Sparksoft is responsible for several federal government IT contracts under the Department of Health and Human Services’ (HHS) Centers for Medicare and Medicaid Services (CMS). The CMS Center for Consumer Information and Insurance Oversight (CCIIO), after the passage of the Affordable Care Act (ACA) in 2010, created the Multidimensional Insurance Data Analytics System (MIDAS) to produce high-quality Business Intelligence (BI) and Data & Analytics products so that the government can monitor and assess the volume and characteristics of health care coverage offered by insurers and requested by Consumers and Small Business employees in the ACA Marketplace and make sure they comply with state and federal statutes, policies and guidance.
Earlier in 2020, shortly after the Coronavirus was declared a pandemic, CMS decided to use the existing Federal Emergency Management Agency (FEMA) Exceptional Circumstances provision to enable Consumers who have been displaced by the COVID-19 pandemic to get or retain their health care coverage. Americans who lost their Minimum Essential Coverage (MEC) due to the pandemic can go to healthcare.gov and request a Special Enrollment Period (SEP), outside of the standard Open Enrollment period (11/01/20XX-12/15/20XX), and apply for and enroll in ACA coverage, including a federal subsidy that keeps their coverage affordable. In response to the pandemic, collaborating with our government partners, Sparksoft developed and produced special analytical reports and trends in MIDAS for CCIIO’s Eligibility & Enrollment business stream, as shown in Figure 1, to track changes in the volume of requests for health care coverage related to COVID-19. Sparksoft has also leveraged the MIDAS platform (using Databricks) to enable power users to do quick and in-depth analysis with access to all ACA marketplace data. This year’s American Rescue Plan (ARP) led to additional policy changes and business requirements, as well as (continuing) Medicaid expansion.
These metrics are available by state, as well as related articles and updates about enrollment trends compared to pre-pandemic levels. In total over 80 million Americans are covered by either the ACA or Medicaid/CHIP:
https://www.cms.gov/newsroom/press-releases/cms-releases-final-snapshot-2021-federal-exchange-open-enrollment-period
Sparksoft also manages the Data Services Hub (DSH or “Hub”) for the federal government. This CMS program is responsible for facilitating the many data exchanges between various ACA data sources, primarily via Application Program Interfaces (API) and webservices, that send and receive data in real time between stakeholders for use in validating that Consumers applying for ACA coverage are eligibile and can receive a subsidy such as the Advanced Premium Tax Credit (APTC). The Hub is the heartbeat of the Health Insurance Exchanges – for both the Federal and State Marketplaces.
Sparksoft ensures that the Hub routes enrollment verification requests between the Federally Facilitated Marketplace (FFM), State-Based Exchanges (SBEs), Medicaid/Children’s Health Insurance Program (CHIP) agencies, and the authoritative data sources such as the Internal Revenue Service (IRS), Social Security Administration, and other Federal agencies. Sparksoft also provides reporting services to the Hub stakeholders, including operational reports detailing the health of the Hub’s virtual machines, sync/async services, bulk file transfers, Electronic File Transfers (EFT), Electronic Data Interfaces (EDI), and a user interfaces for the Marketplace Customer Service Organizations.
COVID-19 has had a major impact on IRS operations and policies such as Failure to Reconcile (FTR). The IRS has experienced significant backlogs in processing tax returns due to office closures, staffing limitations and an increase in tax-related inquiries, putting ACA healthcare consumers at risk of losing their eligibility for APTC. Sparksoft has extended the Hub’s integration support for FTR operations for plan years 2021 and 2022 so that most enrollees can keep their APTC subsidies and maintain their affordable ACA coverage without lapse. Figure 2 shows the basic business and process workflows.
Sparksoft also hosts a critical Hub webservice to support legislation passed by Congress to expand APTC to consumers earning over 400% of the Federal Poverty Level (FPL) and to increase current APTC levels; increased support for consumers who wish to make changes to their existing plan selections or newly enroll during the (expanded) COVID SEP from 2/15/2021-8/15/2021. Sparksoft developed, tested, and released these Hub modifications to production in record time - under a month! Other Hub improvements include cost-saving changes in infrastructure, cloud scaling and optimization, streamlining the DevSecOps pipeline, technical changes to EFT and EDI operations, and ongoing support for States developing their own State-Based Exchange (SBE) instead of relying on the FFM.
As the prime contractor for at least two major ACA programs, MIDAS and Hub, Sparksoft collaborates with our federal partners and other stakeholders to implement and maintain program Roadmaps and to develop and deploy new capabilities in response to the COVID-19 pandemic. We engage CMS business owners and create new forums, where we rapidly develop ad hoc reports to help the government track the impact of COVID-19 on ACA Marketplace activities such as enrollment. Through our DevOps and CI/CD pipeline we continuously deliver changes to our API’s with the IRS and many other stakeholders, in order to facilitate higher volume, more efficient data exchanges, and high quality analytics and reports. Our activities have helped mitigate the risk of American consumers going without access to high-quality healthcare, in keeping with CMS’ mission and promise.
