DHHS, Office of the Secretary, Division of Contract Operations, Room 443H, Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201

R -- PERFORM MEDICAL RECORD REVIEW ON HOSPICE PAYMENTS FOR NURSING FACILITY PATIENTS SOL RFP-15-96-HHS-OS POC Contact: Ms. Gaynel M. Abadie (202) 690-7506 This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; proposals are being requested and a written solicitation will not be issued. This is a request for proposal, RFP-15-96-HHS-OS. This solicitation document and its incorporated provisions are those in effect through Federal Acquisition Circular #37. This is a full and open competition acquisition. The requirement is as follows: BACKGROUND: The Office of Inspector General (OIG) has an oversight responsibility for the Medicare and Medicaid programs, and as such must determine that these programs are operating as free as possible from fraud, waste and abuse and assure that the controls the Department places on the system and all affected parties are effective. Personnel resources are not available within the Office of Evaluations and Inspections (OEI) to provide the services requested. It would not be cost effective to provide all of this medical expertise in-house. STATEMENT OF WORK: Hospice care is an approach to treatment that recognizes that the impending death of an individual warrants a change in focus from curative care to palliative care. To provide this care, Medicare established the Hospice Benefit in 1983. The goal of this benefit is to help terminally ill individuals to continue life with minimal disruption in normal activities while remaining primarily in the home environment. However, if a Medicare beneficiary residing in a skilled nursing facility or nursing facility (SNF/NF) is diagnosed as terminally ill, he/she can also elect the hospice benefit. A hospice patient who is being treated at home may also choose to enter a SNF/NF. When this occurs the hospice takes the full responsibility for the professional management of the patient's hospice care and the nursing facility provides room and board. Room and board includes assistance in the activities of daily living, socializing activities, administration of medication and other activities. When a patient is in the SNF/NF, Medicare pays the hospice a fixed amount for each day that the patient is under their care. In addition, when eligible Medicare/Medicaid nursing facility patients elect to receive hospice care, the State Medicaid program will discontinue payment to the NF and make payments to the hospice for those days when either routine home care or continuous home care was provided. The Medicaid payment to the hospice includes a portion that takes into account room and board being furnished by the nursing facility. By law, the amount paid to the hospice by the State Medicaid program must equal at least 95% of the per diem rate that the State would have paid for nursing facility care. Some have questioned whether it is appropriate to pay both the hospice and the SNF/NF for services provided to Medicare patients. Each patient's medical record from the nursing facility for two months prior to the patients election of hospice care and during the time of hospice care and the hospice medical record will be sent to the medical review contractor. The purpose of this acquisition if for the medical review contractor to review the patient's diagnosis and history to determine if the patient qualifies for the hospice benefit. The contractor will also determine: how services provided by the nursing facility differed once the patient elected Medicare hospice benefits; what types of services are being provided by the hospice; are they of a palliative nature; could they have been provided by the nursing home; what other services are being provided to the patient; and are those services appropriate? The total sample should consist of 262 beneficiaries' records with partial medical records from the SNF/NF and complete records from the hospice. The contractor with the OIG will develop the screening instrument. Screeners would do the first line review and peers would review questionable cases to make final determinations. All records will be provided to contractors within 4 weeks from the effective date of the contract. Results of the medical record review shall be provided to OIG within 6 weeks of receipt of all records to the contractor. The provision at FAR 52.212-1, Instructions to Offerors-Commercial, applies to this acquisition. Submissions shall consist of a pricing proposal that fully details all of the costs to perform the medical record review; and a technical proposal consisting of a cover sheet on letterhead stationary listing the RFP being responded to, the offeror's name, location, and telephone/fax numbers, a statement indicating understanding of the requirements and the ability to comply with the timeframes as previously stated, a resume of proposed professional personnel, including any relevant past and/or current experience, education, or training, along with statements of availability, and samples of similar report documents which the offeror has drafted and which have been issued. The price and technical proposals should address this requirement in sufficient detail that the following criteria can be used to evaluate submissions: Price - Weight 25%/ Technical - (1) Offeror should demonstrate understanding of the problem and statement of work. (Weight: 25%), Offeror should demonstrate ability to fulfill the obligations described in the statement of work (25%), Offeror should demonstrate the qualifications and experience of personnel available to do the work (25%). Offerors must include a completed copy of the provision at FAR 52.212-3, Offeror Representations and Certifications-Commercial Items, with their offer. The clause at FAR 52.212-4, Contract Terms and Conditions-Commercial Items, applies to this acquisition. Any clauses or provisions referenced in this notice can be accessed through the Internet address that follows: http://www.gsa.gov/far/90-37/html/52_000.html/. Offers are due by May 8, 1996, by 4:00 PM EST, at the following location: Department of Health and Human Services, OS/Division of Contract Operations, Room 443H, Humphrey Building, 200 Independence Avenue, SW, Washington, D.C. 20201, ATTN: Ms. Gaynel M. Abadie. The contact point shall be Ms. Gaynel M. Abadie, 202-690-7506. Amendments to this solicitation, if any, shall also be published as a Commerce Business Daily synopsis. (0113)

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