SOURCES SOUGHT
R -- Temporary High Risk Health Insurance Pool Program
- Notice Date
- 4/20/2010
- Notice Type
- Sources Sought
- NAICS
- 541990
— All Other Professional, Scientific, and Technical 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
- DHHS-HCR-1
- Point of Contact
- Kevin Simpson, Phone: 410-786-0017, Linda Anders, Phone: 410-786-0459
- E-Mail Address
-
kevin.simpson@cms.hhs.gov, linda.anders@cms.hhs.gov
(kevin.simpson@cms.hhs.gov, linda.anders@cms.hhs.gov)
- Small Business Set-Aside
- N/A
- Description
- This is a Sources Sought Notice to determine the availability of non-profit organizations to provide services to eligible individuals, beginning in 2010 and ending December 31, 2013, under a temporary high risk health insurance pool program established in section 1101 of the Patient Protection and Affordable Care Act (the Affordable Care Act), Public Law 111-148. The purpose of this Sources Sought Notice is to identify non-profit organizations that would be available to contract with the Department of Health and Human Services (HHS) to operate high risk pool programs consistent with the Affordable Care Act in any states that do not submit an acceptable application to administer the high risk coverage program. HHS anticipates contracting with states (or designated state high risk pools) that submit an acceptable application to operate a high risk pool program. However, in the event that a state (or its designated state high risk pool) does not submit an acceptable application to operate a high risk pool program consistent with section 1101 of the Affordable Care Act, HHS intends to administer the program directly or contract with a non-profit private entity or entities to provide coverage in such states. On April 2, 2010, the Secretary issued a letter to governors and state insurance commissioners (sample letter attached) asking each state to express its interest in participating in the temporary high risk pool program established by the Affordable Care Act. That letter outlines several options for states to participate in developing and operating high risk pools under this program. HHS anticipates learning from states by April 30, 2010 as to whether they will operate such a high risk pool program. Subsequently, HHS may solicit and evaluate bids from non-profit private organizations to operate high risk pools in any states that elect not to contract with HHS for purposes of implementing this program. HHS anticipates that it may contract with one or more non-profit organizations to begin operating high risk pools in those states as early as July, 2010. Due to the urgent need to begin operation of this program, HHS is using this Sources Sought Notice to identify potential contractors before knowing in which states, if any, HHS will need to administer the high risk pool program directly or contract with a non-profit private organization(s) to administer such programs. In order to respond to this notice, potential contractors must be non-profit private organizations and be able to demonstrate the following capabilities: 1. The ability to provide a full range of third-party administrator services in the operation of a temporary high risk insurance program consistent with section 1101 of the Affordable Care Act, providing services that include: a. Claims processing, including health care claims and point of sale prescription drug claims; b. Provision of contracted health care provider and pharmacy networks; c. Utilization review; d. Appeals processes; e. Eligibility determinations and enrollment/disenrollment functions ; f. Full range of member and provider relations services, including call center and website management; g. Plan marketing; and h. Collection of premiums. 2. The ability to have in place a provider network capable of providing a full range of high quality and accessible health care to high risk pool members throughout the state(s) to be covered by the potential contractor. 3. The capacity to begin all third-party administrator functions promptly after the award of contract for all states identified in the contract. 4. The capacity to provide membership, claims, and utilization data as may be required by HHS, including the capacity to establish the accounting and funds controls needed to permit timely tracking of claims payments under each state's high risk insurance program. 5. The capacity to monitor and report to HHS and state authorities information related to misconduct that takes place in the marketplace, including allegations relating to health insurance issuers and employment-based health plans discouraging individuals from remaining enrolled in prior coverage based on an individual's health status, as well as allegations related to fraud and abuse within the high risk pool program. Please include the following in your response: A capability statement that addresses each of the elements identified above, including a list of states where the potential contractor could offer the services described above. Business information -Company Point of Contact, Phone, and Email address Teaming Arrangements: All teaming arrangements shall also include the above-cited information and certifications for each entity on the proposed team. (Note that potential subcontractors are not necessarily required to be nonprofit entities.) Responses must be submitted not later than May 4, 2010. Responses may be submitted electronically to Kevin Simpson (kevin.simpson@cms.hhs.gov) or Linda Anders (linda.anders@cms.hhs.gov) or mailed to Centers for Medicare and Medicaid Services, 7500 Security Blvd, Baltimore, MD 21244-1850, Mail Stop C2-12-16 ATTN: Kevin Simpson. The maximum number of pages for submission is 10 pages. This Sources Sought Notice is for information and planning purposes only and is not to be construed as a commitment by the Government. This is not a solicitation announcement for proposals and no contract will be awarded from this Notice. No reimbursement will be made for any costs associated with providing information in response to this Notice. Respondents will not be notified of the results of this evaluation. Capability statements will not be returned and will not be accepted after the due date.
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/HHS/HCFA/AGG/DHHS-HCR-1/listing.html)
- Record
- SN02126924-W 20100422/100420235128-6a508ee1c25e39db0ba455ce38c74dbe (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
(may not be valid after Archive Date)
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