CMS extends Accenture contract for healthCare.gov website while GAO recommends security fixes

Accenture Federal Services will operate the HEALTHCARE.GOV website through July 10, 2015, under terms of a six-month contract extension issued September 2 by the U.S Centers for Medicare and Medicaid Services (CMS).

That means Accenture, which took over the troubled health insurance website last January from CGI Federal, will maintain healthcare.gov through the second Obamacare open enrollment period which runs from November 15, 2014 to February 18, 2015.

However, neither Accenture nor the CMS has released detailed information on whether the firm has fixed lingering technical problems that continue to hinder payments to insurers and prevent enrollees from correcting errors in their accounts.  

The federal health insurance marketplace’s second open enrollment period will be better than its first, Andy Slavitt, CMS deputy administrator, told a U.S. House of Representatives Energy and Commerce oversight subcommittee hearing earlier this year.  However, it “won’t be perfect,” he cautioned.

Slavitt told lawmakers that although a number of important improvements have been made, work on the website will not be fully completed until sometime in 2015.

The U.S. Government Accountability Office (GAO), the investigative arm of Congress, wants CMS to put in place a mitigation plan to ensure timely and successful performance of the system.

Even its harshest critics agree that, today, healthcare.gov offers a far better consumer experience than when it was launched last October. A “technical surge” team of top information technology  experts, appointed by the White House and led by former Google engineer Mikey Dickerson, successfully addressed most of the front-end issues that initially made it difficult for consumers to shop for insurance last fall. The website is now faster and more accurate.

However, a number of significant back-end problems remained when Accenture took over development of the site in January.

The CMS procurement document, which spells out terms of Accenture’s hiring, noted that healthcare.gov was still:

• Inappropriately denying Medicaid eligibility for many qualified consumers and sending inaccurate or incomplete enrollment information to state Medicaid agencies;

• Forwarding garbled or incomplete enrollment information to private insurers;

• Incorrectly determining the payment owed to private insurers or allowing the government to directly send electronic fund transfers for premium subsidies to insurers; and

• Not allowing consumers to correct errors in their enrollment information (many of which resulted from healthcare.gov malfunctions) or update their accounts to, for example, obtain coverage for newborn children.

During his Congressional  testimony, Slavitt reported that coding corrections had largely eliminated problems with garbled or incomplete information. The Medicaid registration problems had likewise been largely solved.

However, the marketplace was still unable to perform all functions needed to correctly pay insurers or allow consumers to update enrollment information.

“Today we are paying the (insurance) issuers at an estimated basis …” Slavitt said. “… by the end of this year they’ll begin to get paid at a policy-level basis …” Next year, programers will finish linking healthcare.gov to the back end of CMS’ system, he told lawmakers.

Slavitt would not promise the oversight subcommittee that healthcare.gov, will be “fully ready” in November, when people can start purchasing coverage for 2015.

The prospect of starting another enrollment period with important healthcare.gov functions still under construction raises concerns for the GAO.

If management of the website’s development project does not improve, “significant risks remain that upcoming open enrollment periods could encounter challenges,” William Woods, the GAO’s director of acquisition and sourcing management, told the  subcommittee. Two GAO reports, criticizing the development of healthcare.gov and the government’s management of the project, were released in conjunction with the hearing.

To improve the development and management of federal IT resources, the White House announced in August the formation of the United States Digital Services (USDS), a corps of top information technology professionals charged with ensuring that state-of-the-art practices are followed in the development of government websites.

The new unit, headed by tech surge leader Dickerson, is intended  to ensure that mistakes made in the development of healthcare.gov will not be repeated in the development of other federal sites.

The USDS staff have not said what role, if any, they will play in remedying the remaining problems with healthcare.gov; however, IT experts who spoke with Managed Healthcare Executive suspect they will have a role.

Accenture’s contract to run healthcare.gov had been set to expire in January. Earlier this year, CMS raised the prospect that a third IT services firm may be brought in to take over the website.

In July, CMS released an 84-page solicitation for a contractor “capable of working under aggressive time constraints” to provide analysis, design, development, testing, implementation, documentation, services, maintenance and support for the federal health insurance exchange. Responses were originally due August 18; but that deadline was extended to September 18.

CMS had hoped to announce the successful bidder no later than 60 days before the November 15 start of the next enrollment period. That would have given Accenture two months to transition operation of the site to the new vendor. However, CMS officials decided that was too tight a time frame, so CMS now expects to award a new contract in February 2015.  

Bob Pieper is a freelance healthcare writer based in St. Louis.