SRCSGT | R | Support the Centers for Medicare and Medicaid Services (CMS) with program integrity efforts by completing the retroactive payment adjustments, reconciling the final payment for non-renewal contracts, receiving and processing monthly attestations, etc.

FBO DAILY ISSUE OF FEBRUARY 09, 2012 FBO #3729
SOURCES SOUGHT

R -- Support the Centers for Medicare and Medicaid Services (CMS) with program integrity efforts by completing the retroactive payment adjustments, reconciling the final payment for non-renewal contracts, receiving and processing monthly attestations, etc.

Notice Date: 2/7/2012
Notice Type: Sources Sought
NAICS: 541611 — Administrative Management and General Management Consulting Services
Contracting Office: Department of Health and Human Services, Centers for Medicare & Medicaid Services, Office of Acquisition and Grants Management, 7500 Security Blvd., C2-21-15, Baltimore, Maryland, 21244-1850
ZIP Code: 21244-1850
Solicitation Number: APP120997
Archive Date: 3/2/2012
Point of Contact: JIMMIE CURTIS, Phone: 4107868152, JIMMIE CURTIS, Phone: 4107868152
E-Mail Address: JIMMIE.CURTIS1@CMS.HHS.GOV, JIMMIE.CURTIS1@CMS.HHS.GOV
(JIMMIE.CURTIS1@CMS.HHS.GOV, JIMMIE.CURTIS1@CMS.HHS.GOV)
Small Business Set-Aside: N/A
Description: Retroactive Processing and Payment Validation Introduction This SOURCES SOUGHT NOTICE is to determine the availability of potential small businesses (e.g., 8(a), service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business, and women-owned small business) that can provide: support the Centers for Medicare and Medicaid Services (CMS) with program integrity efforts by completing the retroactive payment adjustments, reconciling the final payment for non-renewal contracts, receiving and processing monthly attestations and performing monthly analyses of any discrepancies submitted by Medicare Advantage Organizations (MAOs), Cost Plans, Medicare Advantage Prescription Drug Plans (MA-PDs), Program of All-Inclusive Care for the Elderly (PACE) Plans, and Prescription Drug Plans (PDPs) and reporting on these activities. The information from this market research will help CMS plan their acquisition strategy. Please be sure to indicate if you have a GSA schedule contract. THIS IS STRICTLY MARKET RESEARCH. CMS WILL NOT ENTERTAIN QUESTIONS REGARDING THIS MARKET RESEARCH. This is not an invitation for bid, request for proposal, or other solicitation, and in no way obligates CMS to award a contract. Interested contractors must submit a capability statement to demonstrate their ability to establish and maintain data security systems, in accordance with OMB Circular A-130 Management of Federal Information Resources, Appendix III, "Security of Federal Automated Information Systems", which are necessary for maintaining the strict confidentiality requirements of all CMS data obtained from CMS files, as well as data collected under any potential contract. These confidentiality requirements shall also include all requirements for successfully safeguarding any and all data that could identify individual Medicare beneficiaries. Background Medicare managed care programs operate under Section 1876, Section 1833, and Sections 1851 through 1859 with the Prescription Drug Program operating under Section 1860D of the Social Security Act. These statutory provisions authorize CMS to make payments to eligible managed care organizations on both a cost and a risk basis. Currently, there are over 25 million Medicare beneficiaries enrolled in 850 organizations that are paid over 12.5 billion dollars on a monthly basis. Cost-based organizations are paid based upon an annual budget submission by the contracting organization. Risk-based payments to Medicare Advantage Organizations (MAOs) and some demonstration projects consist of a monthly capitation payment based upon a variety of factors that may include demographic characteristics of each Medicare enrollee. Demographic characteristics include age, sex, and county of residence, Medicaid status, End Stage Renal Disease (ESRD) status, and hospice election. Information regarding the demographic characteristics of each beneficiary comes from several sources, including Medicare beneficiaries, CMS databases, Social Security Administration (SSA) data, and contracting managed care organizations. Monthly capitation payments are calculated differently for cost versus risk-based organizations. However, all requests for enrollment are received from the MAOs and submitted to the CMS Medicare Advantage and Prescription Drug System (MARx). The CMS Medicare Beneficiary Database (MBD) record is checked for Medicare entitlement, and the individual's residence and health status information (demographics) is collected from the source databases. This information, along with the type of managed care organization, determines the capitation amount the MAO shall be paid for the beneficiary for that month. There are several special factors which impact the individual beneficiary payment, and therefore, the aggregate payment to the organization. Those special factors include Medicaid status, Low Income Subsidy (LIS) and ESRD status among others. In some instances (e.g., ESRD status), the payment level is significantly impacted. The Part C & D regulations require that managed care and prescription drug organizations provide CMS with a certification of all data that affects the calculation of CMS' payments to the organizations. Pursuant to that authority, CMS has a requirement that managed care organizations and Part D Sponsors submit monthly statements certifying the accuracy of the enrollment data submitted to CMS for use in the calculation of payments. To make this statement, MAOs shall certify the accuracy of not only their data, but also the data provided by CMS. This requirement, by nature, has led to increased scrutiny by MAOs of CMS' payment systems and reluctance to attest to the accuracy of data that is not controlled by the organization, but rather is provided to CMS by other State and Federal agencies according to widely varying schedules. Because the certification is required monthly, MAOs anticipate all adjustments, with the exception of ESRD, brought to CMS' attention shall be corrected in the next month's report. While CMS is requiring MAOs to dedicate resources to meeting the certification requirement, it shall also be prepared to address more timely the adjustments brought to its attention. Since the implementation of MMA in 2003, timely processing and accuracy of MAO and PDP enrollments (PBP Changes) and disenrollments are having a greater affect on the accuracy of CMS payments. An MAO's failure to process their enrollment requests timely affect the primary capitated payment, risk status and the accuracy of the pharmacy submitted Prescription Drug Events. In order to respond to this notice, contractors must be able to indicate experience and/or the ability to provide all of the numbered points below. Give enough detail so your response clearly indicates that you can provide the following: 1. Ability in conducting pre-payment review and adjustments to beneficiary enrollment information. 2. Ability in producing multiple data files from large scale data collection efforts efficiently using file specification provided by CMS. 3. Ability to perform the data collection and data production using the most cost-efficient methods available and to meet deadlines for both data collection and producing multiple data files on a timely basis. 4. Ability in making reconsideration determinations with Medicare Advantage Organizations that are appealing decisions regarding payment discrepancies. 5. Capability to maintain strict data confidentiality standards including all requirements for use of, access to, and storage of CMS data files and fulfilling all HIPAA regulations. Information Request Interested parties having the capabilities necessary to perform the stated requirements may submit capability statements via email to Jimmie Curtis(jimmiecurtis1@cms.hhs.gov). CAPABILITY STATEMENTS MUST DEMONSTRATE THE MINIMUM REQUIREMENTS OUTLINED ABOVE. Please address each in order listed above. Capability statements shall also include the business size and status,(e.g., small business, 8(a), veteran-owned small business, service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, and women owned small business) including any letters, certificates, or similar documentation indicating such status; corporate structure (corporation, LLC, sole proprietorship, partnership, limited liability partnership, professional corporation, etc.); and tax identification number. Capability Statements shall be limited to 5 pages and shall include any/all teaming arrangements. Please also include the following: Business Information - a. DUNS: b. Company Name c. Company Address d. All Current GSA Schedules Contracts e. Do you have a Government approved accounting system? If so, please identify the agency that approved the system. f. Type of Company (i.e., small business, 8(a), woman owned, veteran owned, etc.) as validated via the Central Contractor Registration (CCR). All offerors must register on the CCR located at http://www.ccr.gov/index.asp g. Company Point of Contact, Phone and Email address h. Point of Contact, Phone and Email address of individuals who can verify the demonstrated capabilities identified in the responses. Teaming Arrangements: All teaming arrangements shall also include the above-cited information and certifications for each entity on the proposed team. Teaming arrangements are encouraged. The Government is interested in potential small business offerors who currently hold GSA schedule contracts to submit a capability statement that will be considered by the agency. The statement must demonstrate that the firm has the capability to perform the required work. All capability statements can be submitted via e-mail, facsimile, or regular mail to the point of contact listed below on or before (February 16, 2012). Responses shall be limited to five (5) pages. CAPABILITY STATEMENTS MUST DEMONSTRATE THE MINIMUM REQUIREMENTS OUTLINED ABOVE. Please address each in order listed above. The synopsis is for information and planning purposes and is not to be construed as a commitment by the Government. This is not a solicitation announcement for proposals and no contract will be awarded from this announcement. No reimbursement will be made for any costs associated with providing information in response to this announcement and any follow-up information requests. Respondents will not be notified of the results of the evaluation. All information submitted in response to this announcement must arrive on or before the closing date. Point of Contact: Questions may be referred to Jimmie Curtis, Contract Specialist, Phone (410) 786-8152,, Email: jimmiecurtis1@cms.hhs.gov; Centers for Medicare & Medicaid Services, ATTN: Jimmie Curtis, Mailstop (B2-14-21), 7111 Security Blvd, Baltimore, MD 21244. Retroactive Processing and Payment Validation
Web Link: FBO.gov Permalink
(https://www.fbo.gov/spg/HHS/HCFA/AGG/APP120997/listing.html)
Record: SN02669599-W 20120209/120207235637-eb18a7dc076d59d344e8e697a88ba7e4 (fbodaily.com)
Source: FedBizOpps Link to This Notice
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R -- Support the Centers for Medicare and Medicaid Services (CMS) with program integrity efforts by completing the retroactive payment adjustments, reconciling the final payment for non-renewal contracts, receiving and processing monthly attestations, etc.