Federally Facilitated Marketplaces
Date signed: 11/5/2024
| PIA Questions | PIA Answers |
|---|---|
OPDIV: | CMS |
PIA Unique Identifier: | P-1710508-331195 |
Name: | Federally Facilitated Marketplaces |
The subject of this PIA is which of the following? | Major Application |
Identify the Enterprise Performance Lifecycle Phase of the system. | Operate |
Is this a FISMA-Reportable system? | Yes |
Does the system include a Website or online application available to and for the use of the general public? | Yes |
Identify the operator: | Contractor |
Is this a new or existing system? | Existing |
Does the system have Security Authorization (SA)? | Yes |
Date of Security Authorization | 4/10/2023 |
Indicate the following reason(s) for updating this PIA. Choose from the following options. |
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Describe in further detail any changes to the system that have occurred since the last PIA. | Marketplace Plan Management System (MPMS) formed as separate tower to provide functionalities previously included within Plan Management (PM). However, no new functionality and no impact on data has occurred with this change. |
Describe the purpose of the system | The purpose of the Federally Facilitated Marketplace is to carry out several functions required by the Affordable Care Act (ACA). A key provision of the ACA is the implementation of Insurance Marketplaces, to help consumers and small businesses obtain health insurance in a way that permits easy comparison of available plan options based on price, benefits and services, and quality. The Marketplaces shall carry out several functions required by the ACA, including certifying Qualified Health Plans (QHP), administering Advance Premium Tax Credits (APTC) and Cost Sharing Reductions (CSR), and providing an easy-to-use website for individuals to determine eligibility and the enrollment for health coverage. The Marketplaces will be required to interact with stakeholders, including consumers, navigators, agents, brokers, employers, Health Plan Issuers, State-based Medicaid, and Children's Health insurance Program (CHIP), Federal agencies for verification checks, third-party data sources, and State Insurance Departments. Exchange Minimum Functions: Consumer Assistance (45 CFR 155.205). Navigator Program (45 CFR 155.210). Agent Broker program (45 CFR 155.220). QHP certification (45 CFR 155.1000). Eligibility Appeals (45 CFR 155.355). Submission of Notices (45 CFR 155.230). Premium Payment (45 CFR 155.240). Exemption Determinations (45 CFR 155.605). Enrollment in QHPs (45 CFR 155.400). Eligibility Determinations (45 CFR 155.300, 155.305, 155.310). Oversight and Financial Integrity (45 CFR 155.200(c)). Establishment of Exchange network adequacy standards (45 CFR 155.1050). Quality Assessments, Disclosures & Data Reporting (45 CFR 155.200(d)). Administration of APTCs and CSRs (45 CFR 155.340). Coordination with Medicaid, Children's Health Insurance Program (CHIP), Benefit Health Plan (BHP) and Pre-existing Condition Insurance Plan (PCIP) (45 CFR 155.345) |
Describe the type of information the system will collect, maintain (store), or share. (Subsequent questions will identify if this information is PII and ask about the specific data elements) | Following type of information is collected from the Consumer and Insurance providers: Insurance Plan Data Information collected from the Consumer and Insurance Provider is stored in FFM indefinitely. Any information not required for production is archived. Consumers can create an account on healthcare.gov using their email address. Credentials for Administrative support users are managed by Enterprise User Administration (EUA) system. FFM does not store user credentials information. |
Provide an overview of the system and describe the information it will collect, maintain (store), or share, either permanently or temporarily. | The purpose of the Federally Facilitated Marketplace is to carry out several functions required by the Affordable Care Act (ACA). A key provision of the ACA is the implementation of Insurance Marketplaces, to help consumers and small businesses obtain health insurance in a way that permits easy comparison of available plan options based on price, benefits and services, and quality. The Federally Facilitated Marketplace is made of the following functionalities: Plan Management (PM): Capture and display insurer plan data for selection. The data collected supports plan certification, recertification, and the decertification processes. Data is used to monitor plan agreements and maintain operational plan data. Data is used for rate review justification and to establish quality benchmarks and metrics for Qualified Health Plans (QHPs). Eligibility and Enrollment (E&E), Insurance Enrollment System (IES), and Standalone Eligibility Services (SES): Determine Eligibility in Medicaid, Children's Health Insurance Program (CHIP), or Qualified Health Plan (QHP) based on Modified Adjusted Gross Income (MAGI) and other factors like disability. Determine eligibility and calculate the Advance Premium Tax Credits (APTCs) and Cost Sharing Reductions (CSR); determine eligibility for individual responsibility exemption. Process eligibility applications, interface with the data services hub for validations where required. Process changes in eligibility. Facilitate QHP selection. Interface with the Data Services Hub (DSH) and States as required. Process appeals and exemptions. Monthly and Annual Internal Revenue Service (IRS) Reporting. Enhanced Direct Enrollment (EDE): The EDE Partner Program will provide the capability for a consumer to complete the application, receive eligibility results, and enroll in plans without leaving the DE partner website. DE partners are third party commercial entities that engage consumers in applying for and enrolling in QHP's by collecting consumer information and passing that information to CMS for an eligibility determination. The DE partners are not to permanently maintain the information. DE partners may only collect the information for the purposes of facilitating consumer eligibility, enrollment, and maintenance of QHP coverage. DE Partner data retention is governed by State/Federal Law, in addition to security and privacy control requirements outlined in the Direct Enrollment Partner (DEP) agreement. FFM leverages Scalable Login System (SLS) to enable consumers to apply for and enroll in health coverage. Access to the system requires authentication and authorization through the Remote ID proofing (RIDP) process via third-party service Experian. following elements may be collected: |
Does the system collect, maintain, use or share PII? | Yes |
Indicate the type of PII that the system will collect or maintain. |
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Indicate the categories of individuals about whom PII is collected, maintained or shared. |
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How many individuals' PII in the system? | 1,000,000 or more |
For what primary purpose is the PII used? | Personally Identifiable Information (PII) is collected and used to validate an individual's identity and for determining a citizenship, immigration status, employment status, incarceration status, in support of eligibility determination in a Qualified Health Plan, Medicaid, or Children's Health Insurance Program (CHIP) program. |
Describe the secondary uses for which the PII will be used (e.g. testing, training or research) | Limited Personally Identifiable Information (PII) is also used in generation of meta-data for research, reporting, data analysis, and business intelligence. Third-party tools are being used to gain visibility into when website traffic is building during busy (peak) periods. Third-party tools have access to the following limited information: Domain from which consumers access the Internet. Internet Protocol (IP) address (an IP or internet protocol address is a number that is automatically given to a computer connected to the Web). Operating system on the consumer's computer and information about the browser used when visiting the site. Date and time of visit. Pages visited. Address of the website that connected to HealthCare.gov (such as google.com or bing.com) However, third-party tools do not have access through Healthcare.gov to the name, address, Social Security Number, or email address of the consumer. |
Describe the function of the SSN. | Per the Affordable Care Act, Section 1414; the Centers for Medicare and Medicaid Services (CMS) must collect the Social Security Number (SSN) for use in determining citizenship and immigration status. If volunteered by the individual, the SSN will also be used for validating or Identification (ID) proofing an individual’s identity prior to enrollment in an Insurance Plan. |
Cite the legal authority to use the SSN. | Affordable Care Act (ACA), Section 1414 Affordable Care Act (ACA), Section 1411, 42 U.S.C. Section 18081 |
Identify legal authorities governing information use and disclosure specific to the system and program. | Affordable Care Act (ACA), Section 1414 Affordable Care Act (ACA), Section 1411, 42 U.S.C. Section 18081 |
Are records on the system retrieved by one or more PII data elements? | Yes |
Identify the number and title of the Privacy Act System of Records (SORN) that is being used to cover the system or identify if a SORN is being developed. | Health Insurance Exchange (HIX) Program SORN 09-70-0560, 02/06/2013 Health Insurance Exchange (HIX) Program SORN 09-70-0560, 05/27/2013 Health Insurance Exchange (HIX) Program SORN 09-70-0560, 10/23/2013
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Identify the sources of PII in the system: Directly from an individual about whom the information pertains |
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Identify the sources of PII in the system: Government Sources |
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Identify the sources of PII in the system: Non-Government Sources |
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Identify the OMB information collection approval number and expiration date | CMS Form Number: CMS-10400 Title: Establishment of Exchanges and Qualified Health Plans OMB control number: 0938-1156 ICR Reference Number: 202406-0938-009 - Extension without change of a currently approved collection was received By OIRA on 6/18/2024. Expiration Date: TBD |
Is the PII shared with other organizations? | Yes |
Identify with whom the PII is shared or disclosed and for what purpose. |
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Describe any agreements in place that authorizes the information sharing or disclosure (e.g. Computer Matching Agreement, Memorandum of Understanding (MOU), or Information Sharing Agreement (ISA)). | The Privacy Policy in the 'Get Started' section of the Individual Application module that is a part of the E&E Application, contains information about the privacy and use of information. The Individual Application module captures the necessary information for the Marketplace to verify an applicant’s eligibility for enrollment in a QHP. This is an information sharing agreement that the consumer should acknowledge for the use and disclosure of information. As appropriate Centers for Medicare and Medicaid Services (CMS) executes Interconnection Security Agreements (ISAs), Computer Matching Agreements (CMAs), Information Exchange Agreements (IEAs), and Service Level Agreements (SLAs) with all Federal, State, Direct Enrollment Partner Agreements and contractual agreements with all Private Sector parties prior to information sharing or disclosure. |
Describe the procedures for accounting for disclosures | The Privacy Policy contains information about privacy and use of information. This policy also contains a link to the Privacy Act Statement and other information related to disclosures. Per language in the Computer Matching Agreements (CMAs), DE Partners agreements, and Interconnection Security Agreements (ISAs), parties are required to report privacy breaches or suspected breaches to CMS within one (1) hour of detection. Disclosure of privacy information between systems is managed under routine use notices. In addition, system logs maintain transaction information only (not the PII itself) as a record or accounting of each time it discloses information as part of routine use. |
Describe the process in place to notify individuals that their personal information will be collected. If no prior notice is given, explain the reason. | The Privacy Policy section of the Individual Application contains information about the privacy and use of information. This also contains a link to the Privacy Act Statement and other information related to disclosures.
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Is the submission of the PII by individuals voluntary or mandatory? | Voluntary |
Describe the method for individuals to opt-out of the collection or use of their PII. If there is no option to object to the information collection, provide a reason. | FFM does not provide a method for individuals to opt-out of the collection or use of PII because FFM requires PII to determine eligibility. The marketplace collects Personally Identifiable Information (PII) when a consumer clicks on “Apply for Coverage” at which point they will be asked to Identity Proof. Upon successful completion of Identity Proofing, the user can proceed to building their household, stating household income, and then continue onto plan compare and plan selection. During the Identity Proofing process and subsequent screens, the marketplace will ask for PII that is used to establish their identity, determine their Eligibility for financial assistance and determine the available plans and premiums for that consumer. DE partners do not provide a method for individuals to opt-out of the collection or use of PII since FFM requires PII to determine eligibility. |
Describe the process to notify and obtain consent from the individuals whose PII is in the system when major changes occur to the system (e.g., disclosure and/or data uses have changes since the notice at the time of original collection). Alternatively, describe why they cannot be notified or have their consent obtained. | Should a major change occur, the privacy statement on healthcare.gov will be updated. In addition, the System of Record Notice (SORN) will be updated and posted on the HHS website to inform the public: |
Describe the process in place to resolve an individual's concerns when they believe their PII has been inappropriately obtained, used, or disclosed, or that the PII is inaccurate. If no process exists, explain why not. | An individual can contact the Health Insurance Marketplace call center at 1-800-318-2596 to report concerns, unlock user accounts, and to reset passwords. An individual seeking access to records about him or her in this system should write to the system manager and reasonably specify the record contents being sought. (These procedures are in accordance with Department regulation 45 CFR 5b.5(a)(2).) To contest a record, the subject individual should contact the system manager, and reasonably identify the record and specify the information being contested. The individual should state the corrective action sought and the reasons for the System Manager: Director, Marketplace Information Technology Group, Center for Consumer Information and Insurance Oversight, Centers for Medicare & Medicaid Services 7500 Security Blvd, Baltimore, MD 21224 |
Describe the process in place for periodic reviews of PII contained in the system to ensure the data's integrity, availability, accuracy and relevancy. If no processes are in place, explain why not. | The Centers for Medicare and Medicaid Services (CMS) has a National Institute of Science and Technology (NIST) compliant continuous monitoring program to ensure system and data integrity, availability, accuracy, and relevancy. The individual enrollment application is designed with logic checks to ensure data accuracy and integrity. Centers for Medicare and Medicaid Services (CMS)/Center for Consumer Information and Insurance Oversight (CCIIO) is establishing and Enrollment Resolution and Reconciliation program to provide services necessary to resolve errors and reconcile discrepancies in enrollment data between the Health Insurance Exchange, State Based Marketplaces, issuer community, and CMS. Annually, CCIIO is required to review and update the enrollment process to ensure data collected is relevant to the health insurance enrollment process. |
Identify who will have access to the PII in the system and the reason why they require access. |
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Describe the procedures in place to determine which system users (administrators, developers, contractors, etc.) may access PII. | The Federally Facilitated Marketplace (FFM) has both public and protected content. Guest/anonymous users will be permitted to access only public content. The Centers for Medicare and Medicaid Services (CMS) uses role-based access controls to ensure administrators and contractors are granted access on a "need-to-know" and "need-to-access" commensurate with their assigned duties. |
Describe the methods in place to allow those with access to PII to only access the minimum amount of information necessary to perform their job. | There are three methods for restricting access. First, is to program user interfaces to limit the display of Personally Identifiable Information (PII) to only those elements needed to perform specific tasks. Second, is to limit the transmission of PII to validate information rather than copy or pull information form another authoritative source. Third, is to implement role-based access controls and auditing to ensure those with access have a "need-to-know" and "need to access". |
Identifying training and awareness provided to personnel (system owners, managers, operators, contractors and/or program managers) using the system to make them aware of their responsibilities for protecting the information being collected and maintained. | Both Federal and Contractor staffs who access or operate a Centers for Medicare and Medicaid Services (CMS) system are required to complete the annual CMS Security Awareness training provided annually as Computer Based Training (CBT) course. Contractors also complete their annual corporate security training. Furthermore, CMS also complies with requirements to complete Internal Revenue Service (IRS) security awareness training for safeguarding Federal Tax Information. |
Describe training system users receive (above and beyond general security and privacy awareness training) | The Federally Facilitated Marketplace (FFM) is a public system and users are provided links to Privacy and Security policies. CMS employees and direct contractors with privileged access are required to complete role-based training and meet continuing education requirements commensurate with their role. |
Do contracts include Federal Acquisition Regulation and other appropriate clauses ensuring adherence to privacy provisions and practices? | Yes |
Describe the process and guidelines in place with regard to the retention and destruction of PII. Cite specific records retention schedules. | Records will be maintained until they become inactive, at which time they will be retired or destroyed, which is ten years. These procedures are in accordance with published records schedules DAA-0440-2015-0006-0001 of the Centers for Medicare & Medicaid Services as approved by the National Archives and Records Administration General Records Schedule 3.2 (GRS 3.2) for electronic records. |
Describe, briefly but with specificity, how the PII will be secured in the system using administrative, technical, and physical controls. | The Federally Facilitated Marketplace (FFM) system is hosted in Amazon Web Services (AWS) cloud environments. The FFM system and application is built using industry best practices and independently reviewed against Federal Information Security Management Act (FISMA) and National Institute of Science and Technology (NIST) Security and Privacy controls to ensure technical, operational, and management controls are properly applied. Personally Identifiable Information (PII) on the Federally Facilitated Marketplace (FFM) system is secured administratively by ensuring that the system goes through the Assessment and Authorization (A&A) process, and all documentation is submitted to the Office of Technology Solutions (OTS) that supports the system and to comply with Federal Information Security Management Act (FISMA) regulations. The system is currently hosted in the Amazon Web Services (AWS) cloud environment. The system is accessed via Internet only, which is protected by firewalls which secure the information from intruders. The physical controls that are in place such as security guards ensure that access to the buildings is granted to authorized individuals. Identification of personnel is checked at each facility. AWS cloud services provider monitors and support the FFM application. The eXchange Operations Center (XOC) is responsible for monitoring the FFM application. The FFM cloud contains continuous monitoring tools for end-to-end alerting, reporting, and trending. The user identity data is stored in the centralized Lightweight Directory Access Protocol (LDAP) store managed by Enterprise User Administration (EUA) system for employees and non-consumers within FFM. FFM leverages Scalable Login System (SLS) to enable consumers to apply for and enroll in health coverage. FFM users and web services send user Identity information to SLS for user authentication and are required to authenticate to establish their identity and role as an individual or system interacting with the target system. If Agent/Brokers or Call Center Representatives forget the password but remember the security question/password that was set during their initial registration, they can use the ‘Forgot Password’ link via the CMS Enterprise Portal to reset their passwords. The new password can be used to log into the system. If users forget the security questions/answers and contact the CMS Help Desk for support, the password is reset, and an email is sent to users with the reset link to reset the password. Consumers can use the ‘Forgot Password’ link via the Marketplace to reset their password. |
Identify the publicly-available URL: | |
Does the website have a posted privacy notice? | Yes |
Is the privacy policy available in a machine-readable format? | Yes |
Does the website use web measurement and customization technology? | Yes |
Select the type of website measurement and customization technologies is in use and if is used to collect PII. (Select all that apply) |
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Web Beacons - Collects PII?: | No |
Web Bugs - Collects PII?: | No |
Session Cookies - Collects PII?: | Yes |
Persistent Cookies - Collects PII?: | No |
Other - Collects PII?: | No |
Does the website have any information or pages directed at children under the age of thirteen? | No |
Does the website contain links to non-federal government website external to HHS? | Yes |
Is a disclaimer notice provided to users that follow external links to websites not owned or operated by HHS? | Yes |