SOLICITATION NOTICE
R -- DDC/RC PERM Project
- Notice Date
- 5/15/2006
- Notice Type
- Solicitation Notice
- NAICS
- 541513
— Computer Facilities Management Services
- Contracting Office
- Department of Health and Human Services, Centers for Medicare & Medicaid Services, formerly known as the Health Care Financing Administration, Office of Acquisition and Grants Management, 7500 Security Blvd. C2-21-15, Baltimore, MD, 21244-1850
- ZIP Code
- 21244-1850
- Solicitation Number
- Reference-Number-DDC-RC-PERM-Project-Synopsis
- Response Due
- 5/31/2006
- Archive Date
- 6/15/2006
- Small Business Set-Aside
- Total Small Business
- Description
- CMS intends to award a 26-month cost reimbursement contract, with two options periods, to one or more small business(s) to assist CMS in performing data processing and medical reviews for the Medicaid and State Children?s Health Insurance Program (SCHIP) Payment Error Rate Measurement (PERM) projects. This is a total small business set-aside. Potential offerors are hereby advised that their accounting system must be adequate for determining costs applicable to the contract and that FAR Clause 52.219-14 and that Limitations of Subcontracting will be incorporated into the solicitation and resultant contract. The North American Industrial Classification System (NAICS) code is 541513. This is not an invitation for bid, request for quote or other solicitation and in no way obligates the Government to award a contract. BACKGROUND: CMS must estimate payment error rates in Medicaid and SCHIP 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, identify those that may be susceptible to significant improper payments, estimate the amount of improper payments, and report those estimates to Congress on an annual basis. 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, any duplicate payments, payments for services not received, and any payment that does not account for credit for applicable discounts. CMS will use a contracting strategy to implement the Medicaid and SCHIP PERM program, which includes reviewing fee-for-service claims and managed care capitation payments. This strategy will engage multiple contractors including a statistical contractor (being procured in a separate procurement), and (A) A Medicaid documentation/database contractor (DDC), and (B) A SCHIP DDC, (C) A Medicaid review contractor (RC), and (D) A SCHIP RC The solicitation may allow Offeror(s) to bid on this work in the following four areas (1) Medicaid DDC; (2) SCHIP DDC; (3) Medicaid RC or (4) SCHIP RC or any combination of the four. The statistical contractor will perform all statistical, sampling and error rate calculation functions for the Medicaid and SCHIP Programs. The DDC will gather and maintain medical policies and corresponding quarterly updates from states, and will collect and maintain medical records from providers. The RC will gather and maintain the data processing manuals, will use the collected policies and medical records to perform medical and data processing reviews; put into place a difference resolution process for the state to dispute the contractor?s findings; provide its findings to the statistical contractor; jointly write the final report with the statistical contractor; and submit the report to CMS. DESCRIPTION OF REQUIREMENTS: The successful documentation/database contract offeror(s) shall coordinate, collect, and maintain all state Medicaid and/or SCHIP policies and/or manuals necessary to conduct medical reviews. This process will also include the collection, on a quarterly basis, and maintenance of all state policy updates related to medical 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 offeror shall have the knowledge and means to manipulate the policy formats for uniformity and relative ease of use by the reviewers. The offeror(s) shall maintain all state Medicaid and/or SCHIP policies in a central housing unit that will be accessed by the reviewers when conducting medical reviews and data processing reviews. The successful documentation/database contract offeror(s) shall also coordinate, request, obtain, scan and upload medical records for the sampled claims. This process will include contacting the providers, and requesting and receiving the medical records associated with the sampled claims. The offeror shall maintain all medical records in a central housing unit that will be accessed by the reviewers when conducting medical reviews. The offeror shall be advised that the size and length of each policy will vary. The offeror shall be prepared to coordinate efforts to obtain policies and quarterly updates of the policies for 17 Medicaid states and/or 17 SCHIP states. The offeror shall also be prepared to handle approximately 800 ? 1200 sampled fee-for-service claims and medical records, or an average of 1000 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. The successful review contract offeror(s) shall make a payment determination for each sampling unit by performing data processing reviews and medical reviews. The offeror shall review each sampling unit to determine if it was processed through the claims payment system correctly, medically necessary, coded correctly and properly paid or denied. The offeror shall validate whether each sampling unit was paid correctly based on: information found on the claim, the information in the medical record, the information in the claims processing system, and state policies. For the managed care initiative, the review contract offeror shall conduct a data processing review of approximately 500 managed care capitation payments for each of the 17 states. The offeror will 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. The offeror(s) shall perform this work for one complete production cycle, which is a 26-month period. This announcement is not a request for proposal (RFP). CMS anticipates release of the Request for Proposal in late May 2006/early June 2006 and it will be made available electronically at http://www.fbo.gov.
- Record
- SN01048029-W 20060517/060515220220 (fbodaily.com)
- Source
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