R -- REQUEST FOR MARKET RESEARCH -- MEDICAID PROVIDER ENROLLMENT

Notice Date

January 10, 2001

Contracting Office

Health Care Financing Administration, Acquisition and Grants Group, C2-21-15, 7500 Security Boulevard, Baltimore, MD., 21244-1850

ZIP Code

21244-1850

Response Due

February 18, 2001

Point of Contact

Dorothy M. Parker (410) 786-5779, Contract Specialist, or Tom Snyder (410) 786-0185, Contract Officer

E-Mail Address

tsnyder@hcfa.gov (dparker2@hcfa.gov)

Description

Background: One of the top priorities of the Health Care Financing Administration (HCFA) is combating fraud, waste, and abuse in the Medicare and Medicaid programs. As such, we believe that effective and appropriate provider enrollment is critical to protecting the integrity of both federal health care programs. HCFA's emerging interest in improving State Medicaid anti-fraud efforts in the provider enrollment area is based principally on three things: 1) ideas generated by internal HCFA discussions at the Administrator/Senior Staff level over the past few years; 2) HCFA's Comprehensive Plan for Program Integrity; and, 3) the results of the work of the National Medicaid Fraud and Abuse Initiative (the Initiative). The work of the Initiative on various anti-fraud issues and, most recently, the results of a series of program integrity reviews of Medicaid State agencies conducted throughout Fiscal Year 2000 identified a need to assist States in improving the provider enrollment process. Additionally, this past summer, the House Commerce Committee focused its attention on the need to strengthen and improve the Medicaid provider enrollment process. Goal: HCFA plans to take proactive measures to increase program safeguard activities by strengthening the provider enrollment process in the Medicaid program, as it has for the Medicare program. The immediate goal is to explore the feasibility of coordinating the Medicare and Medicaid provider enrollment processes in ways that increase the overall effectiveness and efficiency of those systems. It should be noted that provider enrollment is comprised of three distinct and important parts, for which different solutions may be appropriate: 1) collection of information the decision on what information to collect, and the mechanical process of collecting and maintaining it; 2) validation the decision on how to ensure that the information provided is accurate and true, and the mechanical process of carrying out the validation; 3) standard setting -- the decision on where to set the bar for entry into the program, what triggers acceptance or rejection, and the mechanical process for making and enforcing those decisions. Actions might range from basic information sharing to more elaborate systems integration. Products: With this goal in mind, HCFA seeks to model different approaches, which will include an assessment of each of the following: (1) Obstacles -- and specific ideas on how to overcome them; (2) Benefits -- quantified to the extent possible; and, (3) Environmental Impact -- how well each approach fits in with HCFA's other demands and initiatives. HCFA would specifically like to examine:  More specific measures to strengthen the provider enrollment process in the Medicaid program.  The feasibility of using the Medicare provider enrollment application form (855) for the Medicaid provider enrollment program.  The feasibility of a process, or pilot program, where Medicare and Medicaid share provider enrollment verification tasks. For example, Medicare could verify Social Security Numbers and Federal debarment and exclusions, whereas Medicaid could verify more regionalized information such as professional and business licenses and business locations.  Methods for maximizing use of the National Provider Identifier (NPI). Research Venues: The following information is provided to assist in the preparation of a concept paper:  Two HCFA websites that explain the Medicare provider enrollment application process and provide information such as the manual sections that govern Medicare provider enrollment and the actual application forms. These sites are: www.hcfa.gov/medicare/enrollment www.hcfa.gov/medicare/enrollment/links.htm  Additional regulation cites are listed in the various manual sections that can be found on the website.  The Federal Register. A regulation entitled "Medicare Program; Requirements for Establishing and Maintaining Medicare Billing Privileges" is expected to be published in early January 2001.  The Medicaid Fraud Statutes Web site, http://fightfraud.hcfa.gov/  Various State web sites  GAO Report T-HEHS-00-159, July 18, 2000 -- Medicaid: HCFA and States Could Work Together to Better Ensure the Integrity of Providers. NOTICE: HCFA does not intend to award a contract at this time. The sole intent is to obtain market information and technical capabilities for planning purposes. Responses to this notice are not offers and cannot be accepted by HCFA to form a binding contract. Therefore, responses to this request should be brief, with a maximum of ten pages, outlining general capabilities of the prospective contractors and possible alternatives and options with technical approaches. Written statements of interest must be received no later than 4:00 p.m. EST, [30 days after the date of the CBD publication. Responses to this request shall be sent to Mrs. Dorothy M. Parker, C2-22-15, 7500 Security Boulevard, Baltimore, MD. 21244-1850. This notice will be suspended February 18, 2001.

Web Link

ERROR -- (The Medicaid Fraud Statutes Website, http://fightfraud.hcfa.gov/)

Record

Loren Data Corp. 20010112/RSOL015.HTM (W-010 SN50A687)