CMS-10877 Web-Broker Agreement

OMB Control #: 0938-NEW
Expiration Date: XX/XX/20XX

AGREEMENT BETWEEN WEB-BROKER AND
THE CENTERS FOR MEDICARE & MEDICAID SERVICES
FOR THE FEDERALLY-FACILITATED EXCHANGES
AND STATE-BASED EXCHANGES ON THE FEDERAL PLATFORM
THIS WEB-BROKER AGREEMENT (“Agreement”) is entered into by and between THE
CENTERS FOR MEDICARE & MEDICAID SERVICES (“CMS”), as the Party (as defined
below) responsible for the management and oversight of the Federally-facilitated Exchanges
(“FFEs”), also referred to as “Federally-facilitated Marketplaces” or “FFMs” and the operation
of the federal eligibility and enrollment platform, which includes the CMS Data Services Hub
(“Hub”), relied upon by certain State-based Exchanges (“SBEs”) for their eligibility and
enrollment functions (including State-based Exchanges on the Federal Platform [“SBE-FPs”]),
and
,
(hereinafter referred to as Web-broker), a Web-broker that uses a non-FFE Internet website in
accordance with 45 C.F.R. §§ 155.220(c) and 155.221 to assist Consumers, Applicants,
Qualified Individuals, Enrollees, Qualified Employers, and Qualified Employees in applying
for eligibility for enrollment in Qualified Health Plans (“QHPs”) and for Advance Payments of
the Premium Tax Credits (“APTCs”) and Cost-sharing Reductions (“CSRs”) for QHPs, and/or
in completing enrollment in QHPs offered in the individual market through the FFEs or SBEFPs, in applying for a determination of eligibility to participate in the FF-Small Business
Health Options Program (“FF-SHOPs”) or SBE-FP SHOPs and/or in completing enrollment in
QHPs offered through the FF-SHOPs or SBE-FP SHOPs; and providing related Customer
Service. CMS and Web-broker are hereinafter referred to as the “Party” or, collectively, as the
“Parties.” Unless otherwise noted, the provisions of this Agreement are applicable to Webbrokers seeking to assist Qualified Employers and Qualified Employees in purchasing and
enrolling in coverage through an FF-SHOP or SBE-FP SHOP.
WHEREAS:
1. Section 1312(e) of the Affordable Care Act (“ACA”) provides that the Secretary of the
U.S. Department of Health & Human Services (“HHS”) shall establish procedures that
permit Agents and Brokers to enroll Qualified Individuals, Qualified Employers, and
Qualified Employees in QHPs through an Exchange, and to assist individuals in applying
for APTC and CSRs, to the extent allowed by States. To participate in the FFEs or SBEFPs, including an FF-SHOP or SBE-FP SHOP, Agents, Brokers, and Web-brokers must
complete all necessary registration and training requirements under 45 C.F.R. § 155.220.
2. To facilitate the eligibility determination and enrollment processes, CMS will provide
centralized and standardized business and technical services (“Hub Web Services”)
through application programming interfaces (“APIs”) to Web-broker that will enable
Web-broker to establish a secure connection with the Hub. The APIs will enable the
secure transmission of key eligibility and enrollment Information between CMS and
Web-broker. The Hub Web Services are not available for SHOP.
3. To facilitate the operation of the FFEs and SBE-FPs, CMS desires to: (a) disclose
Personally Identifiable Information (“PII”), which is held in the Health Insurance
Exchanges Program (“HIX”), to Web-broker; (b) provide Web-broker with access to the
Hub Web Services, if applicable; and (c) permit Web-broker to create, collect, disclose,
PRA DISCLOSURE: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays
a valid OMB control number. The valid OMB control number for this information collection is 0938-NEW, expiration date is XX/XX/20XX. The time
required to complete this information collection is estimated to take up to 144,652 hours annually for all direct enrollment entities. If you have comments
concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports
Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. ****CMS Disclosure**** Please do not send applications, claims, payments,
medical records or any documents containing sensitive information to the PRA Reports Clearance Office. Please note that any correspondence not pertaining
to the information collection burden approved under the associated OMB control number listed on this form will not be reviewed, forwarded, or retained. If
you have questions or concerns regarding where to submit your documents, please contact Brittany Cain at [email protected].

1

access, maintain, store, and use PII from CMS, Consumers, Applicants, Qualified
Individuals, Enrollees, Qualified Employees, and Qualified Employers—or these
individuals’ legal representatives or Authorized Representatives—to the extent that
these activities are necessary to carry out the functions that the ACA and implementing
regulations permit Web-broker to carry out. The Hub Web Services are not available for
SHOP.
4. Web-broker is an individual or entity licensed as an insurance producer, Agent, or
Broker by the applicable State regulatory authority in at least one FFE or SBE-FP
State; OR Web-broker is an Agent or Broker Direct Enrollment Technology
Provider.
5. Web-broker desires to gain access to the Hub Web Services, and to create, collect,
disclose, access, maintain, store, and use PII from CMS, Consumers, Applicants,
Qualified Individuals, Enrollees, Qualified Employees, and Qualified Employers—or
these individuals’ legal representatives or Authorized Representatives—to perform
the Authorized Functions described in Section II.a of this Agreement. The Hub Web
Services are not available for SHOP.
6. 45 C.F.R. § 155.260(b) provides that an Exchange must, among other things, require
as a condition of contract or agreement with Non-Exchange Entities that the NonExchange Entity comply with privacy and security standards that are consistent with
the standards in 45 C.F.R. §§ 155.260(a)(1) through (a)(6), including being at least as
protective as the standards the Exchange has established and implemented for itself
under 45 C.F.R. § 155.260(a)(3).
7. CMS has adopted privacy and security standards with which the Web-broker, a type
of Non-Exchange Entity, must comply, which are set forth in Appendix A: Privacy
and Security Standards for , Appendix B: Annual Security and Privacy Assessment
(SPA), and the Non-Exchange Entity System Security and Privacy Plan (NEE SSP). 1
0F

Now, therefore, in consideration of the promises and covenants herein contained, the
adequacy of which the Parties acknowledge, the Parties agree as follows:
I. Definitions.
Capitalized terms not otherwise specifically defined herein shall have the meaning set forth in
the Appendix C: Definitions. Any capitalized term that is not defined herein or in Appendix
C: Definitions has the meaning provided in 45 C.F.R. § 155.20.
II. Acceptance of Standard Rules of Conduct.
Web-broker and CMS are entering into this Agreement to satisfy the requirements under 45
C.F.R. § 155.260(b)(2). Web-broker hereby acknowledges and agrees to accept and abide by
the standard rules of conduct set forth below and in the Appendices, which are incorporated by
reference in this Agreement, while and as engaging in any activity as Web-broker for purposes
of the ACA. Web-broker shall strictly adhere to the privacy and security standards—and
ensure that its employees, officers, directors, contractors, subcontractors, agents, and
The references in this Agreement to security and privacy controls and implementation standards can be found in
the NEE SSP located on CMS zONE at the following link: https://zone.cms.gov/document/privacy-and-securityaudit.

1

2

representatives strictly adhere to the same—to gain and maintain access to the Hub Web
Services, if applicable, and to create, collect, disclose, access, maintain, store, and use PII for
the efficient operation of the FFEs and SBE-FPs.
a. Authorized Functions. Web-broker may create, collect, disclose, access, maintain, store,
and use PII for:
1. Assisting with application, eligibility, and enrollment processes for QHP offered
through the FFEs and SBE-FPs, including FF-SHOPs and SBE-FP-SHOPs;
2. Supporting QHP selection and enrollment by assisting with plan selection and plan
comparisons;
3. Assisting with completing applications for the receipt of APTC or CSRs and with
selecting an APTC amount, if applicable;
4. Facilitating the collection of standardized attestations acknowledging the receipt of
the APTC or CSR determination, if applicable;
5. Assisting with the application for and determination of certificates of exemption, if
applicable;
6. Assisting with filing appeals of eligibility determinations in connection with the FFEs
and SBE-FPs, including Qualified Employer appeals for FF-SHOPs and SBE-FPSHOPs;
7. Transmitting Information about the Consumer’s, Applicant’s, Qualified Individual’s,
or Enrollee’s decisions regarding QHP enrollment and/or CSR and APTC
Information to the FFEs and SBE-FPs, if applicable;
8. Facilitating payment of the initial premium amount to the appropriate individual
market QHP, if applicable;
9. Facilitating payment of the initial and group premium amount for FF-SHOP and
SBE-FP SHOP coverage, if applicable;
10. Facilitating an Enrollee’s ability to disenroll from a QHP;
11. Educating Consumers, Applicants, or Enrollees on Insurance Affordability Programs
and, if applicable, informing such individuals of eligibility for Medicaid or the
Children’s Health Insurance Program (“CHIP”);
12. Assisting Enrollees to report changes in eligibility status to the FFEs and SBE-FPs
throughout the coverage year, including changes that may affect eligibility (e.g.,
adding a dependent);
13. Handling FF-SHOP or SBE-FP SHOP coverage changes throughout the plan year
that may impact eligibility, including, but not limited to, adding a new hire, removing
an Employee no longer employed at the company, removing an Employee no longer
employed full-time, and adding a newborn or spouse during a special enrollment
period, if applicable;
14. Correcting errors in the application for QHP enrollment;

3

15. Informing or reminding Enrollees when QHP coverage should be renewed, when
Enrollees may no longer be eligible to maintain their current QHP coverage because
of age, or to inform Enrollees of QHP coverage options at renewal;
16. Providing appropriate Information, materials, and programs to Consumers,
Applicants, Qualified Individuals, Enrollees, Qualified Employers, and Qualified
Employees—or these individuals’ legal representatives or Authorized
Representatives—to inform and educate them about the use and management of their
health Information, as well as medical services and benefit options offered through
the selected QHP or among the available QHP options;
17. Contacting Consumers, Applicants, Qualified Individuals, Enrollees, Qualified
Employers and Qualified Employees—or these individuals’ legal representatives or
Authorized Representatives—to assess their satisfaction or resolve complaints with
services provided by Web-broker in connection with the FFEs and SBE-FPs,
including FF-SHOPs and SBE-FP-SHOPs, the Web-broker, or QHPs;
18. Providing assistance in communicating with QHP Issuers;
19. Providing Customer Service activities related to FF-SHOP or SBE-FP SHOP
coverage if permitted under State and federal law, including correction of errors on
FF-SHOP or SBE-FP SHOP applications and policies, handling complaints and
appeals regarding FF-SHOP or SBE-FP SHOP coverage, responding to questions
about FF-SHOP or SBE-FP insurance policies, assisting with communicating with
State regulatory authorities regarding FF-SHOP or SBE-FP SHOP issues, and
assistance in communicating with CMS;
20. Fulfilling the legal responsibilities related to the efficient functions of QHP Issuers in
the FFEs and SBE-FPs, including FF-SHOPs and SBE-FP-SHOPs, as permitted or
required by Web-broker’s contractual relationships with QHP Issuers; and
21. Performing other functions substantially similar to those enumerated above and such
other functions that CMS may approve in writing from time to time.
b. Standards for Handling PII. Web-broker agrees that it will create, collect, disclose,
access, maintain, use, or store PII that it receives directly from Consumers, Applicants,
Qualified Individuals, Enrollees, Qualified Employers, Qualified Employees—or these
individuals’ legal representatives or Authorized Representatives—and from Hub Web
Services, if applicable, only in accordance with all laws as applicable, including section
1411(g) of the ACA. The Hub Web Services are not available for SHOP.
1. Security and Privacy Controls. Web-broker agrees to monitor, periodically assess,
and update its security and privacy controls documented in the NEE SSP and related
system risks to ensure the continued effectiveness of those controls in accordance
with this Agreement, including Appendix A: Privacy and Security Standards for ,
Appendix B: Annual Security and Privacy Assessment (SPA), NEE Information
Security and Privacy Continuous Monitoring (ISCM) Strategy Guide, and the NEE
SSP. Furthermore, Web-broker agrees to timely inform the Exchange of any material
change in its administrative, technical, or operational environments, or any material
change that would require an alteration of the privacy and security standards within
this Agreement.
4

2. Downstream and Delegated Entities. Web-broker will satisfy the requirement in 45
C.F.R. § 155.260(b)(2)(v) to bind downstream and delegated entities to the same
privacy and security standards that apply to Non-Exchange Entities by entering into
written agreements with any downstream and delegated entities that will have access
to PII as defined in this Agreement. Web-broker must require in writing all
downstream and delegated entities adhere to the terms of this Agreement.
c. Collection of PII. Subject to the terms and conditions of this Agreement and applicable
laws, in performing the tasks contemplated under this Agreement, Web-broker may
create, collect, disclose, access, maintain, store, and use the following data and PII from
CMS, Consumers, Applicants, Qualified Individuals, Enrollees, Qualified Employers,
and Qualified Employees—or these individuals’ legal representatives or Authorized
Representatives—including, but not limited to:
1. For individual market QHP coverage:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

APTC percentage and amount applied
Auto disenrollment Information
Applicant name
Applicant address
Applicant birthdate
Applicant telephone number
Applicant email
Applicant Social Security Number
Applicant spoken and written language preference
Applicant Medicaid Eligibility indicator, start and end dates
Applicant CHIP eligibility indicator, start and end dates
Applicant QHP eligibility indicator, start and end dates
Applicant APTC percentage and amount applied eligibility indicator, start and
end dates
Applicant household income
Applicant maximum APTC amount
Applicant CSR eligibility indicator, start and end dates
Applicant CSR level
Applicant QHP eligibility status change
Applicant APTC eligibility status change
Applicant CSR eligibility status change
Applicant Initial or Annual Open Enrollment Indicator, start and end dates
Applicant Special Enrollment Period eligibility indicator and reason code
Contact name
Contact address
Contact birthdate
Contact telephone number
Contact email
Contact spoken and written language preference
Enrollment group history (past six months)
Enrollment type period
FFE Applicant ID
5

•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

FFE Member ID
Issuer Member ID
Net premium amount
Premium amount, start and end dates
Credit or Debit Card Number, name on card
Checking account and routing number
Special Enrollment Period reason
Subscriber indicator and relationship to subscriber
Tobacco use indicator and last date of tobacco use
Custodial parent
Health coverage
American Indian/Alaska Native status and name of tribe
Marital status
Race/ethnicity
Requesting financial assistance
Responsible person
Dependent name
Applicant/dependent sex
Student status
Subscriber indicator and relationship to subscriber
Total individual responsibility amount

2. For SHOP QHP coverage:
Category
Description

Employee PII
Employee Applicant Name
Employee Unique Employer Code
Employee Home Address
Employee Applicant Mailing Address
Employee Applicant Birthdate
Employee Social Security Number
Employee Applicant Telephone Number (and type)
Employee Applicant Email Address
Employee Applicant Spoken and Written Language Preference
Employee Tobacco Use Indicator and Last Date of Tobacco Use
Employee Sex
Employee Race and Ethnicity
Employer Business Name
If American Indian/Alaska Native: Name and Location of Tribe
Health Coverage Type (Individual or Family, if offered)
Health Plan Name and ID Number
Dental Plan Name and ID Number

6

Category
Description

Employee PII
continued

Employer
Offering
Coverage
Information

Other Sources of Coverage
Accepting or Waiving Coverage
Dependent Information, if applicable, including:
• Dependent Name
• Dependent Date of Birth
• Dependent Social Security Number
• Dependent Relationship to Employee
• Dependent Sex
• Dependent Spoken and Written Language Preference
• Dependent Race and Ethnicity
• If American Indian/Alaska Native: Name and Location of Tribe
• Dependent Tobacco Use Indicator and Last Date of Tobacco Use
• If individual is living outside of home; name of individual,
address, phone, email address
• Dependent Other Sources of Coverage
• Dependent Accepting or Waiving Coverage
• Special Circumstances for Employees and Dependents, i.e.,
marriage, moving, adopting children, losing eligibility for
coverage under a group health plan or losing Employer
contribution, or giving birth
Employer Name/“Doing Business As”
Employer Federal Tax ID Number
Employer Address
Business Type
Employer Attestation to SHOP Eligibility Requirements
Employer Contact Information
Employer Contact Name and Title
Employer Contact Mailing Address (if different than employer address)
Employer Contact Phone Numbers (and type)
Employer Contact Spoken and Written Language Preference
Employer Contact Email Address
Employer Contact Fax Number
Secondary Contact Name (optional)
Secondary Contact Phone number (and type)
Secondary Contact Fax Number
Secondary Contact Email Address
Secondary Contact Authorizations
Employer Coverage Offered
Employer-selected AV Levels (Bronze, Silver, Gold, or Platinum)
Benchmark Plan
7

Category
Description
Employer
Offering
Coverage
Information
continued

Offer of Dependent Coverage
Agent/Broker/Assister/Navigator Name, Organization Name, Contact
Information, FFM User ID
Employer Contribution Information:
• Benchmark Plan ID number-Medical Plan
• Benchmark Plan ID number-Dental Plan
• Percentage towards Employee-Medical Coverage
• Percentage towards Employee Dental Coverage
• Percentage towards Dependent Medical Coverage
• Percentage towards Dependent Dental Coverage
• Employer Offering-Single QHP or Single Metal Level or Single
Issuer
• Employer Offering-Single Stand-alone Dental Plan (“SADP”) or
multiple SADPs
Offer of Stand-alone Dental Coverage
Desired Effective Date of Coverage
Employee Selection Due Date
Waiting Period for New Hires to Enroll
Employee List, including:
• Employee Name
• Employee Date of Birth
• Employee Age
• Employee Social Security Number
• Employee Email Address
• Employee Employment Status
• Employee’s Other Coverage
• Number of Dependents
• Dependent Information, including Dependent Name
• Dependent Date of Birth
• Dependent Age
• Dependent Social Security Number
• Dependent Email Address
• Dependent’s Other Coverage
Payment Method options, including:
• Electronic Funds Transfer Information (Checking Account
Number, Routing Number)
• Credit Card Information (Credit Card type, Name on Credit Card,
Credit Card Number, Expiration Date, Signature, Signature Date)
• Checking Information
Employer Attestation to Consolidated Omnibus Budget Reconciliation
Act (“COBRA”)/Medicare Compliance Questions

8

d. Use of PII. PII collected from Consumers, Applicants, Qualified Individuals, Enrollees,
Qualified Employees, and Qualified Employers—or these individuals’ legal
representatives or Authorized Representatives—in the context of completing an
application for QHP, APTC, or CSR eligibility, if applicable, or enrolling in a QHP, or
any data transmitted from or through the Hub, if applicable, may be used only for
Authorized Functions specified in Section II.a of this Agreement. Such Information may
not be used for purposes other than authorized by this Agreement or as consented to by a
Consumer, Applicant, Qualified Individual, Enrollee, Qualified Employee, and Qualified
Employer—or these individuals’ legal representatives or Authorized Representatives.
e. Collection and Use of Information Provided Under Other Authorities. This Agreement
does not preclude Web-broker from collecting Information from Consumers, Applicants,
Qualified Individuals, Enrollees, Qualified Employees, and Qualified Employers—or
these individuals’ legal representatives or Authorized Representatives—for a nonFFE/non-SBE-FP/non-Hub purpose, and using, reusing, and disclosing the non-FFE/nonSBE-FP/non-Hub Information obtained as permitted by applicable law and/or other
applicable authorities. Such Information must be stored separately from any PII collected
in accordance with Section II.c of this Agreement. The Hub Web Services are not
available for SHOP.
f. Commitment to Protect PII. Web-broker shall not release, publish, or disclose Consumer,
Applicant, Qualified Individual, or Enrollee PII to unauthorized personnel, and shall
protect such Information in accordance with provisions of any laws and regulations
governing the adequate safeguarding of Consumer, Applicant, Qualified Individual, or
Enrollee PII, the misuse of which carries with it the potential to cause financial,
reputational and other types of harm.
1. Technical leads must be designated to facilitate direct contacts between the Parties
to support the management and operation of the interconnection.
2. The overall sensitivity level of data or Information that will be made available or
exchanged across the interconnection will be designated as MODERATE as
determined by Federal Information Processing Standards (FIPS) Publication 199.
3. Web-broker agrees to comply with all federal laws and regulations regarding the
handling of PII—regardless of where the organization is located or where the data
are stored and accessed.
4. Web-broker’s Rules of Behavior must be at least as stringent as the HHS Rules of
Behavior. 2
1F

5. Web-broker understands and agrees that all financial and legal liabilities arising
from inappropriate disclosure or Breach of Consumer, Applicant, Qualified
Individual, or Enrollee PII while such Information is in the possession of Webbroker shall be borne exclusively by Web-broker.
6. Web-broker shall train and monitor staff on the requirements related to the
authorized use and sharing of PII with third parties and the consequences of
2

The HHS Rules of Behavior are available at the following link: https://www.hhs.gov/ocio/policy/hhs-rob.html.

9

unauthorized use or sharing of PII, and periodically audit their actual use and
disclosure of PII.
g. Ability of Individuals to Limit Collection and Use of PII. Web-broker agrees to provide
the Consumer, Applicant, Qualified Individual, Enrollee, Qualified Employee or
Qualified Employer—or these individuals’ legal representatives or Authorized
Representatives—the opportunity to opt in and have Web-broker collect, create, disclose,
access, maintain, store and use their PII. Web-broker agrees to provide a mechanism
through which the Consumer, Applicant, Qualified Individual, Enrollee, Qualified
Employee and Qualified Employer—or these individuals’ legal representatives or
Authorized Representatives—can limit Web-broker’s creation, collection, disclosure,
access, maintenance, storage, and use of their PII to the sole purpose of obtaining Webbroker’s assistance in performing Authorized Functions specified in Section II.a of this
Agreement.
h. Incident and Breach Reporting. Web-broker must implement Incident and Breach
Handling procedures as required by the NEE SSP and that are consistent with CMS’s
Incident and Breach Notification Procedures. Such policies and procedures must identify
the Web-broker’s Designated Security and Privacy Official(s), if applicable, and/or
identify other personnel authorized to access PII and responsible for reporting to CMS
and managing Incidents or Breaches; provide details regarding the identification,
response, recovery and follow-up of Incidents and Breaches, which should include
Information regarding the potential need for CMS to immediately suspend or revoke
access to the Hub for containment purposes. Web-broker agrees to report any Breach of
PII to the CMS IT Service Desk by telephone at (410) 786-2580 or 1-800-562-1963 or
via email notification at [email protected] within 24 hours from
knowledge of the Breach. Incidents must be reported to the CMS IT Service Desk by the
same means as Breaches within 72 hours from knowledge of the Incident.
III. Approval and Renewal Minimum Direct Enrollment (“DE”) Program Participation
Requirements.
a. Completion of Operational Readiness Review Required Under 45 C.F.R. §§
155.220(c)(6), 155.221(b)(4), and 155.221(f).
1. End-to-End Testing and Enrollment Validation Requirement. In order to be
approved as a Web-broker, or to maintain status as an Existing Web-broker during
Web-broker Agreement renewal, Web-broker must demonstrate a successful end-toend DE transaction through any of the following: a history of enrollments
completed via Classic DE or EDE during the term of the prior year’s Web-broker
Agreement or by end-to-end testing either with the Hub or during the EDE business
audit submission process within the term of the prior year’s Web-broker
Agreement, as applicable.
2. Operational and Oversight Information Form. In order to be approved as a Webbroker, Web-broker must submit an Operational and Oversight Information Form to
CMS in the form and manner specified by CMS. In order to maintain status as an
Existing Web-broker during Web-broker Agreement renewal, Web-broker must
submit annually an Operational and Oversight Information Form to CMS in the
form and manner specified by CMS.
10

3. Operational Information. When onboarding annually during Agreement renewal, and
upon request, the Web-broker must provide CMS operational Information, including,
but not limited to, its Designated Representative’s National Producer Number (NPN),
State licensure Information, and Information about its downstream Agents/Brokers, if
applicable.
4. Pre-Approval Website Review. Prospective Web-brokers must receive and resolve
any designated compliance findings identified by CMS during a pre-approval
website review prior to receiving a countersigned Web-broker Agreement. To
facilitate this review, upon request, a Prospective Web-broker must provide CMS
with a set of credentials CMS can use to access the Prospective Web-broker’s
testing DE Environment (i.e., the pre-production environment) to complete the
website review of the Prospective Web-broker’s DE Environment. The Prospective
Web-broker must ensure that the testing credentials are valid and that all APIs and
components in the testing DE Environment are accessible for the duration of the
review. This provision does not apply to Existing Web-brokers that have received a
CMS website review during the term of the prior year’s Web-broker Agreement.
5. Designated Representative Registration and Training with the Exchange. Webbroker’s Designated Representative(s) must complete the applicable annual
registration and training requirements with the Exchange. Web-broker, including
Agent or Broker Direct Enrollment Technology Provider, must provide this
information to CMS to connect to the DE or EDE web services in production.
6. Privacy and Security Documentation. In order to receive approval to participate in
DE and utilize an approved DE Environment, Web-brokers must submit the
complete set of documents outlined in Table 1 of Appendix A: Privacy and Security
Standards for Web-brokers to CMS, except as noted in the “Submission
Requirements” column and must comply with the privacy and security audit
requirements under Section IX of this Agreement. The annual assessment results
that serve as the basis for the documentation in Table 1 of Appendix B: Annual
Security and Privacy Assessment (SPA) are only valid for a period of 365 Days
from the completion date of the assessment. Web-brokers must complete the
continuous monitoring requirements detailed in the Information Security and
Privacy Continuous Monitoring (ISCM) Strategy Guide. 3
2F

The Web-broker must conduct penetration testing which examines the network,
application, device, and physical security of its DE Environment to discover
weaknesses and identify areas where the security posture needs improvement, and
subsequently, ways to remediate the discovered vulnerabilities. Web-brokers must
adhere to the requirements for Penetration Testing described in Section V.b and
Appendix B: Annual Security and Privacy Assessment (SPA) of this Agreement.
b. Web-broker Public List Requirements. In order to be listed on CMS’s Web-broker Public
List, Web-brokers must have completed the applicable onboarding or renewal processes
(see Section III.a of this Agreement); have a valid, countersigned Web-broker
The ISCM Strategy Guide is available on CMS zONE at the following link:
https://zone.cms.gov/document/privacy-and-security-audit.

3

11

Agreement; and have an active, approved Secure Sockets Layer (SSL) production
certificate with the Hub for the applicable plan year or an SSL production certificate
pending CMS approval under Section III.a.5 of this Agreement.
IV. Downstream Use of Web-broker’s DE Environment.
a. Downstream Agent/Broker and DE Entity Application Assister Use of a Web-broker’s
DE Environment. A Web-broker that provides access to its DE Environment to
downstream Agents and Brokers and DE Entity Application Assisters, consistent with 45
C.F.R. §§ 155.220(c)(4) and 155.221(c), must provide a DE Environment to its
downstream Agents and Brokers and DE Entity Application Assisters that complies with
this Agreement and the Web-broker requirements in 45 C.F.R. §§ 155.220 and 155.221.
Web-broker must not provide the capability for downstream Agents/Brokers to use its DE
Environment through the third party’s own website or otherwise outside of Web-broker’s
approved website. The use of embedding tools and programming techniques by
downstream Agents/Brokers, such as iframe technical implementations, that may enable
the distortion, manipulation, or modification of the approved DE Environment and the
overall DE End-User experience developed by Web-broker are prohibited.
As part of the DE or EDE-facilitated application and QHP application processes, Webbroker must not enable or allow the selection of QHPs by a consumer or Agent/Broker on
a third-party website that exists outside of the Web-broker’s approved DE Environment.
This includes pre-populating or pre-selecting a QHP for a consumer that was selected on
a downstream Agent’s/Broker’s website or a lead generator’s website. This prohibition
does not extend to websites that are provided, owned, and maintained by entities subject
to CMS regulations for QHP display (i.e., Web-brokers and QHP Issuers).
The Web-broker must have a written contract or other written arrangement with the
downstream Agent or Broker or DE Entity Application Assisters that governs the
arrangement and requires the adherence to the terms of this Agreement.
Upon request, Web-broker must provide CMS with information about its downstream
Agents/Brokers, Web-broker’s oversight of its downstream Agents/Brokers, and the DE
Environment(s) it provides to each of its downstream Agents/Brokers.
b. QHP Issuer Use of a Web-broker’s DE Environment. Web-broker may provide access to
its DE Environment to QHP Issuers for use by the QHP Issuer and/or the QHP Issuer’s
downstream Agents and Brokers and DE Entity Application Assisters that is branded and
specific to that QHP Issuer. In these cases, the Web-broker would be considered a
downstream and delegated entity of the QHP Issuer under 45 C.F.R. § 156.340. There
must be a written contract or other written arrangement between the Web-broker and the
QHP Issuer that governs the arrangement and requires adherence to the terms of this
Agreement. The QHP Issuer’s DE Environment that is provided by the Web-broker must
comply with the DE requirements applicable to QHP Issuers in 45 C.F.R. §§ 155.221 and
156.1230.
V. DE Environment and Website Requirements.
a. Maintenance of an Accurate Testing DE Environment. Web-broker must maintain a
testing DE Environment that accurately represents the Web-broker’s production DE
Environment and integration with the Classic DE pathway, including functional use of all
12

DE APIs. Web-brokers must maintain at least one testing DE Environment that reflects
the Web-broker’s current production DE Environments when developing and testing any
prospective changes to its production DE Environments. This will require Web-broker to
develop one or more separate testing DE Environments (other than production and the
testing DE Environment that reflects production) for developing and testing prospective
changes to Web-broker’s production DE Environments. Network traffic into and out of
all non-production environments is only permitted to facilitate system testing and must be
restricted by source and destination access control lists, as well as ports and protocols, as
documented in the NEE SSP, SA-11 implementation standard. Web-broker must not
submit actual PII to the FFE Testing Environments. The Web-broker shall not submit test
data to the FFE Production Environments. Web-broker’s testing DE Environment shall be
readily accessible to applicable CMS staff and contractors via the Internet to complete
CMS audits.
Upon request, Web-broker must provide CMS with a set of credentials and any additional
instructions necessary so that CMS can access the testing DE Environment that reflects
the Web-broker’s production environment to complete audits or otherwise confirm
compliance of Web-broker’s production DE Environments. The Web-broker must be able
to provide test credentials for all DE Environments that Web-broker hosts or provides
(and/or prototypes of those DE Environments), including, but not limited to, the Webbroker’s Consumer-facing DE Environment, Web-broker’s Agent/Broker-facing DE
Environment, a Consumer-facing website that the Web-broker provides for use by Agents
or Brokers, and an Agent- or Broker-facing DE Environment that the Web-broker
provides for use by Agents/Brokers. Web-broker must ensure that the testing credentials
are valid and that all APIs and components in the testing DE Environment, including the
remote identity proofing (RIDP) services, are readily accessible via Internet for CMS to
audit or otherwise confirm compliance of Web-broker’s production DE Environment as
determined necessary by CMS.
b. Penetration Testing. The DE Entity must conduct penetration testing which examines the
network, application, device, and physical security of its DE Environment to discover
weaknesses and identify areas where the security posture needs improvement, and
subsequently, ways to remediate the discovered vulnerabilities. Before conducting the
penetration testing, the DE Entity must execute a Rules of Engagement with its Auditor’s
penetration testing team. The DE Entity must also notify its CMS designated technical
counterparts on its annual penetration testing schedule a minimum of 5 business days
prior to initiation of the penetration testing using the CMS-provided form. 4 During the
penetration testing, the Auditor’s testing team shall not target IP addresses used for the
CMS and Non-CMS Organization connection and shall not conduct penetration testing in
the production environment. The penetration testing shall be conducted in the lower
environment that reflects the DE Entity’s current production environment.
3F

c. Limit Concurrent Sessions. The Web-broker must limit the number of concurrent
sessions to one (1) session per a single set of credentials/FFE user ID. However, multiple
sessions associated with a single set of credentials/FFE user ID that is traceable to a
The Penetration Testing Notification Form is available at the following links:
https://zone.cms.gov/document/privacy-and-security-audit.

4

13

single device/browser is permitted.
d. Health Reimbursement Arrangement (HRA) Messaging. If Web-broker implements full
HRA functionality, Web-broker must implement required User Interface (UI) messaging
for qualified individuals who have an HRA offer that is tailored to the type and
affordability of the HRA offered to the qualified individuals consistent with CMS
guidance. Required UI messaging for various scenarios is detailed in the FFEs DE API
for Web-brokers/Issuers Technical Specifications document. 5
4F

e. APTC Selection and Attestation. Web-broker must allow Consumers, Applicants,
Qualified Individuals, and Enrollees—or these individuals’ legal representatives or
Authorized Representatives—to select and attest to an APTC amount, if applicable, in
accordance with 45 C.F.R. § 155.310(d)(2). Web-broker should use the specific language
detailed in the FFE and FF-SHOP Enrollment Manual 6 when providing Consumers,
Applicants, Qualified Individuals, and Enrollees—or these individuals’ legal
representatives or Authorized Representatives—with the ability to attest to an APTC
amount.
5F

VI. Effective Date and Term; Renewal.
a. Effective Date and Term. This Agreement becomes effective on the date the last of the
two Parties executes this Agreement and ends the Day before the first Day of the open
enrollment period (“OEP”) under 45 C.F.R. § 155.410(e)(3) for the benefit year
beginning January 1, 2025.
b. Renewal. This Agreement may be renewed upon the mutual agreement of the Parties for
subsequent and consecutive one (1) year periods upon thirty (30) Days’ advance written
notice to Web-broker.
VII. Suspension.
a. Suspension Pursuant to 45 C.F.R. §§ 155.220 and 155.221. The suspension of the ability
of Web-broker to transact information with the Exchange shall be governed by the
suspension standards adopted by the FFEs or SBE-FPs under 45 C.F.R. §§ 155.220 and
155.221.
b. Duration of Suspension. Consistent with the standards under 45 C.F.R. §§ 155.220 and
155.221, Web-broker will remain suspended until Web-broker remedies or sufficiently
mitigates the issue(s) that were the basis for the suspension to HHS’s satisfaction. If this
Agreement expires prior to HHS removing the suspension, HHS will not execute a
subsequent Web-broker Agreement with Web-broker until Web-broker remedies or
sufficiently mitigates the issue(s) to HHS’s satisfaction.
VIII. Termination.
a. Termination Without Cause. Either Party may terminate this Agreement without cause
and for its convenience upon thirty (30) Days’ prior written notice to the other Party.
The document Direct Enrollment API Specs is available on CMS zONE at the following link:
https://zone.cms.gov/document/direct-enrollment-de-documents-and-materials.
6
The SHOP Enrollment Manual is available on CMS zONE at the following link:
https://zone.cms.gov/document/direct-enrollment-de-documents-and-materials.
5

14

Web-broker must reference and complete the NEE Decommissioning Plan and NEE
Decommissioning Close Out Letter in situations where Web-broker will retire or
decommission its DE Environment. 7
6F

b. Termination of Agreement with Notice by CMS. The termination of this Agreement and
the reconsideration of any such termination shall be governed by the termination and
reconsideration standards adopted by the FFEs or SBE-FPs under 45 C.F.R. § 155.220.
Notwithstanding the foregoing, the Web-broker shall be considered in “Habitual Default”
of this Agreement in the event it has been served with a non-compliance notice under 45
C.F.R. § 155.220(g) more than three (3) times in any calendar year, whereupon CMS
may, in its sole discretion, immediately terminate this Agreement upon notice to Webbroker without any further opportunity to resolve the Breach and/or non-compliance.
CMS may also temporarily suspend the ability of a Web-broker to make its website
available to transact Information with HHS pursuant to 45 C.F.R. §§ 155.220(c)(4)(ii) or
155.221(d).
c. Termination for Failure to Maintain Valid State Licensure. Web-broker acknowledges
and agrees that valid State licensure in each State in which Web-broker assists
Consumers, Applicants, Qualified Individuals, Enrollees, Qualified Employees, and
Qualified Employers—or these individuals’ legal representatives or Authorized
Representatives—in applying for or obtaining coverage under a QHP through an FFE or
SBE-FP is a precondition to the Web-broker’s authority under this Agreement.
Accordingly, CMS may terminate this Agreement if Web-broker fails to maintain valid
licensure in at least one FFE or SBE-FP State, and in each State for which Web-broker
facilitates enrollment in a QHP through the FFE or an SBE-FP. Any such termination
shall be governed by the standards adopted by the FFE under 45 C.F.R. § 155.220(g) and
(h). If Web-broker is an Agent or Broker Direct Enrollment Technology Provider and
maintains no contractual relationships with Agents or Brokers and is not owned or
operated by an Agent or Broker, the entity would no longer meet the applicable definition
under 45 C.F.R. § 155.20 to be an Agent or Broker Direct Enrollment Technology
Provider. Web-broker understands and agrees that in such circumstances CMS may
immediately terminate this Agreement for cause, or the Agent or Broker Direct
Enrollment Technology Provider may provide advance notice to CMS to terminate this
agreement without cause per Section VIII.a of this Agreement. If the Agent or Broker
Direct Enrollment Technology Provider is unable to provide thirty (30) Days’ advance
notice to CMS, the Agent or Broker Direct Enrollment Technology Provider must notify
CMS within thirty (30) Days after the entity no longer meets the applicable definition
under 45 C.F.R. § 155.20 to be an Agent or Broker Direct Enrollment Technology
Provider.
d. Destruction of PII. Web-broker covenants and agrees to destroy all PII in its possession at
the end of the record retention period required under the NEE SSP, which is consistent
with NIST SP 800-88 Rev. 1. If, upon the termination or expiration of this Agreement,
Web-broker has in its possession PII for which no retention period is specified in the
NEE SSP, such PII shall be destroyed within thirty (30) Days of the termination or
The Non-Exchange Entity (NEE) Decommissioning Plan and NEE Decommissioning Close Out Letter are
available on CMS zONE at the following link: https://zone.cms.gov/document/privacy-and-security-audit
.
7

15

expiration of this Agreement. Web-broker’s duty to protect and maintain the privacy and
security of PII, as provided for in the NEE SSP, shall continue in full force and effect
until such PII is destroyed and shall survive the termination or expiration of this
Agreement.
e. Termination of Registration from the FFEs. Web-broker acknowledges that the
termination or expiration of this Agreement will result in the termination of the Webbroker’s registration with the FFE.
IX. Privacy and Security Audit Requirement. In order to receive approval to participate in DE
and utilize an approved DE Environment, Web-broker must contract with one or more
independent Auditor(s) consistent with this Agreement’s provisions and applicable
regulatory requirements to conduct an annual security and privacy assessment (SPA) as
described in Appendix B: Annual Security and Privacy Assessment (SPA), the ISCM
Strategy Guide, and the NEE SSP.
The Auditor must document and attest in the SPA documentation that Web-broker’s DE
Environment, including its website and operations, complies with the terms of this
Agreement, other applicable agreement(s) with CMS (including the EDE Business
Agreement and Interconnection Security Agreement), the Framework for the Independent
Assessment of Security and Privacy Controls, and applicable program requirements. EDE
Entity must submit the resulting SPA documentation to CMS. The SPA must detail EDE
Entity’s compliance with the requirements set forth in Appendix B, including any
requirements set forth in CMS guidance referenced in Appendix B The SPA that Webbroker submits to CMS must demonstrate that Web-broker’s Auditor(s) conducted its review
in accordance with the review standards set forth in Appendix B, the ISCM Strategy Guide,
and the NEE SSP.
CMS will approve Web-broker’s DE Environment only once it has reviewed and approved
the privacy and security audit findings reports. Final approval of Web-broker’s DE
Environment will be evidenced by CMS countersigning the ISA with Web-broker. Upon
receipt of the counter-signed ISA, Web-broker will be approved to use its approved DE
Environment consistent with applicable regulations, this Agreement, and the ISA.
a. Identification of Auditor(s) and Subcontractors of Auditor(s). All Auditor(s), including
any Auditor(s) that has subcontracted with Web-broker’s Auditor(s), will be considered
Downstream or Delegated Entities of Web-broker pursuant to Web-broker’s respective
agreement(s) with CMS and applicable program requirements. Web-broker must identify
each Auditor it selects, and any subcontractor(s) of the Auditor(s), in Appendix E:
Auditor Identification of this Agreement. Web-broker must also submit a copy of the
signed agreement or contract between the Auditor(s) and Web-broker to CMS.
b. Conflict of Interest. For any arrangement between Web-broker and an Auditor for audit
purposes covered by this Agreement, Web-broker must select an Auditor that is free from
any real or perceived conflict(s) of interest, including being free from personal, external,
and organizational impairments to independence, or the appearance of such impairments
to independence. Web-broker must disclose to HHS any financial relationships between
the Auditor, and individuals who own or are employed by the Auditor, and individuals
who own or are employed by a Web-broker for which the Auditor is conducting an ORR
privacy and security audit pursuant to 45 C.F.R. §§ 155.220(c)(6)(iv), 155.221(b)(4)(ii),
16

and 155.221(f). Web-broker must document and disclose any conflict(s) of interest in the
form in Appendix F: Conflict of Interest Disclosure Form, if applicable.
c. Auditor Independence and Objectivity. Web-broker’s Auditor(s) must remain
independent and objective throughout the audit process. An Auditor is independent if
there is no perceived or actual conflict of interest involving the developmental,
operational, and/or management chain associated with the DE Environment and the
determination of security and privacy control effectiveness. Web-broker must not take
any actions that impair the independence and objectivity of Web-broker’s Auditor. Webbroker’s Auditor must attest to their independence and objectivity in completing the DE
audit(s).
d. Required Documentation. Web-broker must maintain and/or submit the required
documentation detailed in Appendix B: Annual Security and Privacy Assessment (SPA),
including templates provided by CMS, to CMS in the manner specified in Appendix B:
Annual Security and Privacy Assessment (SPA). Documentation that Web-broker must
submit to CMS (as set forth in Section III and Appendices B, E, and F of this Agreement)
will constitute Web-broker’s Application.
X. Miscellaneous.
a. Notice. All notices to Parties specifically required under this Agreement shall be given in
writing and shall be delivered as follows:
•
•

If to CMS, by email at: [email protected]
If to Web-broker, to Web-broker’s email address on record.

Notices sent by email shall be deemed to have been given when the appropriate
confirmation of receipt has been received; notices not given on a business Day (i.e.,
Monday-Friday, excluding federal holidays) between 9:00 a.m. and 5:00 p.m. local
time where the recipient is located shall be deemed to have been given at 9:00 a.m.
on the next business Day for the recipient. A Party to this Agreement may change its
contact Information for notices and other communications by providing written
notice of such changes in accordance with this provision. Such notice should be
provided thirty (30) Days in advance of such change, unless circumstances warrant a
shorter timeframe.
b. Assignment and Subcontracting. Except as otherwise provided in this Section, Webbroker shall not assign this Agreement in whole or in part, whether by merger,
acquisition, consolidation, reorganization, or otherwise any portion of the services to be
provided by Web-broker under this Agreement without the express, prior written consent
of CMS, which consent may be withheld, conditioned, granted, or denied in CMS’ sole
discretion. Web-broker must provide written notice at least thirty (30) Days prior to any
such proposed assignment, including any change in ownership of Web-broker or any
change in management or ownership of the DE Environment. Notwithstanding the
foregoing, CMS does not require prior written consent for subcontracting arrangements
that do not involve the operation, management, or control of the DE Environment. Webbroker must report all subcontracting arrangements on its annual Operational and
Oversight Information form during the annual Web-broker agreement renewal process
and submit revisions annually thereafter. Web-broker shall assume ultimate responsibility
17

for all services and functions described under this Agreement, including those that are
subcontracted to other entities, and must ensure that subcontractors will perform all
functions in accordance with all applicable requirements. Web-broker shall further be
subject to such oversight and enforcement actions for functions or activities performed by
subcontractor entities as may otherwise be provided for under applicable law and
program requirements, including this Agreement with CMS. Notwithstanding any
subcontracting of any responsibility under this Agreement, Web-broker shall not be
released from any of its performance or compliance obligations hereunder, and shall
remain fully bound to the terms and conditions of this Agreement as unaltered and
unaffected by such subcontracting.
If Web-broker attempts to make an assignment, subcontracting arrangement or otherwise
delegate its obligations hereunder in violation of this provision, such assignment,
subcontract, or delegation shall be deemed void ab initio and of no force or effect, and
Web-broker shall remain legally bound hereto and responsible for all obligations under
this Agreement.
c. Use of the Hub Web Services. Web-broker will only use a CMS-approved DE
Environment when accessing the APIs and web services that facilitate functionality to
enroll Consumers, Applicants, Qualified Individuals, Enrollees, Qualified Employees,
and Qualified Employers—or these individuals’ legal representatives or Authorized
Representatives—through the FFEs and SBE-FPs, which includes compliance with the
requirements detailed in Appendix A: Privacy and Security Standards for , Appendix B:
Annual Security and Privacy Assessment (SPA), and Appendix D: Standards for
Communication with the Hub.
d. Survival. Web-broker’s duty to protect and maintain the privacy and security of PII and
any other obligation under this Agreement which, by its express terms or nature and
context is intended to survive expiration or termination of this Agreement, shall survive
the expiration or termination of this Agreement.
e. Severability. The invalidity or unenforceability of any provision of this Agreement shall
not affect the validity or enforceability of any other provision of this Agreement. In the
event that any provision of this Agreement is determined to be invalid, unenforceable or
otherwise illegal, such provision shall be deemed restated, in accordance with applicable
law, to reflect as nearly as possible the original intention of the Parties, and the remainder
of the Agreement shall be in full force and effect.
f. Disclaimer of Joint Venture. Neither this Agreement nor the activities of Web-broker
contemplated by and under this Agreement shall be deemed or construed to create in any
way any partnership, joint venture or agency relationship between CMS and Web-broker.
Neither Party is, nor shall either Party hold itself out to be, vested with any power or right
to bind the other Party contractually or to act on behalf of the other Party, except to the
extent expressly set forth in the ACA and the regulations codified thereunder, including
as codified at 45 C.F.R. part 155.
g. Remedies Cumulative. No remedy herein conferred upon or reserved to CMS under this
Agreement is intended to be exclusive of any other remedy or remedies available to CMS
under operative law and regulation, and each and every such remedy, to the extent

18

permitted by law, shall be cumulative and in addition to any other remedy now or
hereafter existing at law or in equity or otherwise.
h. Records. Web-broker shall maintain all records that it creates in the normal course of its
business in connection with activity under this Agreement for the term of this Agreement
in accordance with 45 C.F.R. § 155.220(c)(3)(i)(E). Subject to applicable legal
requirements and reasonable policies, such records shall be made available to CMS to
ensure compliance with the terms and conditions of this Agreement. The records shall be
made available during regular business hours at Web-broker’s offices, and CMS’s review
shall not interfere unreasonably with Web-broker’s business activities. This clause
survives the expiration or termination of this Agreement.
i. Compliance with Law. Web-broker covenants and agrees to comply with any and all
applicable laws, statutes, regulations, or ordinances of the United States of America and
any Federal Government agency, board, or court that are applicable to the conduct of the
activities that are the subject of this Agreement, including, but not necessarily limited to,
any additional and applicable standards required by statute, and any regulations or
policies implementing or interpreting such statutory provisions hereafter issued by CMS.
In the event of a conflict between the terms of this Agreement and any statutory,
regulatory, or sub-regulatory guidance released by CMS, the requirement that constitutes
the stricter, higher, or more stringent level of compliance shall control.
j. Governing Law and Consent to Jurisdiction. This Agreement will be governed by the
laws and common law of the United States of America, including without limitation such
regulations as may be promulgated by HHS or any of its constituent agencies, without
regard to any conflict of laws statutes or rules. Web-broker further agrees and consents to
the jurisdiction of the Federal Courts located within the District of Columbia and the
courts of appeal therefrom, and waives any claim of lack of jurisdiction or forum non
conveniens.
k. Amendment. CMS may amend this Agreement for purposes of reflecting changes in
applicable law or regulations, with such amendments taking effect upon thirty (30) Days’
written notice to Web-broker (“CMS notice period”), unless circumstances warrant an
earlier effective date. Any amendments made under this provision will only have
prospective effect and will not be applied retrospectively. Web-broker may reject such
amendment by providing to CMS, during the CMS notice period, written notice of its
intent to reject the amendment (“rejection notice period”). Any such rejection of an
amendment made by CMS shall result in the termination of this Agreement upon
expiration of the rejection notice period.
l. Audit and Compliance Review. Web-broker agrees that CMS, the Comptroller General,
the Office of the Inspector General of HHS, or their designees may conduct compliance
reviews or audits, which includes the right to interview employees, contractors and
business partners of Web-broker and to audit, inspect, evaluate, examine, and make
excerpts, transcripts, and copies of any books, records, documents, and other evidence of
Web-broker’s compliance with the requirements of this Agreement upon reasonable
notice to Web-broker, during Web-broker’s regular business hours, and at Web-broker’s
regular business location. These audit and review rights include the right to audit Webbroker’s compliance with and implementation of the privacy and security requirements

19

under this Agreement. Web-broker further agrees to allow reasonable access to the
Information and facilities, including, but not limited to, Web-broker website testing
environments, requested by CMS, the Comptroller General, the Office of the Inspector
General of HHS, or their designees for the purpose of such a compliance review or audit.
CMS may suspend or terminate this Agreement if Web-broker does not comply with such
a compliance review request within seven (7) business Days. If any of Web-broker’s
obligations under this Agreement are delegated to other parties, Web-broker’s agreement
with any delegated or downstream entities must incorporate this Agreement provision.
This clause survives the expiration or termination of this Agreement.
m. Access to the FFEs and SBE-FPs. Any Web-broker; its Downstream and Delegated
Entities, including downstream Agents/Brokers; and its assignees or subcontractors,
including, employees, developers, agents, representatives, or contractors, cannot remotely
connect or transmit data to the FFE, SBE-FP or its testing environments, nor remotely
connect or transmit data to a Web-broker’s systems that maintain connections to the FFE,
SBE-FP or its testing environments, from locations outside of the United States of
America or its territories, embassies, or military installations. This includes any such
connection through virtual private networks (“VPNs”).

[REMAINDER OF PAGE INTENTIONALLY LEFT BLANK]

20

This “Agreement Between Web-Broker and the Centers for Medicare & Medicaid Services for
the Federally-facilitated Exchanges and State-based Exchanges on the Federal Platform” has
been signed and executed by:
TO BE FILLED OUT BY WEB-BROKER
The undersigned is an authorized official of Web-broker who is authorized to represent and
bind Web-broker for purposes of this Agreement.

Signature of Authorized Official of Web-broker

Date

Printed Name and Title of Authorized Official of Web-broker

Web-broker Name

Signature of Privacy Officer Attesting Compliance that Web-broker Systems Comply with
Appendices A and B of this Agreement and the Non-Exchange Entity System Security and
Privacy Plan

Printed Name and Title of Privacy Officer Attesting Compliance that Web-broker Systems
Comply with Appendices A and B of this Agreement and the Non-Exchange Entity System
Security and Privacy Plan

Web-broker Partner ID
Web-broker Address

Web-broker Contact Number

Web-broker must indicate in the below checkbox whether Web-broker will assist Qualified
Employees and/or Qualified Employers in applying for or enrolling in SHOP coverage for the
benefit year as defined in Section VI.a of this Agreement:
☐ Web-broker will assist Qualified Employees and/or Qualified Employers in the benefit year as
defined in this Agreement
21

☐ Web-broker will not assist Qualified Employees and/or Qualified Employers in the benefit year as
defined in this Agreement

22

FOR CMS
The undersigned are officials of CMS who are authorized to represent and bind CMS for
purposes of this Agreement.

Jeffrey D. Grant
Deputy Director for Operations
Center for Consumer Information and Insurance Oversight
Centers for Medicare & Medicaid Services

Date

George C. Hoffmann
Deputy CIO and Deputy Director
Office of Information Technology (OIT)
Centers for Medicare & Medicaid Services (CMS)

Date

23

Appendix A: Privacy and Security Standards for Web-brokers
Federally-facilitated Exchanges (“FFEs”) will enter into contractual agreements with all NonExchange Entities, including Web-brokers, that gain access to Personally Identifiable
Information (“PII”) exchanged with the FFEs (including FF-SHOPs) and State-based
Exchanges on the Federal Platform (“SBE-FPs”) (including SBE-FP-SHOPs), or directly from
Consumers, Applicants, Qualified Individuals, Enrollees, Qualified Employees, and Qualified
Employers, or these individuals’ legal representatives or Authorized Representatives. This
Agreement and its appendices govern any PII that is created, collected, disclosed, accessed,
maintained, stored, or used by Web-brokers in the context of the FFEs and SBE-FPs (including
FF-SHOPs and SBE-FP-SHOPs). In signing this contractual Agreement, in which this
Appendix A has been incorporated, Web-brokers agree to comply with the security and
privacy standards and implementation specifications outlined in the Non-Exchange Entity
System Security and Privacy Plan (NEE SSP) 8 while performing the Authorized Functions
outlined in their respective Agreement(s) with CMS.
7F

The standards documented in the NEE SSP are established in accordance with Section 1411(g)
of the Affordable Care Act (“ACA”) (42 U.S.C. § 18081(g)), the Federal Information
Management Act of 2014 (“FISMA”) (44 U.S.C. 3551), and 45 C.F.R. § 155.260 and are
consistent with the principles in 45 C.F.R. §§ 155.260(a)(1) through (a)(6). All capitalized terms
used herein carry the meanings assigned in Appendix C: Definitions. Any capitalized term that
is not defined in the Agreement, this Appendix or in Appendix C: Definitions has the meaning
provided in 45 C.F.R. § 155.20.
In addition, Web-brokers must comply with the annual security and privacy assessment (SPA)
requirements in Appendix B.

References to security and privacy controls and implementation standards can be found in the NEE SSP located on
CMS zONE at the following link: https://zone.cms.gov/document/privacy-and-security-audit.

8

24

Appendix B: Annual Security and Privacy Assessment (SPA)
Consistent with 45 C.F.R. §§ 155.220(c)(6)(iv), 155.221(b)(4)(ii) and 155.221(f), the Web-broker
must contract with one or more independent Auditors to conduct an annual SPA as described below
and in the ICSM Strategy Guide and the NEE SPP. All capitalized terms used herein carry the
meanings assigned in Appendix C: Definitions. Any capitalized term that is not defined in the
Agreement, this Appendix or in Appendix C: Definitions has the meaning provided in 45 C.F.R. §
155.20.
The SPA shall include the following:
•
•
•

Documentation of existing security and privacy controls;
Identification of potential security and privacy risks; and
Corrective action plan describing approach and timeline to implement security and
privacy controls to mitigate potential security and privacy risks.

(1) Independent Third-Party Audit. The Web-broker must contract with an independent third-party
Auditor(s) with experience conducting Information system privacy and security audits to
perform the SPA. The Web-broker and its Auditor(s) should refer to the Framework for
Independent Assessment of Security and Privacy Controls 9 which provides an overview of the
independent security and privacy assessment requirements.
8F

The Web-broker and its Auditor(s) may reference existing audit results that address some or all
of the SPA’s requirements. Such existing audit results must have been generated by an
independent third-party Auditor. In addition, such existing audit results must have been
produced within 365 Days of completion of the SPA. If existing audit reports do not address all
required elements of the SPA, the remaining elements must be addressed by an independent
third-party Auditor.
(2) Assessment Methodology. The SPA methodology herein is based on the standard CMS
methodology and is described in the Framework for Independent Assessment of Security and
Privacy Controls. The Auditor must prepare and Web-broker must submit a Security Privacy
Controls Assessment Test Plan (SAP) that describes the Auditor’s scope and methodology of
the assessment. Web-broker must submit the Auditor-prepared SAP at least thirty (30) Days
prior to commencing the assessment. The assessment methods may include examination of
documentation, logs, and configurations; interviews of personnel; and/or testing of technical
controls. The SPA must provide an accurate depiction of the security and privacy controls in
place, as well as potential security and privacy risks, by identifying the following:
a. Application or system vulnerabilities, the associated business and system risks and
potential impact;
b. Weaknesses in the configuration management process such as weak system
configuration settings that may compromise the confidentiality, integrity, and
availability of the system;
c. Web-broker security and privacy policies and procedures; and
d. Major documentation omissions and/or discrepancies.
This document is located on CMS zONE at the following link: https://zone.cms.gov/document/privacy-andsecurity-audit.

9

25

(3) Tests and Analysis Performed. The SPA must include tests that analyze applications, systems,
and associated infrastructure. 10 The tests should begin with high-level analyses and increase in
specificity. Tests and analyses performed during an assessment should include:
9F

a. Security Control technical testing;
b. Penetration testing;
c. Adherence to privacy program policies;
d. Network and component vulnerability scanning;
e. Configuration assessment;
f. Documentation review;
g. Personnel interviews; and
h. Observations.
(4) Noncompliance and Applicability. The Web-broker must develop a corrective action plan to
mitigate any security and privacy risks if the SPA identifies a deficiency in the Web-broker’s
security and privacy controls as documented in a Plan of Action & Milestones (PO&M).
Alternatively, the Web-broker may document why it believes a critical control is not applicable
to its system or circumstances. The SPA results do not alter this Agreement, including any
penalties for non-compliance. If the Web-broker’s SPA includes findings suggesting significant
security or privacy risks, and the Web-broker does not commence development and
implementation of a corrective action plan to the reasonable satisfaction of CMS, a
comprehensive audit may be initiated by CMS, and/or this Agreement may be terminated for
cause. In addition, CMS may delay providing final approval or may withdraw prior approval of
Web-broker’s DE Environment if the Web-broker does not address to the reasonable
satisfaction of CMS the findings suggesting significant security or privacy risks.
(5) Non-Exchange Entity System Security Plan (“NEE SSP”). The Web-broker must implement the
controls documented in the Security and Privacy Controls for Web-brokers Supplement, though,
CMS strongly recommends Web-brokers participating in Classic DE implement all the NEE
SSP controls. 11 The Web-broker’s Auditor(s) must verify and document the Web-broker’s
implementation and compliance with at least the controls listed in the Security and Privacy
Controls for Web-brokers Supplement. The Security Privacy Assessment Report (SAR) will be
accepted by CMS as documentation of compliance with those controls so long as the assessment
has been conducted within 365 Days of the completion date of the previous assessment.
10F

(6) SPA Documentation Submission. The following table identifies the required SPA
documentation that Web-Brokers must submit to CMS.
Table 1: Web-broker Privacy and Security Document Submission Requirements

The Security and Privacy Controls Assessment Test Plan (SAP) Template and the Security and Privacy
Assessment Report (SAR) Template provide additional guidance on testing methodology and reporting
requirements. These documents are located on CMS zONE at the following link:
https://zone.cms.gov/document/privacy-and-security-audit.
11
The Security and Privacy Controls for Web-brokers Supplement will be posted at the following link on CMS
zONE: https://zone.cms.gov/document/privacy-and-security-audit .
10

26

Document
Security Privacy
Controls
Assessment
Test Plan (SAP)

Description
 The SAP describes the Auditor’s scope and methodology of the
assessment.
 The SAP includes an attestation of the Auditor’s independence.
 The SAP must be completed by the Auditor and submitted to CMS
for review, prior to conducting the security and privacy assessment
(SPA).

Submission Requirements
 Submit via the Entityspecific DE/EDE PME
site at least thirty (30)
days before commencing
the privacy and security
audit; during the planning
phase.

Security and
Privacy
Assessment
Report (SAR)

 The report should contain a summary of findings that includes ALL
findings from the assessment to include documentation reviews,
control testing, scanning, penetration testing, interview(s), etc.
o Explain if and how findings are consolidated.
o Ensure risk level determination is properly calculated,
especially when weaknesses are identified as part of the
Center for Internet Security (CIS) Top 20 and/or OWASP
Top 10.
 The assessment must be conducted by an independent third-party
Auditor with experience outlined in the Framework for Independent
Assessment. Among the experience required include familiarity
with National Institute of Standards and Technology (NIST)
standards, the Health Insurance Portability and Accountability Act
(HIPAA), and other applicable federal privacy and cybersecurity
regulations and guidance.:
 Alternatively, the Web-broker may reference existing audit results
that address some or all of the assessment’s requirements,
assuming the existing audit results were produced by a third-party
Auditor in conformity with the requirements described above.
o If existing audit reports do not address all required elements of
the assessment, the remaining elements must be addressed
utilizing one of the first two assessment options.
o If existing audit reports are utilized, the reports must have been
based on assessment activities completed within the last year.
 The SAR should not include comments that describe the thirdparty assessor’s process for verifying the requirement, unless
there is a specific issue or concern with respect to the requirement
that warrants raising the concern to CMS.
 The penetration test must include the DE Environment and must
include tests based on the Open Web Application Security Project
(OWASP) Top 10.
 A Web-broker must submit the most recent three (3) months of its
Vulnerability Scan Reports.
 All findings from vulnerability scans are expected to be
consolidated in the monthly POA&M (the POA&M is expected to be
updated monthly, if applicable, but only submitted as indicated in
the following row unless additional submissions are requested by
CMS).
 Similar findings can be consolidated.
 Submit a POA&M if its third-party assessor identifies any privacy
and security compliance issues in the SAR.

 Submit via the Entityspecific DE/EDE PME
site using the SAR
template on CMS zONE 12
 Only one final report
should be submitted to
CMS. Unless CMS has
provided comments
and/or requested edits to
the original submission
and requested a revised
resubmission, no
additional reports should
be submitted.

Annual
Penetration
Testing
Network and
Component
Vulnerability
Scans

Plan of Action
and Milestones
(POA&M)

11F

 Submit via the Entityspecific DE/EDE PME
site with the SAR
 Submit via web-broker’s
entity-specific DE/EDE
PME site with the SAR

 Submit via the webbroker’s entity-specific
DE/EDE PME site using

Documents, templates, and other materials will be posted at the following link on CMS zONE:
https://zone.cms.gov/document/privacy-and-security-audit.
12

27

Document






Description
Ensure all open findings from the SAR have been incorporated into
the POA&M.
Explain if and how findings from the SAR were consolidated on the
POA&M; include SAR reference numbers, if applicable.
Ensure the weakness source references each source in detail to
include type of audit/assessment and applicable date range.
Ensure the weakness description is as detailed as possible to
include location/server/etc., if applicable.
Ensure scheduled completion dates, milestones with dates, and
appropriate risk levels are included.
The NEE SSP must include complete and detailed Information
about the Prospective or Existing Web-broker’s implementation
specifications of required security and privacy controls.
The implementation of security and privacy controls must be
completely documented in the SSP before the audit is initiated.

Non-Exchange
Entity System
Security and
Privacy Plan
(NEE SSP) – if
requested



Risk
Acceptance
Form

 Ensure accepted risks are documented using the Risk Acceptance
Form and submitted with the POA&M during the regular POA&M
submission schedule 13.



12F

Submission Requirements
the POA&M template
on CMS zONE with the
SAR

 Web-brokers are not
required to submit the
NEE SSP to CMS.
However, CMS may
request and review
the NEE SSP.
 If requested to submit,
Web-brokers must use
the NEE SSP template on
CMS zONE.
 Submit via the webbroker’s entity-specific
DE/EDE PME site using
the Risk Acceptance
Form on CMS zONE with
the POA&M.

(7) Submission of SPA to CMS. The Web-broker must submit the SPA electronically in a format
specified by CMS during the Agreement renewal or initial onboarding process, but no later than
June 30, for Existing and Prospective Web-brokers, to mitigate risk of any delay in completing
the onboarding process and/or participation in the open enrollment period (OEP) as defined in
Section VI.a of this Agreement. Web-brokers must submit applicable SPA documentation in
accordance with the ISCM Strategy Guide throughout the term of the Agreement.
(8) CMS Review of Web-broker SPA Submission. CMS will review the Web-broker’s SPA
submission. If the SPA indicates that the Web-broker has not sufficiently implemented any
identified required control(s), CMS will require remedial action. A Web-broker that does not
submit the required SPA documentation or implement any required remedial actions may be
subject to the Termination with Cause provision (Section VIII.b) of this Agreement or
prohibited from executing the subsequent plan year’s Agreement. In addition, CMS may delay
providing final approval or may withdraw prior approval of Web-broker’s DE Environment if
the Web-broker does not address to the reasonable satisfaction of CMS findings suggesting
significant security or privacy risks.
[REMAINDER OF PAGE INTENTIONALLY LEFT BLANK]
The Risk Acceptance Form is available on CMS zONE at the following link:
https://zone.cms.gov/document/privacy-and-security-audit.
13

28

Appendix C: Definitions
This Appendix defines terms that are used in the Agreement and other Appendices. Any
capitalized term used in the Agreement or Appendices that is not defined therein or in this
Appendix has the meaning provided in 45 C.F.R. § 155.20.
(1)

Advance Payments of the Premium Tax Credit (“APTC”) has the meaning set forth
in 45 C.F.R. § 155.20.

(2)

Affordable Care Act (“ACA”) means the Affordable Care Act (Public Law 111-148),
as amended by the Health Care and Education Reconciliation Act of 2010 (Public Law
111-152), which are referred to collectively as the Affordable Care Act or ACA.

(3)

Agent or Broker has the meaning set forth in 45 C.F.R. § 155.20.

(4)

Agent or Broker Direct Enrollment Technology Provider has the meaning set forth in
45 C.F.R. § 155.20.

(5)

Applicant has the meaning set forth in 45 C.F.R. § 155.20.

(6)

Auditor means a person or organization that meets the requirements set forth in this
Agreement and contracts with a Direct Enrollment (DE) Entity for the purposes of
conducting an Operational Readiness Review (ORR) in accordance with 45 C.F.R. §§
155.220(c)(6) and 155.221(b)(4) and (f), this Agreement and CMS-issued guidance.

(7)

Authorized Function means a task performed by a Non-Exchange Entity that the NonExchange Entity is explicitly authorized or required to perform based on applicable law
or regulation, and as enumerated in the Agreement that incorporates this Appendix C:
Definitions.

(8)

Authorized Representative means a person or organization meeting the requirements set
forth in 45 C.F.R. § 155.227.

(9)

Breach has the meaning contained in OMB Memoranda M-17-12 (January 3, 2017), and
means the loss of control, compromise, unauthorized disclosure, unauthorized acquisition,
or any similar occurrence where: (1) a person other than an authorized user accesses or
potentially accesses Personally Identifiable Information (“PII”) or (2) an authorized user
accesses or potentially accesses PII for anything other than an authorized purpose.

(10) CCIIO means the Center for Consumer Information and Insurance Oversight within the
Centers for Medicare & Medicaid Services (“CMS”).
(11) Certified Application Counselor means an organization, staff person, or volunteer
meeting the requirements set forth in 45 C.F.R. § 155.225.
(12) Classic Direct Enrollment (“Classic DE”) means, for the purposes of this Agreement,
the original version of Direct Enrollment, which utilizes a double redirect from a Direct
Enrollment (DE) Entity’s website to HealthCare.gov where the eligibility application is
submitted and an eligibility determination is received, and back to the DE Entity’s
website for Qualified Health Plan (“QHP”) shopping and plan selection consistent with
applicable requirements in 45 C.F.R. §§ 155.220(c)(3)(i), 155.221, 156.265 and/or
156.1230(b).
29

(13) Classic Direct Enrollment Pathway (“Classic DE Pathway”) means, for the purposes
of this Agreement, the application and enrollment process used by Direct Enrollment
(DE) Entities for Classic DE.
(14) CMS means the Centers for Medicare & Medicaid Services.
(15) CMS Companion Guides means a CMS-authored guide, available on the CMS
website, which is meant to be used in conjunction with and supplement relevant
implementation guides published by the Accredited Standards Committee.
(16) CMS Data Services Hub (“Hub”) is the CMS federally-managed service to interface
data among connecting entities, including HHS, certain other federal agencies, and State
Medicaid agencies. The Hub is not available for the Small Business Health Options
Program (SHOP).
(17) CMS Data Services Hub Web Services (“Hub Web Services”) means business and
technical services made available by CMS to enable the determination of certain
eligibility and enrollment or federal financial payment data through the Federallyfacilitated Exchange (“FFE”) website, including the collection of personal and financial
Information necessary for Consumer, Applicant, Qualified Individual, or Enrollee
account creations; Qualified Health Plan (“QHP”) application submissions; and
Insurance Affordability Program eligibility determinations. The Hub Web Services are
not available for the Small Business Health Options Program (SHOP).
(18) Consumer means a person who, for himself or herself, or on behalf of another
individual, seeks Information related to eligibility or coverage through a Qualified
Health Plan (“QHP”) offered through an Exchange or Insurance Affordability Program,
or whom an Agent, Broker, or Web-broker registered with the FFE, Navigator, Issuer,
Certified Application Counselor, or other entity assists in applying for a QHP, applying
for APTC and CSRs, and/or completing enrollment in a QHP through the FFEs or Statebased Exchanges on the Federal Platform (“SBE-FPs”) for individual market coverage.
(19) Cost-sharing Reductions (“CSRs”) has the meaning set forth in 45 C.F.R. § 155.20.
(20) Customer Service means assistance regarding eligibility and Health Insurance Coverage
provided to a Consumer, Applicant, or Qualified Individual, including, but not limited to,
responding to questions and complaints; providing Information about eligibility;
applying for APTC and CSRs, and Health Insurance Coverage; and explaining
enrollment processes in connection with the FFEs. Includes assistance provided to
Qualified Employers and Qualified Employees regarding FF-SHOP and SBE-FP SHOP
coverage.
(21) Day or Days means calendar days unless otherwise expressly indicated in the relevant
provision of the Agreement that incorporates this Appendix C: Definitions.
(22) Designated Representative means an Agent or Broker that has the legal authority to act
on behalf of the Web-broker.
(23) Direct Enrollment (“DE”) means, for the purposes of this Agreement, the process by
which a Direct Enrollment (DE) Entity may assist an Applicant or Enrollee with
enrolling in a QHP in a manner that is considered through the Exchange consistent
with applicable requirements in 45 C.F.R. §§ 155.220(c), 155.221, 156.265, and/or
30

156.1230. Direct Enrollment is the collective term used when referring to both
Classic Direct Enrollment and Enhanced Direct Enrollment.
(24) Direct Enrollment (“DE”) End-User Experience means all aspects of the preapplication, application, enrollment, and post-enrollment experience and any data
collected necessary for those steps or for the purposes of any Authorized Functions
under this Agreement.
(25) Direct Enrollment (“DE”) Entity has the meaning set forth in 45 C.F.R. § 155.20.
(26) Direct Enrollment (DE) Entity Application Assisters has the meaning set forth in 45
C.F.R. § 155.20.
(27) Direct Enrollment (“DE”) Environment means an Information technology application
or platform provided, owned, and maintained by a DE Entity through which a DE Entity
establishes an electronic connection with the Hub and, utilizing a suite of CMS APIs,
submits Consumer, Applicant, Qualified Individual, or Enrollee Information to the FFE
for the purpose of assisting Consumers, Applicants, Qualified Individuals, Enrollees,
Qualified Employees, and Qualified Employers—or these individuals’ legal
representatives or Authorized Representatives—in applying for APTC and/or CSRs;
applying for enrollment in QHPs offered through an FFE or SBE-FP; or completing
enrollment in QHPs offered through an FFE or SBE-FP.
(28) Enhanced Direct Enrollment (“EDE”) means, for purposes of this Agreement, the
version of Direct Enrollment which allows Consumers, Applicants, Qualified
Individuals, Enrollees, Qualified Employees, and Qualified Employers—or these
individuals’ legal representatives or Authorized Representatives—to complete all steps
in the application, eligibility and enrollment processes on an EDE Entity’s website
consistent with applicable requirements in 45 C.F.R. §§ 155.220(c)(3)(ii), 155.221,
156.265 and/or 156.1230(b) using application programming interfaces (APIs) as
provided, owned, and maintained by CMS to transfer data between the Exchange and
the EDE Entity’s website.
(29) Enhanced Direct Enrollment (“EDE”) Entity means a DE Entity that has been
approved by CMS to use the Enhanced Direct Enrollment (EDE) Pathway.
(30) Enhanced Direct Enrollment (“EDE”) Pathway means the APIs and functionality
comprising the systems that enable EDE as provided, owned, and maintained by CMS.
(31) Enrollee has the meaning set forth in 45 C.F.R. § 155.20.
(32) Exchange has the meaning set forth in 45 C.F.R. § 155.20.
(33) Existing Web-broker means a Web-broker that completes the Web-broker Agreement
renewal process in order to maintain its status as a Web-broker and continue operating for
the plan year that occurs within the term of this Agreement.
(34) Federally-facilitated Exchange (“FFE”) means an Exchange (or Marketplace)
established by the Department of Health and Human Services (HHS) and operated by
CMS under Section 1321(c)(1) of the ACA for individual or small group market
coverage, including the Federally-facilitated Small Business Health Options Program
(FF-SHOP). Federally-facilitated Marketplaces (FFMs) has the same meaning as
FFEs.
31

(35) Health Insurance Coverage has the meaning set forth in 45 C.F.R. § 155.20.
(36) Health Insurance Exchanges Program (“HIX”) means the System of Records that
CMS uses in the administration of the FFE. As a System of Records, the use and
disclosure of the SORN Records maintained by the HIX must comply with the Privacy
Act of 1974, the implementing regulations at 45 C.F.R. Part 5b, and the “routine uses”
that were established for the HIX in the Federal Register at 78 FR 8538 (February 6,
2013), and amended by 78 FR 32256 (May 29, 2013) and 78 FR 63211 (October 23,
2013).
(37) HHS means the United States Department of Health & Human Services.
(38) Health Insurance Portability and Accountability Act (“HIPAA”) means the Health
Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, as amended,
and its implementing regulations.
(39) Incident or Security Incident, has the meaning contained in OMB Memoranda M-1712 (January 3, 2017) and means an occurrence that: (1) actually or imminently
jeopardizes, without lawful authority, the integrity, confidentiality, or availability of
Information or an Information system; or (2) constitutes a violation or imminent threat
of violation of law, security policies, security procedures, or acceptable use policies.
(40) Information means any communication or representation of knowledge, such as facts,
data, or opinions in any medium or form, including textual, numerical, graphic,
cartographic, narrative, or audiovisual.
(41) Insurance Affordability Program means a program that is one of the following:
(1) A State Medicaid program under title XIX of the Social Security Act.
(2) A State Children’s Health Insurance Program (“CHIP”) under title XXI of the Social
Security Act.
(3) A State basic health program established under section 1331 of the Patient Protection
and Affordable Care Act.
(4) A program that makes coverage in a Qualified Health Plan (“QHP”) through the
Exchange with APTC established under section 36B of the Internal Revenue Code
available to Qualified Individuals.
(5) A program that makes available coverage in a QHP through the Exchange with
CSRs established under section 1402 of the ACA.
(42) Issuer has the meaning set forth in 45 C.F.R. § 144.103.
(43) Non-Exchange Entity has the meaning at 45 C.F.R. § 155.260(b)(1), and includes, but
is not limited, to Qualified Health Plan (“QHP”) Issuers, Navigators, Agents, Brokers,
and Web-brokers.
(44) OMB means the Office of Management and Budget.
(45) Personally Identifiable Information (“PII”) has the meaning contained in OMB
Memoranda M-17-12 (January 3, 2017), and means Information that can be used to
distinguish or trace an individual's identity, either alone or when combined with other
Information that is linked or linkable to a specific individual.
32

(46) Prospective Web-broker is an entity seeking to become a Web-broker that does not have
an executed Web-broker Agreement for the current plan year.
(47) Qualified Employer has the meaning set forth in 45 C.F.R. § 155.20.
(48) Qualified Employee has the meaning set forth in 45 C.F.R. § 155.20
(49) Qualified Health Plan (“QHP”) has the meaning set forth in 45 C.F.R. § 155.20.
(50) Qualified Health Plan (“QHP”) Issuer has the meaning set forth in 45 C.F.R. §
155.20.
(51) Qualified Individual has the meaning set forth in 45 C.F.R. § 155.20.
(52) Security Control means a safeguard or countermeasure prescribed for an Information
system or an organization designed to protect the confidentiality, integrity, and
availability of its Information and to meet a set of defined security requirements.
(53) State means the State that has licensed the Agent, Broker, Web-broker, or Issuer that is
a party to this Agreement and in which the Agent, Broker, Web-broker or Issuer is
operating.
(54) State-based Exchange (“SBE”) means an Exchange established by a State that receives
approval to operate under 45 C.F.R. § 155.105. State-based Marketplace (“SBM”) has
the same meaning as SBE.
(55) State-based Exchange on the Federal Platform (“SBE-FP”) means an Exchange
established by a State that receives approval under 45 C.F.R. § 155.106(c) to utilize the
federal platform to support select eligibility and enrollment functions. State-based
Marketplace on the Federal Platform (“SBM-FP”) has the same meaning as SBEFP.
(56) System of Records means a group of Records under the control of any federal agency
from which Information is retrieved by name of the individual or by some identifying
number, symbol, or other identifying particular assigned to the individual.
(57) System of Records Notice (“SORN”) means a notice published in the Federal Register
notifying the public of a System of Records maintained by a federal agency. The notice
describes privacy considerations that have been addressed in implementing the system.
(58) System of Record Notice (“SORN”) Record means any item, collection, or grouping
of Information about an individual that is maintained by an agency, including, but not
limited to, that individual’s education, financial transactions, medical history, and
criminal or employment history and that contains that individual’s name, or an
identifying number, symbol, or the identifying number, symbol, or other identifying
particular assigned to the individual, such as a finger or voice print or a photograph, that
is part of a System of Records.
(59) Web-broker has the meaning set forth in 45 C.F.R. § 155.20.

33

Appendix D: Standards for Communication with the Hub
The CMS Data Services Hub (“Hub”) and Hub Web Services are not available for the Small
Business Health Options Program (SHOP). Therefore, this Appendix is not applicable to
Web-broker participation in SHOP. All capitalized terms used herein carry the meanings
assigned in Appendix C: Definitions. Any capitalized term that is not defined in the
Agreement, this Appendix or in Appendix C: Definitions has the meaning provided in 45
C.F.R. § 155.20.
(1) Web-broker must possess a unique Partner ID assigned by the Centers for Medicare &
Medicare Services (“CMS”). Web-broker must use its unique Partner ID when interacting
with the Hub and the Direct Enrollment (“DE”) Application Program Interfaces (“APIs”)
for Web-broker’s own line of business.
(2) If Web-broker provides a DE Environment to an Issuer for the exclusive use of
enrollment in that Issuer’s plans, the Web-broker must ensure that each Issuer maintains
its own, unique Partner ID with the Hub.
(3) Web-broker must complete testing for each Hub-related transaction it will implement,
and it shall not be allowed to exchange data with CMS in production mode until testing is
satisfactorily passed, as determined by CMS in its sole discretion. Successful testing
generally means the ability to pass all applicable Health Insurance Portability and
Accountability Act (“HIPAA”) of 1996 compliance standards, or other CMS-approved
standards, and to process electronic data and Information transmitted by Web-broker to
the Hub. The capability to submit these test transactions will be maintained by Webbroker throughout the term of this Agreement.
(4) Transactions must be formatted in accordance with the Accredited Standards Committee
Implementation Guides adopted under HIPAA, available at http://store.x12.org/store/, as
applicable and appropriate for the type of transaction. CMS will make available
Companion Guides for the transactions, which specify necessary situational data
elements.
(5) Web-broker agrees to abide by the applicable policies affecting electronic data
interchange submissions and submitters as published in any of the guidance documents
related to the CMS Federally-facilitated Exchange (“FFE”) or Hub, as well as applicable
standards in the appropriate CMS Manual(s) or CMS Companion Guide(s), as published
on the CMS website. These materials can be found at
https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/companionguide-for-ffe-enrollment-transaction-v15.pdf and
http://www.cms.gov/cciio/resources/regulations-and-guidance/index.html.
(6) Web-broker agrees to submit test transactions to the Hub prior to the submission of any
transactions to the FFE production system and to determine that the transactions and
responses comply with all requirements and specifications approved by the CMS and/or
the CMS contractor. 14
13F

While CMS owns data in the FFE, contractors operate the FFE system in which the enrollment and financial
management data flow. Contractors provide the pipeline network for the transmission of electronic data, including
14

34

(7) Web-broker agrees that prior to the submission of any additional transaction types to the
FFE production system, or as a result of making changes to an existing transaction type or
system, it will submit test transactions to the Hub in accordance with paragraph (2)
above.
(8) If Web-broker enters into relationships with other affiliated entities, or their authorized
designees for submitting and receiving FFE data, it must execute contracts with such
entities stipulating that that such entities and any of its subcontractors or affiliates must
utilize software tested and approved by Web-broker as being in the proper format and
compatible with the FFE system. Entities that enter into contract with Web-broker and
access Personally Identifiable Information (“PII”) are required to maintain the same or
more stringent security and privacy controls as Web-broker.
(9) Pursuant to 45 C.F.R. §§ 155.220(c)(6), 155.221(b)(4), and 155.221(f), Web-broker must
successfully complete an Operational Readiness Review (“ORR”) to the satisfaction of
CMS before Web-broker is able to submit any transactions to the FFE production system
or agrees that CMS may require further reviews or corrective actions at any time during
the term of this Agreement. The ORR will assess Web-broker’s compliance with CMS’
regulatory and contractual requirements, to include the critical Privacy and Security
Controls. This Agreement may be terminated or access to CMS systems may be denied
for a failure to comply with ORR requirements or if, at the sole discretion of CMS, the
results are unsatisfactory.

[REMAINDER OF PAGE INTENTIONALLY LEFT BLANK]

the transport of Exchange data to and from the Hub and Web-broker so that Web-broker may discern the activity
related to enrollment functions of persons they serve. Web-broker may also use the transported data to receive
descriptions of financial transactions from CMS.

35

Appendix E: Auditor Identification
Web-broker agrees to identify, in Part I below, all Auditors selected to complete the annual
security and privacy assessment (SPA) and any subcontractors of the Auditor(s), if applicable. In
the case of multiple Auditors, please indicate the role of each Auditor in completing the SPA.
Include additional sheets, if necessary. All capitalized terms used herein carry the meanings
assigned in Appendix C: Definitions. Any capitalized term that is not defined in the Agreement,
this Appendix or in Appendix C: Definitions has the meaning provided in 45 C.F.R. § 155.20.
TO BE FILLED OUT BY WEB-BROKER
I.

Complete These Rows to Identify Auditors Selected to Complete SPA

Printed Name and Title of Authorized
Official of Auditor 1
Auditor 1 Business Name
Auditor 1 Address
Printed Name and Title of Contact of
Auditor 1 (if different from
Authorized Official)
Auditor 1 Contact Phone Number
Auditor 1 Contact Email Address
Subcontractor Name & Information
(if applicable)
Audit Role
Printed Name and Title of Authorized
Official of Auditor 2
Auditor 2 Business Name
Auditor 2 Address
Printed Name and Title of Contact of
Auditor 2 (if different from
Authorized Official)
Auditor 2 Contact Phone Number
Auditor 2 Contact Email Address
Subcontractor Name & Information
(if applicable)
Audit Role

36

Appendix F: Conflict of Interest Disclosure Form
TO BE FILLED OUT BY WEB-BROKER
Web-broker must disclose to the Department of Health & Human Services (HHS) any financial
relationships between the Auditor(s) identified in Appendix E: Auditor Identification of this
Agreement, and individuals who own or are employed by the Auditor(s), and individuals who
own or are employed by a Web-broker for which the Auditor(s) is conducting an annual security
and privacy assessment (SPA) pursuant to Appendix A: Privacy and Security Standards for Webbrokers of this Agreement and 45 C.F.R. §§ 155.220(c)(6), 155.221(b)(4), and 155.221(f). Webbroker must disclose any affiliation that may give rise to any real or perceived conflicts of
interest, including being free from personal, external, and organizational impairments to
independence, or the appearance of such impairments to independence. All capitalized terms
used herein carry the meanings assigned in Appendix C: Definitions. Any capitalized term that is
not defined in the Agreement, this Appendix or in Appendix C: Definitions has the meaning
provided in 45 C.F.R. § 155.20.
Please describe below any relationships, transactions, positions (volunteer or otherwise), or
circumstances that you believe could contribute to a conflict of interest:
☐ Web-broker has no conflict of interest to report for the Auditor(s) identified in Appendix E:
Auditor Identification.
☐ Web-broker has the following conflict of interest to report for the Auditor(s) identified in
Appendix E: Auditor Identification:
1.

2.

3.

37