SOLICITATION NOTICE
D -- CMS HIERARCHICAL CONDITION CATEGORY (HCC) MAINTENANCE
- Notice Date
- 6/18/2010
- Notice Type
- Justification and Approval (J&A)
- NAICS
- 541519
— Other Computer Related 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
- Point of Contact
- Brenna Smothers, Phone: 410-786-1277, Brian W. Hebbel, Phone: 410-786-5159
- E-Mail Address
-
brenna.smothers@cms.hhs.gov, brian.hebbel@cms.hhs.gov
(brenna.smothers@cms.hhs.gov, brian.hebbel@cms.hhs.gov)
- Small Business Set-Aside
- N/A
- Award Number
- HHSM-500-2010-00106P
- Award Date
- 8/18/2010
- Description
- Two CMS Program Offices, the Center for Drug and Health Plan Choice (CPC) and the Quality Measurement and Health Assessment Group (QMHAG), use the Hierarchical Condition Category (HCC) System as an integral part of their risk adjustment methodology for calculating payment for health plans and hospital quality of care measures for public reporting respectively. Section 4001 of the Balanced Budget Act (BBA) of 1997 authorizes the Secretary of the Department of Health and Human Services (HHS) to implement a risk adjustment methodology that accounts for variations in per capita costs based on health status and other demographic factors for payment. In response to this BBA mandate, the Centers for Medicare & Medicaid Services (CMS) contracted the Research Triangle Institute (RTI) to develop the Hierarchical Condition Category (HCC) System to support the risk adjustment methodology in 2004. The purpose of the HCC algorithm is to group patient diagnosis codes on claims to define patient risk factors for risk adjustment. The CMS HCC algorithm first assigns 15,000+ ICD-9-CM diagnosis codes to 804 groupings ("Dx Groups") and then subsequently aggregates them into 189 clinically relevant categories. In 2006, the Center for Drug and Health Plan Choice (CPC) contracted the Research Triangle Institute (RTI) to maintain 70 of the 189 HCC elements for use in the payment methodology for the Medicare Advantage plans. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 requires hospitals to submit quality measure data to CMS in order to receive full annual payment update (APU) of the services provided. The Act further requires that CMS make the measure data available to the public. Given the MMA authority, CMS established the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) Program that collects, validates and posts the hospital quality measures on Hospital Compare. The MMA requires hospitals to submit data on 10 "core" Process of Care Measures; the DRA of 2005 expands the domains of quality measures to include Structure, Patient Satisfaction and Outcome/Efficiency. In compliance with the DRA requirements, QMHAG developed six Hospital Outcome/Efficiency Measures for the following topics: the 30-Day Mortality and Readmission Measures for Acute Myocardial Infarction (AMI), Heart Failure (HF) and Pneumonia. These measures use all 189 clinically relevant HCC for the risk adjustment models. To meet the RHQDAPU Program needs, QMHAG is required to update the 189 HCC elements yearly to calculate the Outcome/Efficiency Measures. This contract will acquire RTI's expertise to build on and expand the maintenance work that RTI conducts under the contract with CPC (for the 70 HCCs) to include all 189 HCCs which are used by QMHAG.
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/notices/99eb5368233d88ddf9b6ba3ab9c6ea11)
- Place of Performance
- Address: Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Mailstop: C2-21-15, Baltimore, Maryland, 21244, United States
- Zip Code: 21244
- Zip Code: 21244
- Record
- SN02182455-W 20100620/100618235130-99eb5368233d88ddf9b6ba3ab9c6ea11 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
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