SOURCES SOUGHT
D -- Sources Sought Notice - Fraud Prevention System ("FPS") 2.0 - Draft Statement of Work
- Notice Date
- 12/12/2014
- Notice Type
- Sources Sought
- NAICS
- 541512
— Computer Systems Design 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
- DB150097
- Archive Date
- 1/27/2015
- Point of Contact
- Donald E. Bozimski, Phone: 4107861355, Tonya D. Anderson, Phone: 4107684087
- E-Mail Address
-
donald.bozimski@cms.hhs.gov, tonya.anderson@cms.hhs.gov
(donald.bozimski@cms.hhs.gov, tonya.anderson@cms.hhs.gov)
- Small Business Set-Aside
- Total Small Business
- Description
- Draft Statement of Work ('SOW') for Fraud Prevention system ('FPS') 2.0 Requirement Sources Sought Notice FRAUD PREVENTION SYSTEM (FPS) Purpose of Notice: This is a SOURCES SOUGHT NOTICE posted for INFORMATIONAL PURPOSES ONLY and will be used to assist the Centers for Medicare and Medicaid Services (CMS) in determining the availability of eligible Service-Disabled Veteran-Owned Small Business, HUB Zone, women-owned small business, and 8(a) with the technical capability necessary to successfully perform the requirements described herein. THIS IS NOT A FORMAL REQUEST FOR PROPOSAL (RFP) AND DOES NOT COMMIT THE CENTERS FOR MEDICARE AND MEDICAID SERIVICES (CMS) TO AWARD A CONTRACT NOW OR IN THE FUTURE. THIS IS STRICTLY MARKET RESEARCH TO ASSIST IN DETERMINING THE APPROPRIATE ACQUISITION STRATEGY TO OBTAIN CONTRACTOR SUPPORT SERVICES TO PERFORM THE SAME OR SIMILAR REQUIREMENTS TO THOSE DESCRIBED IN THIS NOTICE. THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) MAY OR MAY NOT ISSUE A REQUEST FOR PROPOSAL OR REQUEST FOR QUOTATION. RESPONSES TO THIS SOURCES SOUGHT NOTICE SHALL BE THE SUBMISSION OF A CAPABILITY STATEMENT; ACCORDINGLY, CMS WILL NOT ENTERTAIN QUESTIONS REGARDING THE RESULTS OF THE MARKET RESEARCH. THE CONTRACT IS ANTICIPATED TO BE COST PLUS AWARD FEE (CFAF). THE CONTRACTING OFFICE RESERVES THE RIGHT TO AWARD ANY OTHER TYPE OF TASK ORDER DETAILED INFORMATION IS PROVIDED VIA THE DRAFT STATEMENT OF WORK WHICH IS POSTED ON THIS ANNOUNCEMENT. The purpose of this notice is to obtain information regarding the availability and capability of qualified small businesses that can provide an IT development and data services solution in support of the CMS requirements for the FRAUD PREVENTION SYSTEM (FPS). Prior to engaging in procurement activity to acquire vendors for the Fraud Prevention System potential businesses will need to demonstrate the ability to provide the services defined in this notice. Background The loss of taxpayer dollars through waste, fraud, and abuse drives up health care costs. CMS is pursuing an aggressive program integrity strategy that will prevent fraudulent transactions from occurring, rather than simply tracking down fraudulent providers and pursuing illegitimate claims. CMS' program integrity mission also encompasses the operations and oversight necessary to ensure that CMS makes accurate payments to legitimate providers and suppliers for appropriate, reasonable, and necessary services and supplies for eligible Medicare beneficiaries. Reversing the traditional pay- and-chase approach to detection and prevention is the main goal of the National Fraud Prevention Program, a long-term, sustainable approach that incorporates innovative technologies in integrated solutions. Working with qualified vendors, CMS hopes to decrease those inefficiencies by: A. Plan and execute a tailored development approach to complete design, development, testing and implementation of the predictive modeling system, and iterate with continuous refinements of the modeling system and output reports during the Base Year. B. Design the system to operate using software and IT infrastructure compatible with the CMS IT environment and enterprise architecture and in accordance with the CMS system development framework and security. C. Maintain CMS Authority to Operate (ATO) and/or CMS interim ATO for hosting the predictive modeling system and/or authorization using CMS data sources and business intelligence at the Contractor's facility. D. Generate and coordinate delivery (daily or more frequently) output reports in the format(s) accepted for use by all stakeholders. The reports shall target preventing payment of claims identified as having high risk of fraud, waste, or abuse until claims are validated. E. Continually test and refine the predictive modeling system and integrity of the results to minimize false positives, refine the taxonomy of classifications, score the issues to support prioritization and continuously improve the model and/or edit based on user feedback. F. Define agreed to metrics to measure implementation results and outcomes that can be computed and reported directly from the predictive modeling system. G. No later than 30 days prior to completion of each performance period, deliver a draft Summary Report addressing all findings and results of the predictive modeling system including assessment for future use, limitations, scalability, recommended areas for capability improvements, observations on any CMS data limitations, and areas for further investigation and development. Revise and submit a completed Summary Report that incorporates CMS feedback prior to the end of the Task Order. H. Support users of the predictive analytic reports with any needed interpretation of finding and address user feedback. The type and level of user support shall include telephone and email support as directed by the Contracting Officer's Representative (COR). I. Implement a system/tool that enables review and tracking of predictive model/edit outputs and results by all CMS partners supporting enrollment, payment processing, investigations, audit, and enforcement. J. Business Intelligence Reporting Tools (Dashboard) connect to the live FPS2 system and allows drill-down capabilities to claims level. K. Integrate edit module in the claims authorization processing and document the change order request to permit implementation of Edits. L. Incorporate the ability to suspend claims for review by the Recovery Audit Contractor (RAC) Anticipated Period of Performance The government expects that the final contract for this body of work will be for a base period of 12 months and four (4) twelve month option periods to be exercised at the discretion of the government. Capability Statements In response to this Sources Sought Notice, CMS is seeking capability statements. Capability statements are NOT proposals and do not address price/cost. The contractor community is merely asked to provide information which may demonstrate that they have expertise and capacity to meet the requirements of this work as a prime contractor, with subcontractors as they deem necessary. For the purposes of responding to this notice, contractors should address the following experience and advanced knowledge: The contractor shall demonstrate the necessary infrastructure support to effectively interface with all stakeholders, including the CMS program staff, RACs, ZPICs, MACs and Law Enforcement. The contractor shall demonstrate the knowledge and skillsets to further develop the ability to integrate data from disparate data sources with varying formats. These data sources shall include claims data, quality data and, in the case of managed care, encounter data. The contractor shall demonstrate contractual experience with, but not limited to, the following specific data sets, levels of Certifications and Platforms: Traditional Fee-for-Service Medicare National Claims History Files that includes all Administrative claims data under the Medicare fee-for-service program: • Institutional data (e.g., Part A -- Hospitals) • Professional data (e.g., Part B -- Physicians) • Prescription drug event (PDE) data • Encounter data • Online Survey, Certification and Reporting (OSCAR) • Minimum Data Set (MDS) • Outcome and Assessment Information Set (OASIS) • Quality Data(e.g., HEDIS) • Consumer Assessment of Healthcare Providers and Systems (CAHPS) Data integration of platforms and experience with critical data integration techniques including: • Integrating large health care data sets: o using a wide variety of data sources o that reside in different locations or are maintained by different organizations o that a wide range of users can access and use data (accounting for a variety of roles of the data users and timeframe) • Use and knowledge of multiple data integration platforms such that the Offeror can provide a comparative evaluation of optimal criteria for such platforms • Medicare programs and in the interactions between those programs as they pertain to the provision of care for Medicare enrollees. • Programming and analysis of large health care data sets (such as: Part A, Part B, DME and HHA) including expertise in working with Medicare data. The contractor's staff should be knowledgeable in conducting complex health services research using Medicare data. • The nature of these tasks will require multi-disciplinary skills including but not limited to; epidemiology, health economics, public health, statistics or biostatistics, health care, health services research and research design methodology. • Extensive Medicare experience • Past performance with FISS,MCS,VMS and PECOS • Experience in 912 audits • FISMA compliant data center • Extensive Experience in Part A, Part B, DME and HHA ISO; and • CMMI level 3 or equivalent at time of award. Demonstrate capability to manage at a minimum 4 million complex transactions daily by submitting documentation including, but not limited to, role and contract number. Responses Requested Responses are required no later than January 12, 2015. Documentation should be sent to: Donald.Bozimski@cms.hhs.gov and cc: Tonya.Anderson@cms.hhs.gov in the following format: 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 font size for any charts will be Calibri 11. The maximum number of pages for submission is 15 pages. 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. If this results in a contract award, the awardee must be Capability Maturity Model Infrastructure (CMMI) Level 3 certified or equivalent. Additional Information CMS also requests the following additional information: Business Information: • DUNS • Company Name • Company Address • Do you have an adequate accounting system? If so, please identify the agency that made the determination. Documentation showing an audit of the contractor's accounting system certifying that the system is acceptable to conduct cost-type contract work (if such an audit has been done). • Type of company (e.g., small business, 8(a), woman owned, veteran, etc.) as validated via the System for Award Management (SAM), the Official U.S. Government system that consolidated the capabilities of CCR/FedReg, ORCA, and EPLS.. All potential offerors must register on the SAM<located at https://www.sam.gov/portal/SAM/#1Contract vehicles you are currently participating • Company Point of Contact, Phone and Email address • Teaming Arrangements: All teaming arrangements should also include the above-cited information and certifications for each entity on the proposed team. 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). Disclaimer and Important Notes: This notice does not obligate the Government to award a contract or otherwise pay for the information provided in response. 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. Teaming Arrangements: Firms seeking to respond to this notice as a team or to rely on subcontractors to perform any portion of the work must include the above-requested information and certifications for each entity on the proposed team or each proposed subcontractor. Responses must clearly indicate the nature of the teaming arrangement (i.e. Joint Venture, Mentor/Protégé, or Subcontractor) The contractor and any subcontractors must not have any relationships or arrangements through business operations or its employees that could be considered as possibly lessening the company's objectivity concerning any aspect of the proposed tasks. If such relationships or arrangements exist, contractors or subcontractors shall be required, during the procurement process (if one occurs), to identify potential conflicts of interest and discuss how the conflicts will be addressed and mitigated. Capability statements will be reviewed and assessed to determine whether any eligible Service-Disabled Veteran-Owned Small Business, HUBZone, Women-Owned Small Business, and 8(a) contractors have the ability to perform the work requirements detailed in this notice. The government will not be responding to vendors in relation to information received and vendors are advised to not share proprietary information in response to this capability statement. Vendors are advised that the issuance of this notice does not obligate the government to cover any costs for submission in response to this announcement.
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/HHS/HCFA/AGG/DB150097/listing.html)
- Place of Performance
- Address: At Contractor Site, United States
- Record
- SN03595209-W 20141214/141212234609-1f2edfd958edda2b39beaed8cfa968d4 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
(may not be valid after Archive Date)
| FSG Index | This Issue's Index | Today's FBO Daily Index Page |