Part D Transaction Facilitator

Statement of Objectives (SOO)

This document outlines the high-level outcomes and objectives for a Part D Transaction Facilitator contract. The Centers for Medicare & Medicaid Services (CMS) requires a contractor to support accurate tracking of True Out-of-Pocket (TrOOP) costs, facilitate eligibility queries, and ensure secure and compliant exchange of protected health information (PHI) related to Medicare Part D prescription drug benefit program coordination of benefits (COB).

• Part D Transaction Facilitation: Maintain Medicare Part D Eligibility Index, respond to eligibility queries, build a database of payer BIN/PCNs, accept and route Part D transactions, identify and accept supplemental claims, create and route TrOOP balance transfer transactions, and create and route coordination of benefits information. Requires a 24/7 real-time network.

• HIPAA-Compliant BAA Execution: Ensure full compliance with HIPAA Privacy Rule for PHI exchange, execute BAAs with Part D plan sponsors, and publish standard BAA language.

• Pharmacy Eligibility Query (E1) Support: Provide timely and accurate responses to E1 eligibility queries using NCPDP standard E1 transaction, utilize Medicare Eligibility Index, apply matching criteria, and maintain the E1 environment.

• Disaster Recovery (DR) and System Architecture Compliance: Design and re-architect the DR environment to meet federal continuity and security requirements, maintaining system availability at a Moderate risk level.

• Information Security and Privacy Compliance: Ensure compliance with federal information security and privacy requirements, safeguard PII, handle CUI, and provide immediate notification of threats.

• Program and Technical Management: Provide transparent, accurate, and timely project management, including developing a PMP, maintaining a project schedule, participating in reviews, and submitting status reports.

• Transition-In Support (Optional): Ensure a seamless transition from the incumbent contractor.

• Section 508 Compliance: Ensure all Information and Communication Technology (ICT) developed or delivered complies with Section 508 of the Rehabilitation Act.

• Contract Type: Firm-Fixed-Price (FFP) with Time-and-Materials (T&M) Order-level materials (OLMs) CLINs.

• Offerors must submit a Performance Work Statement (PWS) and a Quality Assurance Surveillance Plan (QASP) as part of their technical proposal.

• The PWS must incorporate all technical requirements from Appendices A through I.

• The QASP must address performance objectives, standards, Acceptable Quality Levels (AQLs), surveillance methods, and remedies.

• Not specified in this document.

• Appendices A through I define binding technical specifications, data formats, matching criteria, and transaction standards that are non-negotiable and must be incorporated into the PWS.

• The overall information system risk level is Moderate.

• The contract involves Personally Identifiable Information (PII) at a Moderate confidentiality impact level.

Request for Information (RFI)

This RFI is issued by the Centers for Medicare & Medicaid Services (CMS) to conduct market research regarding the accurate, timely, and compliant processing of Part D Coordination of Benefits (COB) related transactions between Medicare Part D plans and other payers. The goal is to determine the availability and technical ability of GSA MAS vendors and to inform future procurement methods.

• Document Provided: A draft Statement of Objectives (SOO) including Transition-In and Part D Transaction Facilitation tasks is included.
• Vendor Action Required: Vendors are asked to review the SOO and address specific questions based on their experience. Feedback may be used to refine the SOO and a future Request for Quotation (RFQ).
• Not a Solicitation: This RFI is for information and planning purposes only and does not constitute an RFP or RFQ. The Government will not pay for any costs incurred in responding to this RFI.
• Submission Deadline: Responses are due by May 7, 2026.
• Submission Format: Responses must be submitted via the GSA eBuy portal in Microsoft Word or Adobe PDF format. Hard-copy responses or other formats will not be accepted.

Responses should include three sections:

• Section I: General Vendor Information (Organization Name, UEI, mailing address, POC contact, licenses, expertise, GSA credentials).
• Section II: Contact information for the organization's views (if different from Section I).
• Section III: Concise responses to the listed questions, referencing specific SOO sections where applicable. A table format is provided for questions and responses.

Vendors are asked to provide feedback on:

• Sufficiency of technical detail in the SOO.
• Potential issues with the SOO that would prevent submitting a quote.
• Recommendations for contract type (FFP vs. T&M) for specific tasks.
• Suitable contract vehicles (e.g., GSA MAS, GSA Alliant).
• Labor categories to meet requirements.
• Project management methods.
• Recommended CLIN structure for the payment schedule.
• Need for teaming arrangements.
• Likelihood of responding to a future RFQ and whether they would submit as a prime.