Plan Management Audit and Monitoring (PMAM)

Plan Management Audit and Monitoring (PMAM) Background Overview of the Requirement In order to respond to this notice, interested parties must be able to demonstrate that they possess the experience and/or the ability to provide the full range of services outlined below: - Establish a QHP Issuer Assessment Process for CCIIO to use in conducting assessments and reporting the results. - Develop a methodology to select QHP Issuers and/or their QHPs for assessments which can include various types of audits or reviews. - Develop protocols, methodologies, and guides to be followed during assessments, including audit activities. - Develop auditing standard operating procedures (SOPs) for various types of audits or reviews. - Schedule and conduct entrance and exit conferences with CMS and any other parties, as appropriate. - Respond quickly to perform specialized assessments on short notice, in some instances. - Conduct assessments to evaluate whether QHP Issuers are complying with legislative and regulatory requirements in the ACA, and are achieving the expected and/or desired results. - Document all work performed through the use of work papers. - Adhere to rigorous internal controls which will ensure that findings are reliable, accurate, and supportable. - Prepare written reports which include assessment findings, conclusions, and recommendations. - Submit findings via electronic reporting systems. - Have a sufficient number of staff to perform simultaneous assessments. - Coordinate with State regulators or other entities, about reviews and audits, as needed. ? Please see the attachment for a complete copy of the sources sought documentation.