SOURCES SOUGHT
R -- Management and Review of Plan Benefit Packages Submitted by Medicare Advantage Organizations
- Notice Date
- 11/21/2006
- Notice Type
- Sources Sought
- NAICS
- 541611
— Administrative Management and General Management Consulting 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, MD, 21244-1850, UNITED STATES
- ZIP Code
- 00000
- Solicitation Number
- 70133
- Response Due
- 12/4/2006
- Archive Date
- 1/31/2007
- Small Business Set-Aside
- Total Small Business
- Description
- Management and Review of Plan Benefit Packages Submitted by Medicare Advantage Organizations Centers for Medicare and Medicaid Services (CMS) THIS IS NOT A FORMAL REQUEST FOR PROPOSAL (RFP) AND DOES NOT COMMIT THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) TO AWARD A CONTRACT NOW OR IN THE FUTURE. This is a SOURCES SOUGHT NOTICE to determine the availability of potential small businesses on the GSA MOBIS Schedule (e.g., small business, 8(a), service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, and women-owned small business) that can provide assistance in the management and review of Plan Benefit Packages (PBPs) submitted by Medicare Advantage (MA) organizations. History: The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) expanded the role of private entities in providing benefits to Medicare beneficiaries. Initially, the law added a new section to the Social Security Act; 1860D (Part D) that offered prescription benefits beginning in 2006 through Prescription Drug Plans (PDPs). Secondly, the statute allowed for payments to MA ?local plans? (formerly Medicare Plus Choice (M+C) plans) and created a new type of private plan, ?regional? MA plans. Finally, the legislation specified that beginning with the 2006 contract year organizations bidding for contracts or with contracts that offered PDPs and MAs must annually submit bids that support the actuarial basis of its pricing. The bidding process was first implemented in 2005 for enrollment and payments to MA organizations beginning January 1, 2006. It required MA organizations to submit bid amounts to CMS by June 6, 2005 containing their estimate of monthly costs for providing services and benefits for the average beneficiary in each plan. The purpose of the bidding by MA organizations was to base the monthly payment on an organization?s monthly expected revenue needs rather than an administratively set amount. CMS reviewed the actuarial value of the bid and negotiated a bid amount with the MA organization. Each bid contained a rate which was compared to a benchmark rate announced by CMS (performed annually). The comparison was used to establish additional premiums or rebates due to enrollees of the MA organization. A premium was not charged to the enrollee if the benchmark rate was higher than the bid and rebates provided. The submitted bids were subject to review by CMS. All data was submitted as part of the bid process and subject to audit by CMS or by any person or organization that CMS designated. Medicare Advantage Bidding MA organizations must submit an aggregate monthly bid amount for each coordinated care, private-fee-for-service, or Medical Savings Account plan the organization intends to offer. Each aggregate bid for a MA plan represents the MA organization?s estimate of its average monthly required revenue to provide coverage in the service area of the plan for an MA eligible beneficiary with a nationally average risk profile. Each bid is for a uniform benefit package for the service area. The bid shall contain all estimated required revenue, including administrative costs and return on investment (profit, retained earnings). When preparing the bid form, the MA organization must: ? Report the Medicare base period allowed costs, ? Enter the estimated adjustments needed to project the base period costs to the contract year, ? Report the estimated cost sharing values for the contract year, and ? Compute the benchmark, rebate, and member premium. MA organizations that do not have base period costs (or do not have fully credible experience) must enter an estimated rate that estimates the Medicare costs for the contract year. Also, MA organizations must make an actuarial projection for their populations concerning the expected utilization of each supplemental (both mandatory and supplemental) benefit. CMS reviews the reasonableness of the projections as part of the bid review process. Review and Approval of Bids CMS has the responsibility to: (i) review each MA organization?s bid to ensure they are actuarially sound, and (ii) negotiate with MA organizations to request additional information or adjustments of bid amounts. CMS has the authority to negotiate with MA organizations in a style similar to the type of negotiations conducted by the Office of Personnel Management with the Federal Employees Health Benefit Program. Organizations may also charge separate premiums for supplemental benefits and for prescription drug coverage. Health Plan Management System The Health Plan Management System (HPMS) is a CMS information system and data exchange mechanism for the data related to Medicare managed care organizations. By serving as the centralized repository for Medicare managed care data, the HPMS provides its users with access to this information as well as with an analytical framework for exploring the data. In addition to its analytical functions, the HPMS will support the bid process by providing for: (1) a bid pricing tool, (2) a bid pre-uploaded validation tool, (3) a bid submission module, and (4) a bid desk review module. The bid pricing tool forms the bid in combination with the Plan Benefit Package (PBP). The pre-uploaded validation tool compares the PBP to the bid to identify errors prior to upload. The bid submission module downloads PBP and bid pricing tool software, creates plan structures, uploads plans and resubmissions, and plans for the use of a digital signature. Finally, the bid desk review module will integrate the bid desk review into HPMS and support the concurrent reviews of the Office of the Actuary and the Center for Beneficiary Choices/Medicare Advantage Group. Purpose CMS is seeking the services of a contractor to assist in the management and review of benefits contained within a MA organization?s PBP. Each of the plan?s bids must undergo an electronic desk review analysis involving a crosscheck of each benefit category against items shown on the bid pricing tool. For example, do optional supplemental benefit packages in the bid pricing tool agree with the benefits shown in the PBP? Do premiums for mandatory supplemental benefits agree with premiums shown within the bid pricing tool? These and other questions must be answered. To accomplish this task, the contractor shall review the current electronic desk review and adjust it to reflect the new requirements of the bid pricing tool. Additionally, the contractor shall ensure that benefit packages and individual benefits do not discriminate against classes of beneficiaries who require high-priced medical services. Renal dialysis is one example. CMS is required to ensure that a steerage/discrimination bias does not occur in benefit packages offered to beneficiaries who need costly services, or other items such as diabetic supplies as well as clinical and diagnostic services. A review of pricing data for benefit services offered to Medicare beneficiaries needs to be completed by CMS before the bid submitted by the MA organization can be approved. The contractor shall assist CMS in analyzing benefit outlier criteria to ascertain if a particular benefit is discriminatory as offered. As part of this review, the contractor shall be required to provide analysis of benefits, services, and their associated costs to population segments to identify any plans that may exceed reasonable plan design criteria. The plan design criteria shall be provided by CMS to the contractor who will incorporate the standards into an evaluation tool. This tool shall enable CMS staff to test the various bid submissions and shall be revised periodically during the bid season. Task Descriptions: The tasks under this contract shall focus on the management, analysis, and processing of Plan Benefit Packages (PBP) submitted by MA organizations. The review period begins the first Monday in June and continues for a six month period. The remaining six months under the contract shall be devoted to preparing for the subsequent bid season. A contractor shall be able to demonstrate they have extensive knowledge with managed care regulations and specific experience with reviewing and processing benefit information provided by MA organizations. The tasks shall include the following: 1. Proficiency with the electronic desk review system that serves as the basis for reviewing all PBPs. The contractor shall be responsible for making changes to the electronic desk review system using lessons learned from the previous bid season. Additionally, the contractor shall provide training to CMS staff on changes made to the electronic desk review system that will impact the following bid season. 2. Perform first-line reviews of over 10,000 PBPs representing initial and renewal submissions and plan corrections. Second-line reviews must be performed to ensure quality and consistency among the reviewers. 3. Identify and research MA operation and policy issues related to the review of PBPs. 4. Analyze data from the MA PBP submissions with the objective of identifying instances of steerage and discrimination against specific classes of beneficiaries. The results of any analyses shall be presented to CMS. 5. Make several presentations to CMS staff on the concluded 2008 bid season highlighting changes in various markets from prior year submissions. Contractor Requirements: PLEASE NOTE: Any potential offeror must demonstrate the following: 1. Working knowledge and an understanding of the Medicare Prescription Drug Improvement Act of 2003. 2. Current knowledge and experience working with the Health Plan Management System (HPMS) and those modules (such as the electronic desk review system) related to managed care and the bid season. If prior experience of the HPMS is not possessed, then the contractor shall possess experience using large data bases to examine and manipulate data and issue reports to management. 3. Experience with using a sophisticated Excel spreadsheet enabling CMS to identify MA organizations submitting potentially discriminatory benefit packages affecting high-risk Medicare enrollees. This CMS Excel spreadsheet (known as Ask Marty) is used to evaluate the scope and range of potentially discriminatory benefit structures. If prior experience with this spreadsheet is not possessed, then the contractor shall possess experience using a similar type of Excel spreadsheet to manipulate and analyze data. 4. Develop data analysis tools (such as the electronic desk review used to process PBPs) that answer many difficult questions regarding Medicare beneficiary access to a wide range of Medicare managed care and prescription drug offerings. If the contractor does not have experience with a PBP-related data analysis tool such as the electronic desk review system, then contractor shall possess experience with similar types of analytical software tools to review and process large volumes of work. 5. Ability to respond quickly to information requests from CMS for 2007 and 2008 managed care data. This task requires taking raw bid data (contained in the Ask Marty spreadsheet) and transforming it into readable information. The response time for the presentation of the data can run from four hours to 24 hours after receiving a data request from CMS. 6. Experience in communicating with many companies (such as Medicare Advantage organizations) and assisting them with meeting mandated deadlines (e.g. the approval of health benefit packages). 7. Experience in preparing and giving presentations before small and large audiences on topics related to the Medicare Prescription Drug Improvement and Modernization Act of 2003. 8. Ability to assign, a team comprised of managed care specialists, statisticians, and computer programmers available during critical times of the contract period. This requirement is due to the seasonal need for the contractor to review and process the submission of PBPs which begins in June and continues for a period of four months (could vary). During the entire contract period, the contractor?s staff must be available to respond to requests for managed care information, participate in meetings with CMS staff, assist in presentations involving the PBP, and other projects involving managed care activities. 9. Development of a plan to respond to conflict of interest issues when dealing with the managed care community. It is essential that the offeror be free of all perceived, potential or actual conflicts. Specifically, the offeror must not have any relationships or arrangements through its business operations or its employees that could be considered as possibly lessening the company?s objectivity concerning any aspect of this action. If such relationships or arrangements exist, offerors shall be required, during the procurement process, to identify potential conflicts of interest and discuss how the conflicts will be addressed and mitigated. Capability Submission: Specify the name and telephone number of a point of contact and indicate your size standard under the following North American Industry Classification System (NAICS) (formerly known as the SIC code): 541611-Administrative Management and General Management Consulting Services ? (Size Standard: $6.5 million). Additional information on NAICS codes can be found at www.sba.gov. The synopsis is for information and planning purposes and is not to be construed as a commitment by the Government. This is not a solicitation announcement for proposals and no contract will be awarded from this announcement. No reimbursement will be made for any costs associated with providing information in response to this announcement and any follow-up information requests. Respondents will not be notified of the results of the evaluation. All information submitted in response to this announcement must arrive on or before the closing date. Responses must be submitted not later than December 4, 2006. Responses shall be limited to fifteen (15) pages. Resumes of key people are limited to 2 pages and may be submitted as an attachment, which will not count towards the page limit. Documentation should be sent to: Centers for Medicare & Medicaid Services Attn: Heather Robertson, Contract Specialist Office of Acquisitions and Grants Management Acquisitions and Grants Group Division of Beneficiary Support Contracts Mailstop: C2-21-15 7500 Security Boulevard Baltimore, MD 21244 Please refer any questions to: Point of Contact Name: Heather Robertson, Contract Specialist Phone: 410-786-6888 Fax: 410-786-9088 Email: heather.robertson@cms.hhs.gov
- Record
- SN01184694-W 20061123/061121220205 (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 |