SOURCES SOUGHT
99 -- Agreed-Upon Procedure Review of Cost–Based Medicare Managed Care Organizations (MCO) Cost Reports
- Notice Date
- 6/15/2009
- Notice Type
- Sources Sought
- NAICS
- 541219
— Other Accounting 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, Maryland, 21244-1850
- ZIP Code
- 21244-1850
- Solicitation Number
- RFP-CMS-09-91062-MCO
- Archive Date
- 7/16/2009
- Point of Contact
- Liz Hammond, Phone: 4107867440
- E-Mail Address
-
elizabeth.hammond@cms.hhs.gov
(elizabeth.hammond@cms.hhs.gov)
- Small Business Set-Aside
- N/A
- Description
- Agreed-Upon Procedure Review of Cost-Based Medicare Managed Care Organizations (MCO) Cost Reports THIS IS NOT A FORMAL REQUEST FOR PROPOSAL (RFP) AND DOES NOT COMMIT THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) TO AWARD A CONTRACT NOW OR IN THE FUTURE. This is a SOURCES SOUGHT NOTICE to determine the availability of companies (small, and/or disadvantaged) that are qualified to support CMS in the examination engagements for the review of the Managed Care Organizations (MCOs). Background: From the beginning of the Medicare program in 1965, Medicare has recognized the unique nature of Health Maintenance Organizations (HMOs) and HMO-like entities and has provided for alternative payment methodologies appropriate for such organizations. The original Medicare amendments to the Social Security Act included the authority for prepaid plans to receive payments for physician services on a basis other than individual charges. Even before the enactment of the federal HMO Act in 1973, the 1972 amendments to the Social Security Act provided authority to contract with HMOs on a risk-sharing basis and on a cost basis. The Tax Equity and Fiscal Responsibility Act (TEFRA) was passed in September 1982 in which Congress mandated the provision of managed care plan options to Medicare beneficiaries. The statute allowed Medicare beneficiaries to enroll in HMOs reimbursed on a cost basis (also known as MCOs) or "risk-contracting" HMOs. HMOs reimbursed on a cost basis are reimbursed for "reasonable cost" incurred for Medicare covered services rendered, related administration on those medical services, plan administration, and a defined special administration. The special administration is reimbursed 100%. In 1996, Section 202 of the Health Insurance Portability and Accountability Act (HIPAA) added section 1893, to the Social Security Act. Section 1893 established the Medicare Integrity Program (MIP). MIP was established to strengthen CMS's ability to deter waste, fraud and abuse in the Medicare program. It provides for separate and stable long term funding for MIP activities. MIP expands CMS's contracting authority so the agency can more aggressively carry out program safeguard functions. The Balanced Budget Act of 1997 (BBA) established the Medicare+Choice (M+C) program, allowing additional types of managed care organizations to secure Medicare contracts. A major intent of the BBA was to replace TEFRA with a new managed care options (i.e. M+C plans, etc.) for beneficiaries. It allowed for new beneficiary options in addition to the well established types of HMO options operating under TEFRA contracts.   The recently-enacted Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) has expanded the role of private entities in providing benefits to Medicare beneficiaries. First, the law adds a new section to the Social Security Act, 1860D ("Part D") that offers prescription benefits beginning in 2006 through Prescription Drug Plans (PDPs). Secondly, the statute allows for payments to Medicare Advantage Organizations (MAOs) "local plans" formerly M+C plans, and creates a new type of private plan, "Regional" MA plans or Regional Preferred Provider Organizations (RPPOs). CMS's Office of Financial Management (OFM) has overall responsibility for the fiscal integrity of all Agency programs which include the oversight of cost-based managed care organizations as well as the mandated one-third financial audit requirement. OFM will conduct periodic audits of cost-based managed care organizations in accordance with Section 1876 of the Social Security Act and based on criteria established by CMS. Description of work: The objective of the agreed-upon procedure review is to determine whether reimbursable costs claimed by the managed care organization are reasonable, allowable, and allocable in accordance with applicable Medicare laws and regulations. In addition, the contractor shall evaluate the MCO's Medical Review programs and make recommendations for improvement. The review includes, but is not limited to, the review of the MCO procedures and internal controls over duplicate payments and situations when Medicare is a Secondary Payer (MSP). In addition, the contractor shall evaluate the accuracy and allowability of Medical Coding (CPT codes) and related Relative Value Units (RVUs) (if applicable) to ensure fair apportionment and the accuracy of the claimed medical services costs.   Requirements for Submitting RFI Responses to CMS: CMS requests capability responses to the Request for Information (RFI). In order, to respond to the RFI a vendor must be able to indicate experience and/or specific knowledge related, Managed Care Organizations (MCOs). Therefore, responses should provide enough detail to clearly indicate the vendor has knowledge and/or can provide information for the following points: 1. Detailed information about a vendor's understanding of Medicare managed care cost reimbursement principles and the required cost reporting formats. 2. Detailed information about the Medicare cost apportionment methodologies and, the ability to distinguish administrative and general cost from plan administration costs and their respective allocation and apportionment methodologies. 3. Detailed information about prior work experience in performing reviews of Managed Care Organizations including, but not limited to the review of medical claims costs and the review of financial information as it relates to Managed Care Organizations. 4. An understanding of effective communication with all the parties involved. 5. Provide a list of completed training(s) related, to the Managed Care Organizations including, the dates, sponsor and objective of the training(s). 6. Detailed information about the ability to maintain and manage large size data files while ensuring security of confidential information including, but not limited to beneficiary information and, plan payment information. 7. Detailed information about the vendor's capacity to conduct the audits (e.g. the number of staff hours, staff titles, experience, maximum audits that can be performed in a nine (9) month timeframe and, the length of audits) 8. Detailed information related to the proficient use of Access database. Please note, the points (above) allow responses from either a vendor with specific experience and/or detailed knowledge about Managed Care Organizations. CMS requests that a vendor do not repeat information and/or examples.   • Business Information: 1. DUNS 2. Company Name 3. Company Address 4. Website (as applicable) 5. NAICS code (in which you would operate under for this service) 6. Do you have a Government approved accounting system? If so, please identify the agency that approved the system. 7. Type of Company (i.e. small business, 8(a), woman owned, veteran owned, etc.) as validated via the Central Contractor Registration (CCR). a. All contractors must register on the CCR located at http://www.ccr.gov/index.asp 8. The copy of the information as seen in the CCR. 9. Do you have a GSA Schedule(s). If so, please identify the Schedule(s) as appropriate to this RFI (e.g. GSA Schedule 520, entitled, "Financial Accounting Business Solutions".) Please note, CMS does not intend to award the following Contract under, a GSA Schedule. This information is for market research purposes only. a. Company Point of Contact(s), Phone, and E-mail address(es) b. Point of Contact(s), Phone and Email address(es) of individuals who can verify the demonstrated capabilities identified in the responses. Submit Responses in the Following Manner: Responses must be submitted via email to the Point of Contact listed below no later than Monday, July 6, 2009 COB. The response should include, the Project Identification Number in the subject line; and, a response shall be submitted via email in format compatible with Microsoft (MS) Office 2003 including, but not limited to MS Project, MS PowerPoint, MS Excel and MS Visio. Moreover, the font size shall be Times New Roman Size 12 with no less that single spacing between lines. Responses shall be limited to ten (10) pages; and, each page shall be number starting with page one (1) after, the Table of Contents. Responses shall be limited to ten (10) pages excluding, the Cover Page and, Table of Contents.   Capability responses shall be submitted in the following order: • Cover page (not included in the ten [10] pages) a. Company Name b. Address c. Website (as applicable) d. Project Identification Number (e.g. RFP-CMS-09-91062 MCO) e. Project Name (i.e. Uniformed Examination Procedures) • Table of Contents (not included in the ten [10] pages) • Business Information {(outlined above & not included in the ten [10] pages) • Points 1 through 8 Please note, responses will not be returned. All information marked proprietary shall be treated as such. CMS shall not be responsible to answer questions about this notice. Disclaimer This is not an invitation for bid, request for proposal or other solicitation and in no way obligates CMS to award a contract. The sole intent is to obtain capabilities for contractors and procurement planning purposes. Documentation should be sent to: Centers for Medicare & Medicaid Services Attn: Liz Hammond, Contract Specialist Office of Acquisitions and Grants Management Acquisitions and Grants Group Division of Medicare Support Contracts Mailstop: C2-21-15 7500 Security Boulevard Baltimore, MD 21244 Point of Contact Name: Liz Hammond, Contract Specialist Phone: 410-786-7440 Email: elizabeth.hammond@cms.hhs.gov (preferred) (End of text)
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/HHS/HCFA/AGG/RFP-CMS-09-91062-MCO/listing.html)
- Place of Performance
- Address: Various, United States
- Record
- SN01844634-W 20090617/090615234528-f699ebadd9e5f255deabcf6e309600aa (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
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