SOLICITATION NOTICE
R -- Point of Sale Facilitated Enrollment
- Notice Date
- 7/28/2006
- Notice Type
- Solicitation Notice
- NAICS
- 524292
— Third Party Administration of Insurance and Pension Funds
- 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-CMS-POSFE-2007
- Archive Date
- 10/1/2006
- Description
- Contracting Office Address Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Office of Acquisition and Grants Management, Acquisition and Grants Group, Division of Beneficiary Support Contracts, 7500 Security Boulevard, Baltimore, MD 21244 Description The Centers for Medicare and Medicaid Services (CMS) intends to negotiate and award a contract, pending availability of funds, for Prescription Drug Benefit adjudication. The North American Industrial Classification System (NAICS) code is 524292, Third Party Administration of Insurance and Pension Funds. 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 The purpose of this contract is for the contracted plan to pay claims for those unassigned dual eligible and LIS-eligible beneficiaries who could not specifically be ruled out as ineligible for the process. Following a post-adjudicative screening against State Medicaid eligibility systems to verify Medicaid eligibility by another CMS contractor, the plan would enroll those beneficiaries identified as dual eligible or LIS eligible into their Part D plan and reverse all other claims. Description of Requirements CMS will compete this requirement among those contractors that meet the following criteria: 1. The contractor is a PDP Sponsor under contract with CMS. 2. Capacity to adjudicate claims at the point-of-sale for individuals claiming to be full-benefit dual eligibles with no Part D plan enrollment who present at a pharmacy with a prescription drug need; 3. Capacity to process claims against an extract of CMS? Medicare Beneficiary Database, refreshed and downloaded to the plan on a nightly basis, or via an alternative methodology approved by CMS, with the ability to implement fortified security measures for such data; 4. Ability to rapidly establish connectivity with CMS and its Medicaid Eligibility Verification Contractor, and to be ready to test such connectivity by December 1, 2006; 5. Capacity to allow for unobstructed claims submissions by out-of-network pharmacies; 6. Ability to reverse claims to pharmacies for any claims submitted on behalf of beneficiaries who have been determined or deemed ineligible for the Medicare low-income subsidy; and 7. Capacity for rapid enrollment of eligible beneficiaries into its Part D plan. The contracted CMS PDP Sponsor will be required to have one plan in each region with a premium at or below the regional low-income premium subsidy amount in 2007. As the low-income premium subsidy amount for 2007 will not be announced until early-to-mid August 2006, CMS PDP Sponsors who anticipate meeting this criterion will be invited to submit a proposal. The CMS PDP Sponsor will be required to submit an estimate for incremental administrative costs, in the form of fixed price per claim transaction fees, in its proposal. Such administrative costs must be entirely exclusive of those administrative costs submitted and reimbursed under the Part D bid, such as costs related to enrollment and member services for enrolled beneficiaries, network contracting, or other overhead. Should no contractor meet this criterion, the contracted CMS PDP Sponsor must agree to submit information on beneficiaries in the uncovered regions to CMS for random enrollment into another plan and use the plan-to-plan reconciliation process to secure reimbursement for the amounts of paid claims for the affected beneficiaries. Point of Contact Email your questions to Chip Farmer, Contract Specialist, at edward.farmer@cms.hhs.gov or to Debra A. Hoffman, Contracting Officer, at debra.hoffman@cms.hhs.gov.
- Record
- SN01100353-W 20060730/060728220408 (fbodaily.com)
- Source
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