MODIFICATION
R -- Medicaid Error Rate (MER) Review Contractor
- Notice Date
- 8/26/2005
- Notice Type
- Modification
- NAICS
- 541611
— Administrative Management and General Management Consulting Services
- Contracting Office
- Department of Health and Human Services, Centers for Medicare & Medicaid Services, formerly known as the Health Care Financing Administration, Office of Acquisition and Grants Management, 7500 Security Blvd. C2-21-15, Baltimore, MD, 21244-1850
- ZIP Code
- 21244-1850
- Solicitation Number
- Reference-Number-RFP-PERM-RC2005
- Response Due
- 8/31/2005
- Archive Date
- 9/15/2005
- Point of Contact
- Leisa Bodway, Contracting Officer, Phone 410-786-1278, Fax 410-786-9643, - Monica Carter, Contract Specialist, Phone 410-786-7432, Fax 410-786-9643,
- E-Mail Address
-
LBodway@cms.hhs.gov, MCarter@cms.hhs.gov
- Small Business Set-Aside
- Total Small Business
- Description
- Description "CMS intends to award one (1) cost-type contract set-aside for small business to assist CMS in performing data processing and medical reviews for the Medicaid Error Rate (MER) project. Potential offerors are hereby advised their accounting system must be determined adequate for segregation of costs under a cost reimbursement contract in accordance with FAR 30 & 31 in order to be eligible for award of a contract. Please also be advised that in accordance with FAR 52.219-14 Limitations of Subcontracting, "By submission of an offer and execution of a contract, the Offeror/Contractor agrees that in performance of the contract in the case of a contract for - (1) services (except construction). At least 50 percent of the cost of contract performance incurred for personnel shall be expended for employees of the [small business] concern."" BACKGROUND: CMS must estimate improper payments in the Medicaid program as directed by the Improper Payments Information Act of 2002 (IPIA). The IPIA directs each executive agency, in accordance with the Office of Management and Budget (OMB) guidance, to review all of its programs and activities annually, identify those that may be susceptible to significant improper payments, estimate the annual amount of improper payments, and submit those estimates to Congress. The IPIA defines improper payments as: (a) any payment that should not have been made or that was made in an incorrect amount, including both overpayments and underpayments, under statutory, contractual, administrative, or other legally applicable requirements; and (b) payments made to an ineligible beneficiary, any duplicate payments, payments for services not received, and any payment that does not account for credit for applicable discounts. To implement error rate measurement in Medicaid, CMS will use a national contracting strategy. Under this strategy, CMS will engage three contractors: (1) a statistical contractor (posted to Fedbizopps.gov August 4, 2005); (2) a documentation/database contractor (posted to Fedbizopps.gov August 10, 2005); and (3) a review contractor. The statistical contractor will perform all statistical, sampling and error rate calculation functions. The documentation/database contractor will gather medical policies and other necessary information from states; will maintain a database of the medical policies (along with quarterly updates to these policies) and will gather medical records from providers. All information collected by the documentation/database contractor will be maintained in electronic format. The review contractor will use the policies and medical records obtained by the documentation/database contractor to perform the medical reviews, provide findings to the statistical contractor, jointly write the final report with the statistical contractor and submit the report to CMS. DESCRIPTION OF REQUIREMENTS: The successful offeror, as the review contractor, shall make a payment determination for each sampling unit by performing data processing reviews and medical reviews. The review contractor shall review each sampling unit to determine if was processed through the claims payment system correctly, medically necessary, coded correctly and properly paid or denied. The review contractor shall validate whether each sampling unit was paid correctly based on: information found on the sampling unit, the information in the medical record, the information in the claims processing system, and state policies. The review contractor shall conduct the data processing reviews on-site for each state selected, visiting each state between two and five times. The medical reviews may be performed at a central location. The sampling unit is defined as an individually priced service (e.g., a physician office visit, a hospital stay, a month of enrollment in Medicare). The sampling unit may be a claim or line item. It is estimated that between 800 ? 1200 sampling units or an average of 1000, per state, will need to be reviewed to achieve 3% precision at the 95% confidence level. The contractor shall perform this work for one complete production, December 31, 2005, through November 30, 2007. This announcement is not a request for proposal (RFP). CMS anticipates release of the Request for Proposal September 2005 and it will be made available electronically at http://www.fedbizopps.gov.
- Record
- SN00880333-W 20050828/050826211909 (fbodaily.com)
- Source
-
FedBizOpps.gov Link to This Notice
(may not be valid after Archive Date)
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