SOLICITATION NOTICE
R -- Point of Sale - Facilitated Enrollment
- Notice Date
- 8/1/2007
- 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, Office of Acquisition and Grants Management, 7500 Security Blvd. C2-21-15, Baltimore, MD, 21244-1850, UNITED STATES
- ZIP Code
- 00000
- Solicitation Number
- Reference-Number-CMS-POSFE-2008
- Archive Date
- 10/1/2008
- Description
- Presolicitation for Contractor to Administer the 2008 Point-of-Sale Facilitated Enrollment (POS FE) Process for the Medicare Part D Prescription Drug Program 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 & Medicaid Services (CMS) is seeking to award a contract, under full and open competition, to a national Prescription Drug Plan (PDP) Sponsor to administer the POS FE process. The POS FE process provides immediate Part D prescription drug coverage for Medicare beneficiaries who are also Medicaid eligible or LIS eligible, but not yet enrolled in a Part D plan. The purpose of this contract is for the contracted plan to pay claims for eligible beneficiaries. Following a post-adjudicative screening against State Medicaid eligibility systems to verify Medicaid eligibility by another CMS contractor, the sponsor would enroll those beneficiaries identified as dual/LIS eligible into an appropriate Part D plan and attempt to collect claim costs for those who were ruled out as ineligible for the process. Requirements: CMS will compete this requirement among those contractors that meet the following criteria: 1. Be a PDP Sponsor under contract with CMS in both 2007 and 2008; 2. Have in each PDP region (excluding U.S. Territories) a plan benefit package (PBP) with a basic benefit and a premium at or below the 2008 region-specific low-income premium subsidy amount (including a $1.00 per month de minimis amount); 3. Have the capacity to adjudicate claims at the point-of-sale for individuals claiming to be full-benefit dual eligibles or other LIS eligibles, with no Part D plan enrollment, who present at the POS with an immediate prescription drug need; 4. Have the capacity to contract with the CMS TrOOP Facilitator contractor to perform front end edits on claims submitted by pharmacists to the POS FE contractor for purposes of rejecting claims for lack of Medicare Part D eligibility or the presence of other Part D plan enrollment 5. Have the capacity to partner with a CMS Eligibility Verification contractor who will query State Medicaid eligibility verification systems on those beneficiaries who pass the POS FE front end edits but whose dual or LIS eligible status is unknown; 6. Have the ability to establish connectivity with CMS and its designated contractors within 6-8 weeks of the award date of the contract; 7. Have the ability to submit enrollment to CMS within 7 calendar days of confirmation of POS FE from CMS or CMS's contractor; and 8. Have the ability to notify beneficiaries whose eligibility for POS FE cannot be confirmed and collect claim costs from them if they cannot subsequently establish dual or LIS eligibility. All PDPs who anticipate meeting criterion #2 above and who meet all other listed criteria, are invited to submit a proposal to the RFP (when posted) for consideration by the Agency. (Actual ability to meet criterion #2 will not be known for certain until mid-August when the low-income premium subsidy amount is announced) Period of performance will be one fifteen-month base period (three months for transition and twelve months of operations) beginning September 28, 2007 through December 31, 2008. This procurement is subject to the availability of funds. Point of Contact: Chip Farmer, Contract Specialist, 410-786-1997, Edward.farmer@cms.hhs.gov.
- Record
- SN01358563-W 20070803/070801220637 (fbodaily.com)
- Source
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