SOURCES SOUGHT
R -- Payment Error Rate Measurement (PERM)
- Notice Date
- 4/29/2009
- Notice Type
- Sources Sought
- NAICS
- 541513
— Computer Facilities Management 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
- HHS-CMS-DRCG-SS-09-001
- Point of Contact
- Joseph M Feibel,, Phone: 410- 786-8261, Evelyn Dixon,, Phone: 410-786-1561
- E-Mail Address
-
joseph.feibel@cms.hhs.gov, Evelyn.Dixon@cms.hhs.gov
- Small Business Set-Aside
- N/A
- Description
- This is a Small Business Sources Sought notice. This is NOT a solicitation for proposals, proposal abstracts, or quotations. The purpose of this notice is to obtain information regarding: (1) the availability and capability of qualified small business sources; (2) whether they are small businesses; HUBZone small businesses; service-disabled, veteran-owned small businesses; 8(a) small businesses; veteran-owned small businesses; woman-owned small businesses; or small disadvantaged businesses; and (3) their size classification relative to the North American Industry Classification System (NAICS) code for the proposed acquisition. Your responses to the information requested will assist the Government in determining the appropriate acquisition method, including whether a set-aside is possible. An organization that is not considered a small business under the applicable NAICS code should not submit a response to this notice." BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) must estimate payment error rates in Medicaid and CHIP as directed by the Improper Payments Information Act (IPIA) of 2002 (Public Law 107-300). The IPIA directs each executive agency, in accordance with the Office of Management and Budget (OMB) guidance, to review all of its programs and activities annually, identify those that may be susceptible to significant improper payments, estimate the annual amount of improper payments, and submit those estimates to Congress. The IPIA defines improper payments as: (a) any payment that should not have been made or that was made in an incorrect amount, including both overpayments and underpayments, under statutory, contractual, administrative, or other legally applicable requirements; and (b) payments made to an ineligible beneficiary or on the behalf of an ineligible beneficiary, any duplicate payments, payments for services not received, and any payment that does not account for credit for applicable discounts. The Payment Error Rate Measurement (PERM) was established to fulfill the estimation and reporting requirements of the IPIA. CMS will use a national contracting strategy to implement the Medicaid and CHIP PERM program, which includes reviewing fee-for-service claims and managed care capitation payments. This strategy engages: (1) A statistical contractor (being procured in a separate solicitation), and (2) A review contractor (RC). For efficiency purposes, the CMS is combining the portions of the Statements of Work for two contracts previously awarded to Small Businesses. The efforts under the Review Contract and certain portions of the Documentation Contract will be one statement of work under one contract. REQUIREMENTS: 1) Demonstrate the ability to coordinate, collect, and maintain all state Medicaid or CHIP policies and/or manuals necessary to conduct medical reviews and data processing reviews. This process will also include the collection, on a quarterly basis, and maintenance of all state policy updates related to medical, data processing, or payment policy. The policies and corresponding updates will appear in a variety of formats (e.g., via website, electronic PDF format, and hardcopy). The contractor shall have the knowledge and means to manipulate the policy formats for uniformity and relative ease of use by the reviewers. The contractor shall maintain all state Medicaid or CHIP policies in a central housing unit that will be accessed by the reviewers when conducting medical reviews and data processing reviews. 2) Demonstrate the skills used to review Medicaid and CHIP medical records in order to validate the payment amount for certain Medicaid and CHIP claims. The results of the contractor's reviews will be used to determine the payment error rates for Medicaid and CHIP payments. In order to effect accurate and timely reviews, the review contractor will gather and maintain medical policies, data processing manuals, and corresponding quarterly updates from states; will collect and maintain medical records from providers; will use the collected policies and medical records to perform medical and data processing reviews; will put into place a difference resolution process for states to dispute and resolve the contractor's findings; will provide its findings to the statistical contractor; will jointly write the final report with the statistical contractor; and will submit the report to CMS. 3) Demonstrate the knowledge to coordinate, request, obtain, scan and/or upload medical records for sampled claims. This process will include contacting the Medicaid and CHIP providers, and requesting and receiving the medical records associated with the sampled claims. The contractor shall maintain all medical records in a central housing unit that will be accessed by the reviewers when conducting medical reviews. 4) Please note that the size and length of state policies will vary. Demonstrate the ability to coordinate efforts to obtain policies and quarterly updates of the policies for 17 Medicaid and CHIP states. Also demonstrate your ability to prepare, to handle, store, and review approximately 800 - 1200 sampled fee-for-service claims and medical records, and approximately 500 sampled managed care capitation payment records, or an average of 1500 sampled claims and medical records, for each state. The sampling unit is defined as an individually priced service (e.g., a physician office visit or a hospital stay). The sampling unit may be a claim or line item. All sampling units will be original paid claims with a paid date between October 1, 2009, and September 30, 2010. 5) Demonstrate the ability to make a payment determination for each sampling unit by performing data processing reviews and medical records reviews. Each sampling unit shall be reviewed to determine if it was processed through the claims payment system correctly; was medically necessary, coded correctly and properly paid or denied. The contractor shall validate whether each sampling unit was paid correctly based on: information found on the sampling unit, the information in the medical record, the information in the claims processing system, and state policies. The contractor shall visit each state at least twice and conduct the data processing reviews on-site, if necessary. The contractor shall also provide its review findings to the states and the statistical contractor; maintain a difference resolution process; jointly write the final report with the statistical contractor; and submit the report to CMS. 6) Demonstrate the ability to deliver to CMS, timely and in appropriate formats: periodic progress reports; results of medical and data processing reviews in compliance with recognized industry standards and CMS' preferred taxonomy; state-level Medicaid and CHIP policy databases; and reports and analyses, including a final national and state-specific error rate report, that may be required to meet CMS reporting requirements or improve functioning of the PERM process. PERIOD OF PERFORMANCE: CMS intends to award a 26-month cost plus fixed fee contract, with up to two options (total period of performance will not exceed five (5) years), to assist CMS in performing data processing and medical reviews for the Medicaid and Children's Health Insurance Program (CHIP) Payment Error Rate Measurement (PERM) project. The period of performance will commence upon award of this contract or October 1, 2009, (whichever is later), and will terminate December 1, 2011. RESPONSE REQUESTED: CMS seeks responses from small businesses who may be available and capable of performing the work. We request the following: 1. Contractor's Response to the six (6) requirements above. 2. Information regarding contractor's (a) staff expertise, including availability, experience, and formal or other training; (b) current in-house capability and capacity to perform the work; (c) prior completed projects of similar nature; (d) corporate experience and management capability; and (e) examples of prior completed Government contracts, references, and other related information. 3. Business Information -- a. DUNS: b. Company Name c. Company Address d. Current GSA Schedules appropriate to this Sources Sought e. Do you have a Government approved accounting system? If so, please identify the agency that approved the system. f. Type of company (e.g., small business, 8(a), woman owned, veteran, 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 4. Email your responses addressing the specific requests detailed above to joseph.feibel@cms.hhs.gov on or before 12:00 PM (noon) local time Baltimore, MD May 15, 2009. Also, provide an original and two (2) copies through first class mail. Please be advised that email transmitted files over 5 megabytes are not delivered during standard working hours, are only released from the CMS server after 5:00 PM EST, and may affect the timeliness of your response. 5. In this regard please limit your electronic document to the following Page Size, Font Type and Size, Spacing and Page Numbering - Preference for Microsoft Word (or PDF) document with page size 8.5 by 11 inches. Font shall be Times New Roman Size 12 with no less than single spacing between lines. The number of pages shall be limited to twenty (20) pages total. 6. Potential contractors are hereby advised that their accounting system must be adequate for determining costs applicable to the contract and that FAR Clause 52.219-14 Limitations of Subcontracting will be incorporated into the solicitation and resultant contract. 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. However, responses to this notice will not be considered adequate responses to a solicitation. Confidentiality. No proprietary, classified, confidential, or sensitive information should be included in your response. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s).
- Web Link
-
FedBizOpps Complete View
(https://www.fbo.gov/?s=opportunity&mode=form&id=5dcc608613be9a2e92ea8c7d09d595e6&tab=core&_cview=1)
- Place of Performance
- Address: Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS), formerly known as the Health Care Financing Administration, Acquisition and Grants Group, 7500 Security Blvd. C2-21-15, Central Building, Baltimore, Maryland, 21244-1850, United States
- Zip Code: 21244-1850
- Zip Code: 21244-1850
- Record
- SN01804761-W 20090501/090429221917-5dcc608613be9a2e92ea8c7d09d595e6 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
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