SOURCES SOUGHT
R -- Medicare Part A Provider Cost Report Appeals (MPAPA)
- Notice Date
- 8/31/2012
- Notice Type
- Sources Sought
- NAICS
- #541990
— All Other Professional, Scientific, and Technical 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
- SS_CMS_2013_130168
- Archive Date
- 9/29/2012
- Point of Contact
- Edward M. Rutherford, Phone: 4107866648
- E-Mail Address
-
edward.rutherford@cms.hhs.gov
(edward.rutherford@cms.hhs.gov)
- Small Business Set-Aside
- N/A
- Description
- Background THIS IS A SOURCES SOUGHT NOTICE 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) IN ACCORDANCE WITH FAR 7.104(d). THE POTENTIAL SMALL BUSINESS WILL NEED TO DEMONSTRATE THE ABILITY TO PROVIDE SERVICES AS SPECIFIED BELOW. History: Section 1878 of the Social Security Act established that providers may request and receive a hearing before the Provider Reimbursement Review Board [PRRB] for a cost reporting period for which a provider filed a Medicare cost report. The contractor's Notice of Program Reimbursement [NPR] is final and binding unless a timely request for a hearing is filed with the PRRB [see 42 CFR §405.1835] or the Intermediary Hearing Officer [see 42 CFR §405.1811] and a decision is rendered, or unless one of the provisions for reopening in 42 CFR §405.1885 is exercised. Therefore, the NPR is the base determination for appealing a cost report. Under 42 CFR §405.1835, individual providers may bring an appeal before the PRRB if the amount in controversy is $10,000 or more. Under 42 CFR §405.1811, providers may request an Intermediary hearing if the amount in controversy is at least $1,000 but less than $10,000. Under 42 CFR §405.1837, providers may request a group appeal of a single issue involving a question of fact or interpretation of law, regulations, or CMS ruling, which is common to all providers in the appeal as long as the aggregate claims in dispute total at least $50,000. Additionally, providers under common ownership or control which have an issue in common must file a group appeal if the amount in controversy is, in the aggregate, $50,000 or more. A request for hearing must be filed with Intermediary Hearing Office or the PRRB, as appropriate, within 180 calendar days from the date of receipt by the provider of the NPR. This contractor will represent the Centers for Medicare and Medicaid Services (CMS) and it's Medicare Administrative Contractors (MACs) with respect to PRRB appeals. Work Description: The MPAPA Contractor will be expected to perform the following activities. 1. Coordinate Medicare Part A Cost Report individual and group appeals before the PRRB. This includes, but not limited to: a. Managing the appeal workload b. Working with MACs regarding appeals c. Preparing and reviewing jurisdictional briefs d. Reviewing and approving position papers e. Communicating with the provider or provider's representative f. Preparing and approving appeal resolutions when issues are resolved prior to a hearing g. Preparing for hearings h. Providing legal staff for hearings i. Post hearing briefs j. Working with Office of General Counsel when necessary 2. Provide a hearing officer and coordinate Medicare Part A Cost Report individual appeals before a hearing officer. Requirements: The services required are to be provided by a contractor with experience in Medicare cost reports, Medicare Part A cost report reimbursement issues, Provider Reimbursement Review Board [PRRB] appeals functions and Intermediary Hearing Officer Appeals functions. There are no exceptions to the requirements listed below; offerors who do not clearly demonstrate such capabilities, assets and experience will not be given further consideration. Give enough detail so your response clearly indicates that you can provide the following: • Capability to analyze Medicare reimbursement issues and determine how issues may be presented before the PRRB. • Capability to represent the Federal Government in hearings before the PRRB. • Capability to provide an Intermediary Hearing Officer[s]. • Capability to analyze PRRB and Intermediary appeal requirements. • Capability to analyze PRRB and Intermediary appeal documentation. • Capability to analyze Medicare contractors' audit and reimbursement work papers. • Capability to develop an automated process to track pertinent information related to PRRB individual appeals, PRRB group appeals, and Intermediary Hearing Officer appeals. • Capability to perform national coordination of PRRB appeals functions and Intermediary Hearing Officer Appeal's functions. • The contractor shall have Medicare cost report audit and reimbursement experience • Capability to analyze proposed and final Medicare reimbursement regulations. • Capability to analyze proposed and final Medicare policy instructions. Anticipated Contract Type: CMS anticipates issuance of a Cost Reimbursement-type contract under the forthcoming solicitation. However, CMS does reserve the option to use any other procurement instrument as deemed appropriate at the time of the official solicitation Capability Statement: Please provide a brief capability statement for our organization, tailored to demonstrate your relevant experience and/or ability to provide requirements of this magnitude. All offerors will also submit written documentation that their accounting system is adequate for determining costs applicable to the anticipate contract type. (See FAR 16.301-3(a)(3).) The written documentation shall be a letter signed by the appropriate Government official attesting to the adequacy of the accounting system. CAPABILITY STATEMENTS MUST DEMONSTRATE THE MINIMUM REQUIREMENTS OUTLINED ABOVE. Please address each in order listed above. Teaming Arrangements: All teaming arrangements shall include the above-cited information. Teaming arrangements are encouraged. This is not an invitation for bid, request for proposal or other solicitation and in no way obligates CMS to award a contract. The sole intent of this Sources Sought Notice is to obtain capabilities for set-aside and procurement planning purposes. The capability statement shall be limited to 15 pages and include the following information: 1. Business Information and Identification 2. DUNS No. 3. Company Name & Address 4. Company Point of Contact, phone number and email address. 5. Type of company under NAICS, as validated via the Central Contractor Registration (CCR). Additional information on NAICS codes can be found at www.sba.gov. All offerors must be registered on the Central Contractor Registration system, located at http://www.ccr.gov. 6. Corporate structure (corporation, LLC, sole proprietorship, partnership, limited liability partnership, professional corporate, etc.); 7. Point of Contact, names, phone numbers, and emails of references who can verify the capabilities/experience identified in the responses. All capability statements must be submitted via email as an attachment to edward.rutherford@cms.hhs.gov. Responses shall be limited to 15 pages. The subject line of the email shall read SS-CMS-2013-130168. Responses must be submitted no later than 12:00 PM EST, September 14, 2012. They should clearly reflect the respondent's ability to meet the requirements included in this notice. Capability statements will not be returned and will not be accepted after the due date. Respondents will not be notified of the results of the review of their submissions. Information received will be considered solely to make informed decisions regarding a potential small business set-aside. Disclaimer and Important Notes: This notice does not obligate the Government to award a contract or otherwise pay for the information provided in response. The Government reserves the right to use information provided by respondents for any purpose deemed necessary and legally appropriate. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed to allow the Government to determine the organization's qualifications to perform the work. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted. After a review of the responses received, a pre-solicitation synopsis and solicitation may be published in Federal Business Opportunities.
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/HHS/HCFA/AGG/SS_CMS_2013_130168/listing.html)
- Place of Performance
- Address: Contractor's facility & CMS Central Office, United States
- Record
- SN02865431-W 20120902/120901001011-e2c4b7a0f4a6ed9902fb529cec21dc06 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
(may not be valid after Archive Date)
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