Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO)

Centers for Medicare and Medicaid Services (CMS) awarded this Master IDIQ on March 1, 2019 to deliver quality improvement and beneficiary protection services under the Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization program, with ordering authority extending through February 27, 2029—approximately 2 years and 7 months of runway remaining. The vehicle is unrestricted and multiple-award.

The contract carries a combined potential value of $1.2 billion across eight task orders. Nearly all combined potential value has been obligated: $1.19 billion (99% of the ceiling). Task-order activity peaked in 2019 with five awards, dropped to two in 2020, and one in 2021; no awards have been issued since February 2021, signaling minimal new ordering momentum over the past five years.

CMS is the sole customer across all task orders. The competitive base is highly concentrated: Livanta LLC holds four orders valued at $649.3 million combined potential, and Ohio Kepro, LLC holds two orders at $512.3 million. Avar Consulting Inc. and Provider Resources, LLC account for the remaining two orders at $25.1 million and $8.9 million respectively. All task orders are unrestricted and competitively sourced.

Awarded task orders perform beneficiary protection case reviews, claim review and beneficiary oversight services, and person and family engagement strategy support through beneficiary care management programs. Two large case-review orders dominate the portfolio: one valued at $596.8 million and another at $512.3 million, both extending through April 30, 2029 and employing cost-plus-fixed-fee pricing. A more recent claim-review order issued in February 2021 carries $52.3 million in ceiling value with firm-fixed-price terms and an August 2025 completion date.

Pursuit requires demonstrated expertise in Medicare beneficiary claim and case review operations, statutory compliance with federal healthcare quality review requirements, and organizational capacity to scale to large, multi-year engagements. The vehicle's aging order pipeline and high obligated percentage suggest limited additional task-order capacity for new competitors absent significant reshuffling of existing contracts before the ordering deadline.

The purpose of the Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization (QIO) contract is to improve healthcare services for Medicare beneficiaries through BFCC-QIO performance of numerous statutory review functions, including, but not limited to, quality of care reviews, beneficiary complaint reviews, discharge and termination of service appeals in various provider settings, medical necessity reviews, and Emergency Medical Treatment and Labor Act (EMTALA) reviews. CMS wants to ensure that care provided by the Medicare Program is medically necessary, reasonable, meets professionally recognized standards of care, is provided in the appropriate setting, and complies with certain standards under the EMTALA.