MODIFICATION
R -- Workers Compensation Review Contractor
- Notice Date
- 9/6/2016
- Notice Type
- Modification/Amendment
- NAICS
- 524298
— All Other Insurance Related Activities
- 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-2016-8A-0008
- Archive Date
- 10/7/2016
- Point of Contact
- Debbie R Stidham, Phone: 410-786-5129, Stephen D. Stoyer, Phone: 410-786-9803
- E-Mail Address
-
debra.stidham@cms.hhs.gov, stephen.stoyer@cms.hhs.gov
(debra.stidham@cms.hhs.gov, stephen.stoyer@cms.hhs.gov)
- Small Business Set-Aside
- Competitive 8(a)
- Description
- The Centers for Medicare & Medicaid Services (CMS) anticipates releasing a solicitation for the Workers' Compensation Review Contractor (WCRC) on or about September 22, 2016, as a competitive 8(a) set-aside utilizing FAR part 15 procedures. CMS anticipates awarding a fixed price contract. The resultant contract will include a 12 month base period plus (4) four one (1) year options. The anticipated proposal due date is October 24, 2016 with an anticipated award date of February 8, 2016. This solicitation is expected to be issued pending the availability of funds. These dates are provided for planning purposes only and are subject to change. SCOPE: The WCRC shall, in accordance with CMS guidelines, evaluate workers' compensation Medicare set-aside arrangement (WCMSA) proposals, and on an optional basis evaluate proposals from other non-group-health plans, and project the future medical costs, including prescription drugs, related to the workers' compensation (WC) injury, illness, or disease that would be otherwise reimbursable by Medicare. This future cost projection is known as the WCMSA. The contractor shall, upon reviewing complete WCMSA proposals, recommend the WCMSA amount for each proposal to CMS for final determination. PURPOSE: The purpose of this contract is to procure an impartial entity, not as an agent of the Federal government, to independently recommend the future Medicare-covered medical services costs related to the WC injury, illness, and/or disease and to price the future Medicare covered prescription drug expenses related to the WC injury, illness and/or disease thereby taking Medicare's payment interests appropriately into account. BACKGROUND: Insurers, agencies, and attorneys have significant responsibilities under the Medicare Secondary Payer (MSP) provisions of the Social Security Act Section 1862(b) [42 U.S.C. 1395y] to protect Medicare's interests. Because Medicare does not pay for an individual's WC-related medical services and/or prescription drugs when the individual receives a WC settlement, or other non-group-health plan settlement, that includes funds for future medical and/or prescription drug expenses, it is highly critical that the individual consider Medicare's interests at the time of settlement. For this reason, CMS recommends that parties to a WC settlement set aside funds, known as a Workers' Compensation Medicare Set-Aside Arrangement or "WCMSA", or non-group-health plan medical set-aside arrangements "NGHP MSA", for all future medical and/or prescription drug expenses related to the WC injury or illness/disease that would otherwise be reimbursable by Medicare. More information on CMS policies, procedures, and operational guidelines pertaining to the CMS WCMSA review process is available at: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Workers-Compensation-Medicare-Set-Aside-Arrangements/WCMSA-Overview.html Medicare is a nationwide Federal health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). Congress enacted Medicare in 1965 as Title XVIII of the Social Security Act ("the Act"; 42 U.S.C. § 301 et seq.) for persons 65 years of age or older, certain younger disabled persons, and persons with end-stage renal disease (ESRD). The Medicare program serves well over 43 million beneficiaries and processes over one billion claims per year. Fee-for-service (FFS), or "traditional," Medicare consists of two primary parts: Hospital Insurance (HI) otherwise known as Part A, and Supplemental Medical Insurance (SMI) also known as Part B. A third part of Medicare, known as "Medicare Part C" or the "Medicare Advantage (MA) program," was established by the Balanced Budget Act of 1997 (Public Law 105-33). It allows beneficiaries the option of receiving their Medicare benefits through private managed care plans and related kinds of organizations. Finally, the Medicare prescription drug program, also known as "Medicare Part D," was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/HHS/HCFA/AGG/RFP-CMS-2016-8A-0008/listing.html)
- Record
- SN04257541-W 20160908/160907173452-fbe10d0a0b0fc24e17ccb3046bb155f6 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
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