SOURCES SOUGHT
R -- Independent Evaluation of Audit Program Development Protocols
- Notice Date
- 1/5/2007
- Notice Type
- Sources Sought
- NAICS
- 541611
— Administrative Management and General Management Consulting 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, MD, 21244-1850, UNITED STATES
- ZIP Code
- 00000
- Solicitation Number
- Reference-Number-08251978
- Response Due
- 1/19/2007
- Archive Date
- 2/3/2007
- Small Business Set-Aside
- Total Small Business
- Description
- The Centers for Medicare & Medicaid Services (CMS) is seeking to identify small businesses (SDB, WOB, HUBZone, VOSB and SDVOSB) particularly General Services Administration contract holders with capabilities or prior experience for potential award of a contract to conduct activities required by the Medicaid Integrity Program provisions in the Deficit Reduction Act. The overall activities include the review of the actions of individuals or entities furnishing items or services under a Medicaid state plan; the audit of claims for payment of these services; identifying overpayments to individuals or entities receiving Federal funds; and educating providers of services, managed care entities, beneficiaries, and other individuals with respect to payment integrity and quality of care. Under the provisions of Deficit Reduction Act (DRA) of 2005, Section 6034, Congress directed the Centers for Medicare & Medicaid Services (CMS) to establish the Medicaid Integrity Program (MIP). The Comprehensive Medicaid Integrity Plan (CMIP), developed in accordance with this legislation, will guide CMS efforts to fulfill this new obligation. There are two broad responsibilities under this new program. Reviewing the actions of individuals or entities furnishing items or services for which payment may be made by Medicaid; conducting audits of claims for payment; identifying overpayments and educating providers and others on payment integrity and quality of care; and Providing effective support and assistance to the States to combat Medicaid fraud, waste, and abuse. CMS hired a contractor to develop a Medicaid Payment Integrity Audit System. The Contractor is developing four protocols for the Medicaid Integrity Contractor(s) (MIC) to use when reviewing actions of Medicaid providers. The protocols consist of 1) Reviewing the actions of individuals or entities furnishing items or services for which payment may be made by Medicaid; 2) conducting audits of claims for payment; 3) identifying overpayments and 4) educating providers and others on payment integrity and quality of care. The Independent Evaluation Contractor will be required to review and test the protocols developed by this Contractor. The purpose of this contract(s) is to have a Contractor evaluate and test the audit protocols developed by CMS Audit Protocol Development (APD) Contractor. The Contractor shall evaluate and test the design of the audit program by ensuring the audit protocols include valid and reliable methodologies to meet the requirements of Section 6034 of the DRA described in the background section above. The major activities under this contract are: 1. Development of Protocol Testing Plan. The Contractor shall review the draft protocols developed by the APD Contractor and develop a plan for evaluating and testing the audit protocols and providing recommendations for the revision of the protocols 2. Testing of the audit protocols. The Contractor shall test the draft APD audit protocols developed for each of the four statutorily mandated MIC activities as follows: X The effectiveness in evaluating the actions of the individuals or entities furnishing items or services for which payment may be made by Medicaid; X The effectiveness of determining accuracy of paid claims to ensure compliance with Medicaid rules and regulations; X The effectiveness of identifying inappropriate payments; and X The effectiveness in educating providers and others on payment integrity and quality of care based on audit findings. Testing the audit protocols to verify the accuracy of paid claims will include the examination of Provider's paid claims and documentation to determine any inappropriate payments. Any identified inappropriate payments and other related appropriate actions will be recommended to the CMS Project Officer (PO). Please submit your Capability Statement responses to the requirements above in the following manner: 1. E-mail your responses addressing your capability to perform the requirements detailed above to john.cruse@cms.hhs.gov on or before 12:00 PM (noon) local time Baltimore, MD Friday, January 19, 2007. Please be advised;1, that e-mail transmitted files over 5 megabytes are not delivered during standard working hours and are only released from the CMS server after 5:00 PM EST, and may affect the timeliness of your response. 2, Responses should be submitted in MicroSoft Word document with page size 8.5 by 11 inches. Document Font shall be Time New Roman Size 10-12 with no less than single spacing between lines. The number of pages shall be limited to 10 total pages. Other considerations: CMS will use the information submitted in response to this Sources Sought at its discretion and will not provide comments to any submission; however, the content of any responses to this Notice may be reflected in subsequent RFP(s). CMS reserves the right to contact any respondent to this Notice for the sole purpose of enhancing CMS understanding of the submission. This notice is for informational purposes only and does not constitute a solicitation or Request for Proposal. This Notice is not to be construed as a commitment by the Government. The Government will not pay for any information provided as a result of this Notice and will not recognize or reimburse any costs associated with any submissions.
- Place of Performance
- Address: Contractor's Site
- Zip Code: 21244
- Country: UNITED STATES
- Zip Code: 21244
- Record
- SN01205808-W 20070107/070105220439 (fbodaily.com)
- Source
-
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