SOURCES SOUGHT
99 -- Examination Engagement for Review of Medicare Advantage Organizations and Prescription Drug Plans Financial Information
- Notice Date
- 6/15/2009
- Notice Type
- Sources Sought
- NAICS
- 541219
— Other Accounting 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, Maryland, 21244-1850
- ZIP Code
- 21244-1850
- Solicitation Number
- RFP-CMS-09-91062
- Archive Date
- 7/16/2009
- Point of Contact
- Liz Hammond, Phone: 4107867440
- E-Mail Address
-
elizabeth.hammond@cms.hhs.gov
(elizabeth.hammond@cms.hhs.gov)
- Small Business Set-Aside
- N/A
- Description
- Examination Engagement for Review of Medicare Advantage Organizations and Prescription Drug Plans' Financial Information 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 companies (small, and/or disadvantaged) that are qualified to support CMS in the examination engagements for the review of the Medicare Advantage Organizations (MAOs) and Prescription Drug Plans (PDPs). Background: From the beginning of the Medicare program in 1965, Medicare has recognized the unique nature of Health Maintenance Organizations (HMOs) and HMO-like entities and has provided for alternative payment methodologies appropriate for such organizations. The original Medicare amendments to the Social Security Act included the authority for prepaid plans to receive payments for physician services on a basis other than individual charges. Even before the enactment of the federal HMO Act in 1973, the 1972 amendments to the Social Security Act provided authority to contract with HMOs on a risk-sharing basis and on a cost basis. In 1996, Section 202 of the Health Insurance Portability and Accountability Act (HIPAA) added section 1893, to the Social Security Act. Section 1893 established the Medicare Integrity Program (MIP). MIP was established to strengthen CMS's ability to deter waste, fraud and abuse in the Medicare program. It provides for separate and stable long term funding for MIP activities. MIP expands CMS's contracting authority so the agency can more aggressively carry out program safeguard functions. The Balanced Budget Act of 1997 (BBA) established the Medicare+Choice (M+C) program, allowing additional types of managed care organizations to secure Medicare contracts. A major intent of the BBA was to replace the Tax Equity and Fiscal Responsibility Act (TEFRA) with new managed care options (i.e. M+C plans, etc.) for beneficiaries. It allowed for new beneficiary options in addition to the well established types of HMO options operating under TEFRA contracts.   The recently-enacted Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) has expanded the role of private entities in providing benefits to Medicare beneficiaries. First, the law adds a new section to the Social Security Act, 1860D ("Part D") that offers prescription benefits beginning in 2006 through Prescription Drug Plans (PDPs). Secondly, the statute allows for payments to Medicare Advantage Organizations (MAOs) "local plans" formerly M+C plans, and creates a new type of private plan, "Regional" MA plans or Regional Preferred Provider Organizations (RPPOs). CMS's Office of Financial Management (OFM) has overall responsibility for the fiscal integrity of all Agency programs which includes the mandated one-third financial audit requirement. OFM will conduct annual audits of the financial records of at least one third of the MAOs and PDPs as required by Sections 1857(d)(1) and 1860D-12 of the Social Security Act. Description of work: The main objectives of the examinations are to provide assurance that Medicare Advantage and Prescription Drug payments were proper and organizations' self reported information used to determine payment amounts were valid and correct. The audit contractor shall document the results of the examination, extrapolate the value of appropriate exceptions to the entire population and propose payment adjustments. The examination engagements shall be made in accordance with the Uniform Examination Program (UEP) for the Medicare Advantage Organizations (MAO) and Prescription Drug Plans (PDP) which, includes: • Governmental Accounting Standards Board (GASB) • Generally Accepted Accounting Procedures (GAAP) • Generally Accepted Auditing Standards (GAAS) • Generally Accepted Government Auditing Standards (GAGAS). • American Institute of Certified Public Accountants (AICPA) • General Accounting Office Government Auditing Standards (2007 revision, Yellow Book) • Social Security Act (the Act) Titles XVIII and XIX and; the Code of Federal Regulation (CFR) governing the MAO program including, standards and processes for imposing the enforcement provisions.   Requirements for Submitting RFI Responses to CMS: CMS requests capability responses to the Request for Information (RFI). • In order, to respond to the RFI a vendor must be able to indicate experience and/or specific knowledge related, to the Medicare Advantage Program (MAO) and/or the Medicare Prescription Drug Program (PDP). Therefore, responses should provide enough detail to clearly indicate the vendor has knowledge and/or can provide information for the following points: 1. Detailed information related to the audits including, but not limited to the list of auditees, objective of the audits, critical audit procedures, length of the audit, size of the samples tested, the sampling software methodology and, the extrapolation process which, should include examples of audit results and, materiality thresholds (if applicable). 2. Information about an audit program; and, describe the audit procedures applicable for this work including, but not limited to a list of documents reviewed, length of audit, sampling methodology, data manipulation and, materiality threshold. 3. Provide a sample of an audit finding; and, include a condition, cause, effect, criteria and, recommendation. 4. Supply a complete understanding of the reconciliation process for the Medicare Prescription Drug payment. 5. Provide a list of completed training(s) related, to the Medicare Advantage and/or the Medicare Prescription Drug program including, the dates, sponsor and objective of the training(s). 6. Information about an audit program(s) which, relates to the Medicare Advantage and/or Medicare Prescription Drug program including, but not limited to a list of documents for review, the length of the audit, the sampling methodology, data manipulation and, materiality threshold. 7. Detailed information about the ability to maintain and manage large size data files while ensuring security of confidential information including, but not limited to beneficiary information and, plan payment information. 8. An understanding of effective communication with all the parties involved. 9. Detailed information related to the proficient use of Access database. 10. Detailed information about the vendor's capacity to conduct the audits (e.g. the number of staff hours, staff titles, experience, maximum audits that can be performed in a nine (9) month timeframe and, the length of audits)   Please note, the points (above) allow responses from either a vendor with specific experience and/or detailed knowledge about the Medicare Advantage Program and/or Prescription Drug Program. CMS requests that a vendor do not repeat information and/or examples.   • Business Information: 1. DUNS 2. Company Name 3. Company Address 4. Website (as applicable) 5. NAICS code (in which you would operate under for this service) 6. Do you have a Government approved accounting system? If so, please identify the agency that approved the system. 7. Type of Company (i.e. small business, 8(a), woman owned, veteran owned, etc.) as validated via the Central Contractor Registration (CCR). a. All contractors must register on the CCR located at http://www.ccr.gov/index.asp 8. The copy of the information as seen in the CCR. 9. Do you have a GSA Schedule(s). If so, please identify the Schedule(s) as appropriate to this RFI (e.g. GSA Schedule 520, entitled, "Financial Accounting Business Solutions".) Please note, CMS does not intend to award the following Contract under, a GSA Schedule. This information is for market research purposes only. a. Company Point of Contact(s), Phone, and E-mail address(es) b. Point of Contact(s), Phone and Email address(es) of individuals who can verify the demonstrated capabilities identified in the responses. Submit Responses in the Following Manner: Responses must be submitted via email to the Point of Contact listed below no later than Monday, July 6, 2009 COB. The response should include, the Project Identification Number in the subject line; and, a response shall be submitted via email in format compatible with Microsoft (MS) Office 2003 including, but not limited to MS Project, MS PowerPoint, MS Excel and MS Visio. Moreover, the font size shall be Times New Roman Size 12 with no less that single spacing between lines. Responses shall be limited to ten (10) pages; and, each page shall be number starting with page one (1) after, the Table of Contents.   Responses shall be limited to ten (10) pages excluding, the Cover Page and, Table of Contents. Capability responses shall be submitted in the following order: 1. Cover page (not included in the ten [10] pages) a. Company Name b. Address c. Website (as applicable) d. Project Identification Number (e.g. RFP-CMS-09-91062) e. Project Name (i.e. Uniformed Examination Procedures) 2. Table of Contents (not included in the ten [10] pages) 3. Business Information {(outlined above & not included in the ten [10] pages) 4. Points 1 through 10 Please note, responses will not be returned. All information marked proprietary shall be treated as such. CMS shall not be responsible to answer questions about this notice. Disclaimer This is not an invitation for bid, request for proposal or other solicitation and in no way obligates CMS to award a contract. The sole intent is to obtain capabilities for contractors and procurement planning purposes. Documentation should be sent to: Centers for Medicare & Medicaid Services Attn: Liz Hammond, Contract Specialist Office of Acquisitions and Grants Management Acquisitions and Grants Group Division of Medicare Support Contracts Mailstop: C2-21-15 7500 Security Boulevard Baltimore, MD 21244 Point of Contact: Name: Liz Hammond, Contract Specialist Phone: 410-786-7440 Email: elizabeth.hammond@cms.hhs.gov (preferred) (End of text)
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/HHS/HCFA/AGG/RFP-CMS-09-91062/listing.html)
- Place of Performance
- Address: Various, United States
- Record
- SN01844640-W 20090617/090615234534-f08464014bfd045cd0d3a682e265ca2c (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 |