SOLICITATION NOTICE
B -- Obtain and Analyze Additional Data on Private Long-Term Care Claims Denials and Approvals
- Notice Date
- 6/13/2007
- Notice Type
- Solicitation Notice
- NAICS
- 541618
— Other Management Consulting Services
- Contracting Office
- Department of Health and Human Services, Program Support Center, Division of Acquisition Management, Parklawn Building Room 5-101 5600 Fishers Lane, Rockville, MD, 20857, UNITED STATES
- ZIP Code
- 00000
- Solicitation Number
- Reference-Number-100-02-0014--0003
- Response Due
- 7/30/2007
- Archive Date
- 8/14/2007
- Description
- The Department of Health and Human Services intends to negotiate with LifePlans, Inc., Two University Office Park, Suite 304, 51 Sawyer Road, Waltham, MA 02154, on a sole source basis under the authority of FAR 6.302.1. The purpose of this negotiation would be to modify an existing contract, 100-02-0014, in order to obtain and analyze additional data on private long-term care claims denials and approvals. The primary purpose of this contract modification is to conduct an in-depth empirical investigation of allegations that inappropriate claims denial practices are widespread within the private long-term care insurance (LTCI) industry or within certain companies that hold significant market share within the industry. Concerns about claims payment practices in the private LTCI industry have been raised in the media and a Congressional committee has scheduled hearings and proposes to launch and investigation. The premise of this contract modification is that a scientifically credible determination as to whether inappropriate LTCI claims denials are common can be made most rapidly and cost-effectively accomplished by modifying and expanding the scope of work under the aforementioned existing Contract. The Government first contracted with Lifeplans to design a longitudinal study of an ?admission cohort? of private long-term care insurance claimants in 2001. The baseline data was collected on a sample of nearly 1500 claimants from ten private insurance companies during 2003-2005. Longitudinal follow-up (every four months) on surviving members of the admission cohort is still ongoing; however, all data has been collected and analyzed for the baseline ?in-person? interviews and subsequent follow-up interviews (by telephone every four months) through the fourth wave of follow-up interviews (16 months). The ten private insurance companies whose policyholder/claimants have participated/continue to participate in the Lifeplans? LTCI Admission Cohort study collectively account for over 80 percent of all in-force private LTCI policies. Thus, when properly weighted for corporate market share of in-force policies, the sample for this study is about as close as is possible to a nationally representative sample of private LTCI policyholders who have filed claims to access the benefits covered by their policies. The first published report from this study is available at http://aspe.hhs.gov/daltcp/reports/2006/admcohort.htm. The second report (16 month follow-up) will be published shortly. A major requirement of this acquisition is that the Contractor possesses considerable background in research on private long-term care insurance so that the study can be completed in time to provide information relevant to Government policymaking. LifePlans, Inc. alone has both the research experience and pre-established relationships and track record of doing research with a significant majority of long-term care insurance companies that allows for specific and timely analyses to be performed. LifePlans, Inc. is in receipt of grant from the Robert Wood Johnson Foundation in the amount of approximately one half the cost of this study. Any other contractor would have to; 1) have existing relationships with long term care insurers, 2) have the data system capabilities for this nationwide study, 3) acquire specialized knowledge of the survey instruments, sample design and nurse assessment capability relating to private long-term care insurance, and, 4) be able to propose competitively with a firm that receives approximately half the cost of the study required in the Statement of Work via a grant. Therefore, the Government believes that to award this Contract to any contractor but LifePlans would result in a significant increase in cost and even then would not assure adequate representation among participating insurance companies.? The current contract modification proposes to have the Contractor obtain additional claims files from insurance companies. It is anticipated that all ten of the companies involved in the study will agree to make additional claims data available. Lifeplans will then analyze 500 claims approved and 500 claims denied during calendar year 2006. Senior clinicians will review the claims files to determine the appropriateness of both claims denied and claims approved based on the requirements of the individual claimants policies. It is anticipated that expanding the data collection with regard to claims approved/denied will be much more cost-effective and affordable as a modification to the current contract than as a new procurement. Lifeplans has the experience and the expertise, in the form of the Caring Network of trained clinicians familiar with insurance claims adjudication processes to review the claims material provided. Lifeplans also has developed relationships with participating insurers based on past research that will enable Lifeplans to access this very sensitive proprietary data. Finally, in view of the seriousness of the allegations with respect to widespread inappropriate LTCI claims denials, there is an urgent need to obtain the results of these claims analyses as quickly as possible and it is anticipated that Lifeplans will be able to complete these additional analyses within one year following award of the contract modification. Thus, the Government believes that to award this contract modification to any other contractor than Lifeplans would raise the cost of the additional data collection/analysis beyond the funds currently available to the Government for such research and would also fail to assure the continued participation of all of the currently participating major insurers in providing additional claims data for analysis. The purpose of this synopsis is to determine whether there may be other sources with the requisite qualifications to perform the work described above. Any organization capable of performing the work should submit a statement of capabilities with documentation supporting its ability to meet the Government=s requirement as described above. No solicitation document is available. Capability statements should be submitted within 45 days of the publication of this synopsis to the contact point and address given above. See Note 22.
- Record
- SN01317539-W 20070615/070613220657 (fbodaily.com)
- Source
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