health and Human Services for Transparency, Best Practices In Medicare and ACA Contract Proposals

**In 2021, the Contact Center Operations (CCO) is accepting contract proposals for 1-800-MEDICARE and the federally facilitated marketplace (FFM) call center (1-800-318-2596)**

Washington, D.C. -- Today, Reps. Annie Kuster (NH-02) and Diana DeGette (CO-01) sent a letter to Seema Verma, the Centers for Medicare & Medicaid Services Administrator at the U.S. Department of Health and Human Services, urging for transparency in the upcoming Contact Center Operations (CCO) contract proposals. The CCO contract operates 1-800-MEDICARE and the federally facilitated marketplace (FFM) call center (1-800-318-2596), which provide toll-free, nationwide, 24/7 phone services. Together, these call lines serve a combined population of approximately 75 million Americans and answer inquiries from caregivers, providers, navigators, brokers, and other assisters - making them a critical source of information and enrollment assistance.

As the Department of Health and Human Services considers proposals for the new CCO contract, this letter seeks to highlight the importance of these call centers to millions of Medicare beneficiaries and Marketplace consumers, and the need for the current contracting process to enable open and fair competition and encourage proposals that prioritize innovative, best-in-practice solutions, including those drawn from the private sector.

"Our seniors have earned their Medicare benefits throughout their lives, and it is the responsibility of the government to ensure they receive the care they deserve," said Rep. Kuster. "The CCO contract is worth tens of billions of dollars and it directly impacts the wellbeing and experience of Medicare beneficiaries and ACA enrollees in New Hampshire and across the country. We need transparency from the federal government and to follow best private sector practices to ensure this process is conducted with the utmost care and responsibility. We must not turn our backs on our seniors -- they should have the resources they need to access their Medicare benefits."

Rep. Kuster continued, "1-800-MEDICARE is an essential service and resource for our Medicare beneficiaries, and I am committed to making sure this federal contract process does not present barriers to fair competition and an efficiently run program for beneficiaries. I will always look out for our seniors, and I urge the Department of Health and Human Services to do the same and ensure transparency and private sector innovation."

"Our seniors have spent most of their lives paying into the Medicare program that many of them now rely on to provide them the health care they need as they age," said Rep. DeGette. "Their needs, however, are very different than Americans who sign up for health care through one of our ACA exchanges. We have a responsibility to ensure both groups are getting the help they need, when they need it."

"Given the importance of these call centers to millions of Medicare beneficiaries and Marketplace consumers, we believe it is critical that the current contracting process enables open and fair competition and encourages proposals that prioritize innovative, best-in-practice solutions, including those drawn from the private sector," the members wrote. "Too often, the federal contracting process presents insurmountable barriers to entry for potential partners, to the ultimate detriment of federal programs and the individuals they serve."

"The two phone lines serve uniquely different programs and populations, and tools that work to assist beneficiaries of one program may not be well suited to the other," the members continued. "Further, the size and scope of the combined contract may limit competition and inhibit innovation by restricting eligibility to only the country's largest contractors. Counterintuitively, separating the contract may actually reduce costs and drive greater program efficiencies."

The full letter can be read below:

The Honorable Seema Verma

Administrator

Centers for Medicare & Medicaid Services

U.S. Department of Health and Human Services

7500 Security Boulevard

Baltimore, MD 21244

Dear Administrator Verma:

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) took the first steps toward seeking proposals for the next Contact Center Operations (CCO) contract, which will commence on June 1, 2022. The CCO contract operates 1-800-MEDICARE and the federally facilitated marketplace (FFM) call center (1-800-318-2596), which provide toll-free, nationwide, 24/7 phone services. Together, these call lines (or call centers) serve a combined population of approximately 75 million Americans, and answer inquiries from caregivers, providers, navigators, brokers, and other assisters - making them a critical source of information and enrollment assistance.

The CCO contract has historically been a ten-year, multi-billion dollar contract, and has been held by the same contractor (or its successor) since 2002. Given the importance of these call centers to millions of Medicare beneficiaries and Marketplace consumers, we believe it is critical that the current contracting process enable open and fair competition and encourage proposals that prioritize innovative, best-in-practice solutions, including those drawn from the private sector. Too often, the federal contracting process presents insurmountable barriers to entry for potential partners, to the ultimate detriment of federal programs and the individuals they serve.

We encourage CMS to consider the possible merits of separating the CCO contract into separate contracts to operate 1-800-MEDICARE and the Marketplace call center. The two phone lines serve uniquely different programs and populations, and tools that work to assist beneficiaries of one program may not be well suited to the other. Further, the size and scope of the combined contract may limit competition and inhibit innovation by restricting eligibility to only the country's largest contractors. Counterintuitively, separating the contract may actually reduce costs and drive greater program efficiencies.

To that end, we would appreciate a response to the following questions to provide clarity from the Department:

1.Has CMS considered the possible advantages and efficiencies that could be gained by separating the CCO contract into a contract to operate 1-800-MEDICARE and a separate contract to operate 1-800-318-2596, the Marketplace phone line?

2.How will CMS foster an open and fair procurement process for the next CCO contract?

3.How does CMS collect and track information on the experience of Medicare beneficiaries and Marketplace consumers accessing the contact center?

4.How will CMS ensure that the next CCO contractor delivers innovation and can improve the contact center experience for both Medicare beneficiaries and Marketplace consumers?

5.How will CMS ensure that the CCO contract review process allows for the adoption of relevant experience and best practices from the private sector?

6.Given the COVID-19 public health emergency and the shift toward remote or virtual call centers, what safeguards has CMS put in place, or will put in place, for the CCO contract to protect beneficiary and consumer information?

Thank you in advance for your consideration of this important matter.