MEDICARE PROGRAM SAFEGUARD CONTRACTOR DRAFT STATEMENT OF WORK This annoucement supercedes the annoucement posted to the Commerce Business Daily on 3/13/98. The Health Care Financing Administration (HCFA) intends to issue the Medicare Integrity Program's (MIP) Program Safeguard Contractor (PSC) DRAFT Statement of Work (SOW) for comment on April 6, 1998 and hold a Pre-Solicitation Conference for this effort on April 17, 1998. BACKGROUND: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides a stable source of incrementally increasing funds earmarked for the Medicare program safeguard activities in order to promote the integrity of the Medicare program. In addition, it enables HCFA to contract with a broader group of entities other than the insurers currently serving as Medicare Intermediaries and Carriers. Activities such as audit, medical review, and potential fraud investigations will be consolidated into a single contract in order to ensure that potential fraud and abuse problems are identified and investigated from all angles. This effort will establish a Contractor called a "Program Safeguard Contractor (PSC)" dedicated to program integrity. The PSC will work closely with affiliated contractors which are entities that perform claims processing and other non-program safeguard activities. The geographical jurisdiction in which the work will be done is yet to be determined. However, the PSC will eventually be responsible for performing program safeguard functions for all Medicare providers in its jurisdiction, thereby allowing it to see the full scope of the potential fraud and abuse issues. The PSC will utilize the affiliated contractors' standard claims processing system to access the claims and perform many of its functions. The PSC will be responsible for program safeguard functions such as medical review of Medicare claims; potential fraud case development; cost report audits; data analysis; assisting with the processing of appeals of claims denial; identification of overpayments; and education of certain providers. These activities will be coordinated to promote and facilitate in-depth comprehensive evaluation of Medicare providers. ABOUT THE PSC Draft SOW: The PSC Draft SOW will be released to the general public on or about April 6, 1998 for a 30 day comment period which will close on May 6, 1998. HCFA is interested in receiving questions and comments regarding the entire Draft SOW. However, there are also several specific SOW areas in which HCFA is particularly interested in receiving comments. These specific areas will be identified in the PSC Draft SOW information. Questions and comments should be submitted after April 6th via the MIP Internet web site. HCFA will evaluate comments received from the general public at the end of the comment period and modify the PSC Draft SOW accordingly for an anticipated formal solicitation. At the pre-solicitation conference, we will attempt to answer as many questions from the database (see below) as possible in the time allowed. ABOUT THE HCFA MIP INTERNET WEB SITE: HCFA has provided information about the Medicare Integrity Program (MIP) on the Internet for several months (WWW.HCFA.GOV/MEDICARE/MIP/). We intend to use this site to provide information about the PSC Draft SOW, Pre-Solicitation Conference, post the MIP Bidder's List, generate a PSC Interested Parties Database and generate a PSC SOW Question and Comment Database. On or about March 17, 1998, the MIP Internet web site will contain information about the pre-solicitation conference and instructions for ordering a CD-ROM or paper version of the PSC Draft SOW. By responding to this announcement at the web site, a PSC Interested Parties Database will be generated which will be available for viewing on the MIP web site at all times during the comment period. This database will provide organizations with information about other organizations also interested in the PSC effort so that partnering, teaming, subcontracting, etc. relationships can be developed for the anticipated formal proposal submissions. On or about April 6, 1998, the web site will allow for downloading of the PSC Draft SOW and provide instructions for submitting questions and comments to the PSC SOW Question and Comment Database. This database will contain all questions and comments asked to date and will be available for viewing on the MIP web site at all times during the comment period. You are encouraged to visit the MIP Internet web site for all information regarding the PSC Draft SOW and pre-solicitation conference. HOW TO OBTAIN CONFERENCE INFORMATION: HCFA will hold a Pre-Solicitation Conference for the PSC Draft SOW on April 17, 1998 in order to explain the requirements of the Draft SOW to interested sources. The conference date is subject to change. Therefore, you should visit the MIP web site to confirm the date before traveling to Baltimore. Organizations wishing to attend the Pre-Solicitation conference must RSVP by April 15, 1998. Conference attendees should obtain conference information prior to release of the PSC Draft SOW on April 6, 1998, in order to make economical travel arrangements. To obtain detailed conference information please visit the MIP web site at WWW.HCFA.GOV/MEDICARE/MIP/ or contact Dawn Tucker, Contract Specialist, at 410-786-5162, or send E-mail to PSC@HCFA.GOV. Conference attendance is limited to 2 people per organization and HCFA is not responsible for travel costs for the pre-solicitation conference. E-mail communications should include company name, address, point of contact, business type (i.e. audit firm, health insurance company, health care provider, information technology company, other), business size (i.e. small, small disadvantaged, women-owned, other) number of attendees, format preference for the PSC Draft SOW (see below). HOW TO OBTAIN THE PSC Draft SOW: The PSC Draft SOW will be available to the general public on or about April 6, 1998. Since the PSC Draft SOW is large and includes numerous attachments available only in electronic format, HCFA will NOT be providing the PSC Draft SOW to the public in an all paper form. Therefore, the following formats are available: 1) Internet downloading of SOW and all attachments (see above); 2) All inclusive CD ROMs; and 3) For interested sources who do not have Internet access and do not have access to a computer with CD ROM capability, paper SOW and primary attachments will be provided with CD ROM secondary (laws, regulations, manuals and user guides) attachments available for viewing at the HCFA library from 8:00 to 4:00 pm daily M-F (contact Elnora Scott at 410-786-7804 if you intend to visit the HCFA library to view secondary attachments). You are encouraged to use the Internet MIP web site to obtain a copy of the PSC Draft SOW. If you choose to download the Draft SOW or order a CD ROM or a paper Draft SOW via Internet form, please do so ONLY ONCE to maintain the integrity of the PSC Interested Parties Database. The CD ROM or paper Draft SOW will then be sent to you in the requested format on or about April 6th. Only one Draft SOW will be sent to each organization. For interested sources who choose not to use the Internet MIP web site to obtain a copy of the PSC Draft SOW or pre-solicitation conference information, please contact Dawn Tucker, Contract Specialist at 410-786-5162, or write to HCFA, ATTN: Dawn Tucker, 7500 Security Blvd., C2-21-15, Baltimore, MD 21244-1850, or send E-mail to PSC@HCFA.GOV.

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