The Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) may have a continuing requirement for Part D Transaction Facilitator.

Section 1860D-2(b)(4)(D) of the Social Security Act (the Act) authorizes the Secretary to establish procedures for determining whether costs for Part D eligible individuals are being reimbursed through insurance or otherwise, a group health plan, or other third party arrangement and for alerting the Part D plans in which such individual are enrolled about the other prescription drug coverage. Section 1860D-23 of the Act requires Part D plan sponsors to coordinate benefits with State Pharmaceutical Assistance Programs (SPAPs) and other providers of prescription drug coverage. When a Medicare Part D beneficiary has other prescription drug coverage, coordination of benefits (COB) permits the plans providing coverage for the same beneficiary to determine each of their payment responsibilities to avoid duplication of payment and prevent Medicare from paying primary when it is the secondary payer. Section 1860D-2 of the Act provides beneficiaries with protection against high out-of-pocket expenditures by requiring Part D sponsors to track beneficiary “true out-of-pocket” (TrOOP) expenditures. Costs for covered Part D drugs are treated as “incurred” only if they were paid by the individual, paid on behalf of a low-income subsidy-eligible individual under the Section 1860D-14 provisions, or paid under an SPAP. In Part D, COB also serves the function of providing a mechanism supporting the tracking and calculating to beneficiaries’ TrOOP.

To calculate TrOOP, Part D sponsors must determine what other entities made payments on covered drugs. Using the authority provided under Section 1860D-2 of the Act, CMS established a “TrOOP facilitation process” that captures TrOOP-relevant data from SPAPs and other providers of prescription drug coverage either online or in a batch process and sends it to the relevant Part D sponsor for TrOOP calculation. Part D rules require sponsors to track the beneficiary’s TrOOP costs and gross covered drug spending and correctly apply these costs to the TrOOP and benefit limits in order to correctly administer the benefit and provide the catastrophic level of coverage at the appropriate time. The TrOOP threshold and gross covered drug spending are calculated on an annual basis and must be transferred between Part D plans if a beneficiary changes plan enrollment during the coverage year. An automated process to manage the plan-to-plan transfer of these data is a component of the TrOOP facilitation process. Also, a component of the TrOOP facilitation process is the functionality for pharmacies to verify beneficiary Medicare eligibility and Part D enrollment information via on-line, real-time eligibility queries to the TrOOP facilitator.

• The purpose of this task order is to obtain Medicare Part D Transaction Facilitator services. The services performed under this requirement include but are not limited implementing an Information system (IS) program that adheres to CMS IS policies, standards, procedures, and guidelines, participate and fully cooperate with CMS IS audits, reviews, evaluations, tests and/or assessments that involve CMS information or information systems, reporting and processing corrective actions for all findings, document compliance with CMS security requirements and maintain such documentation in the systems security profile, perform mid-tier (3-zone) architecture development, manage all mid-tier code development, update and maintain all system and user documentation, receive and return standardized NCPDP transactions or other transactions that support Part D COB prepare and submit an incident report to CMS of any suspected or confirmed incidents. Recompete of 47QTCA21D000L/75FCMC21F0074.