R -- MEDICARE MANAGED CARE (MMC) -- PROGRAM INTEGRITY CONTRACTOR (PIC)

Notice Date

March 16, 2001

Contracting Office

Department of Health and Human Services, Health Care Financing Administration, Acquisition and Grants Group, 7500 Security Blvd., C2-21-15, Central Building, Baltimore, MD, 21244-1850

ZIP Code

21244-1850

Solicitation Number

RFP-HCFA-01-0016

Response Due

April 1, 2001

Point of Contact

Theresa Schultz, Contract Specialist, Phone 410-786-8496, Fax 410-786-9922, Email TSchultz@hcfa.gov

E-Mail Address

Theresa Schultz (TSchultz@hcfa.gov)

Description

The Health Care Financing Administration (HCFA) intends to award multiple Indefinite Delivery Indefinite Quantity (IDIQ) contracts for Medicare Managed Care Program Integrity Contractors (MMC-PIC). Please note that this is the solicitation notice for the previously released DRAFT SOW entitled _Medicare Managed Care Program Safeguard Contractor_ that was published in the CBD on January 25, 2001. Services are required from technically qualified offerors who will assist HCFA in the areas of HCFA Management and Oversight, State Survey, Marketing, Audit of Financial and Medical Records, Claims, Payments and Benefit Packages, Validation of Enrollment and Encounter Data and Related Payment Activities, Intermediate Sanctions and Civil Monetary Penalties, Monitoring, and Other Alternatives to Fee-For-Service Medicare. The major goals of the MMC -- PIC are to: identify areas vulnerable to waste, fraud and abuse in both the management and operation of the MMC program; identify current incidents of waste, fraud and abuse; and deter and prevent future waste, fraud and abuse by providing recommendations to HCFA on how to strengthen areas of vulnerability found in the MMC program. In order to be considered for this contract, the offeror shall possess, at a minimum, expertise and/or a thorough understanding of the following: 1) Principles of managed care and the operation and management of Managed Care Organizations (MCOs); 2) Physician Incentive Plan (PIP) guidance; 3) The sections of the Social Security Act and the Code of Federal Regulations (CFR) governing the Medicare plus Choice (M+C) program and the standards and processes for imposing the enforcement provisions; 4) The M+C Contractor Performance Monitoring System; 5) The standards in the Monitoring Guide for M+C and _1876 plans that pertain to Quality Improvement/Management; 6) Proficient use of Access database; 7) The CFR sections governing the M+C program as they relate to marketing practice and marketing materials; 8) A wide variety of statistical analysis packages (Example: SAS and SPSS-X) and statistical analysis methods; 9) Ability to evaluate an MCO using data analysis methods; 10) Ability to work with the Medicare Enrollment and Payment systems; 11) Ability to work with the Health Plan Management System (HPMS); and 12) Requirements imposed on Federal Agencies by the Budget and Accounting Procedures Act of 1950, Federal Manager_s Financial Integrity Act of 1982 (FMFIA), GAO Title II, Chief Financial Officer Act of 1990, Government Auditing Standards (1994 revision, Yellow Book), Title XVIII and XIX of the Social Security Act, committee of Sponsoring Organizations of the Treadway Commission (COSO) report, Generally Accepted Accounting Procedures (GAAP), Generally Accepted Auditing Standards (GAAS), and Generally Accepted Governmental Auditing Standards (GAGAS). The offeror must be free of all conflicts of interest with Managed Care Organizations or M+C plans in order to perform the work under this solicitation. The offeror must not have any relationships or arrangements through its business operations or its employees that could lessen the company_s objectivity concerning any aspect of the MMC Program Integrity program (FAR 9.504). Substantial conflict of interest information will be required with submission of proposals. HCFA will solicit offers with the intent of awarding multiple IDIQ contracts for one base year plus unlimited renewal years. The contract will have fixed price and cost-reimbursement pricing mechanisms available to allow for each Task Order to be negotiated as appropriate. This procurement will be a full and open competition with a partial set-aside minimum of 40% of awards for small businesses. Per FAR 19.102, the North American Industry Classification System (NAICS) code for this effort is 541611 with a small business size standard not to exceed $5 Million. The solicitation will be available on or about March 30, 2001, via the Internet at http://www.fedbizopps.gov, solicitation number RFP-HCFA-01-0016. Offerors must register at fedbizopps before downloading the solicitation. The HCFA point of contact for this effort is: HCFA, OICS, Office of Acquisition and Grants, Division of Medicare Contracts, Attn: Theresa Schultz, Contract Specialist, Mail Stop C2-21-15, 7500 Security Blvd., Baltimore, MD 21244-1850, (410)786-8496, tschultz@hcfa.gov. If the solicitation is not available on the http://www.fedbizopps.gov web site on March 30, 2001, interested offerors are advised to access the site periodically until it is available. Offerors are asked to refrain from contacting HCFA concerning the exact date/time the solicitation will be made available on the Internet site.

Web Link

Visit this URL for the latest information about this (http://www.eps.gov/cgi-bin/WebObjects/EPS.woa/wa/SPF?A=P&P=RFP-HCFA-01-0016&L=3305)

Record

Loren Data Corp. 20010320/RSOL004.HTM (D-075 SN50G4U5)