The Department of Health and Human Services, the Centers for Medicare and Medicaid Services has a requirement for Independent Systems Acceptance and Verification for the Exchange (ISAVE).

CMS is mandated to support the Patient Protection and Affordable Care Act of 2010 amended by the Health Care and Education Reconciliation Act of 2010 as the “Affordable Care Act” (ACA), and the No Surprises Act and Transparency provisions of the Consolidated Appropriations Act (CAA) of 2021, as the NST. These regulatory mandates are required in support of Center for Consumer Information and Insurance Oversight (CCIIO) solutions such as the Health Insurance Exchange (also referred to as the “Marketplace” or “Exchange”) as the information technology (IT) aspect of the Health Care Law implementation and workstream several NST workstream. The Marketplace allows individuals and small employers to directly compare and shop for certain competitive private health insurance options, known as Qualified Health Plans (QHP), based on price, quality, and other factors. The NST solutions support greater healthcare cost transparency for providers, insurers, and consumers and creates remedies for violations to the law via 9 workstreams. The CMS Center for Consumer Information and Insurance Oversight (CCIIO), Marketplace Innovations and Technology Group (MITG) manages both the Exchange and NST programs. More information about these programs is available on the Marketplace.gov and CMS.gov websites. The Marketplace has been operating for more than a decade and, to take the operations to the next  level, CCIIO/MITG decided to shift independent testing to outcome-based testing as a key transformation objective. The decision was based on analysis and research that revealed our development vendors are already producing code that is production ready, with requirements validated and basic integration accomplished. MITG wanted “independent” testing to transform from duplicating what is already being accomplished by the development vendors to provide value-add testing capabilities focused on validation of business processes and outcomes. This test transformation is important to MITG as it will address enhanced user experience and improve efficacy of the business operational complexity of both the Marketplace and NST. Both programs include many concurrent, overlapping system/sub-system releases (only some of which are synchronized) and functional requirements that are not always integrated across subsystems.

• Task 0: Business-to-Test Baseline & Methodology (Special Transition-In Period)
• Task 1: Program Management and Contract Oversight
• Task 2: Independent Testing (Marketplace)
• Task 3: Test Advisory and Other Testing Support Services
• Task 4: Continuous Improvement
• Task 5: Transition In/Out