Sources Sought Notice - 250239 - Final_082624.pdf

Sources Sought Notice 250239 No Surprises Act (NSA) Complaints Help Desk (NSA CHD)

THIS IS NOT A FORMAL REQUEST FOR PROPOSAL (RFP) AND DOES NOT

COMMIT THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

TO AWARD A CONTRACT NOW OR IN THE FUTURE

Purpose of Notice

This is a SOURCES SOUGHT NOTICE (Notice) issued for the purpose of planning and market research. The purpose of this notice is to determine the availability of small businesses (e.g., 8(a), service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business, and women-owned small business) on the General Services Administration (GSA) Multiple Award Schedule (MAS) SIN 541611 (Administrative Management and General Management Consulting Services) that have the capability to support CMS in activities associated with the NSA CHD.

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 the capability assessment. All information submitted in response to this announcement must arrive on or before the closing date.

A. General Background

Enacted on December 27, 2020, the NSA, which was enacted as part of the Consolidated Appropriations Act, implements provisions that protect individuals from surprise medical bills for emergency services, air ambulance services furnished by nonparticipating providers, and non-emergency services furnished by nonparticipating providers at participating facilities in certain circumstances. Additionally, the NSA also sets forth a complaints processes with respect to potential violations of balance billing requirements.

Specifically, the NSA directs the Departments of Labor (DOL), Health and Human Services (HHS), and the Department of Treasury to establish a process to receive complaints regarding violations of the application of qualifying payment amount requirements by group health plans and health insurance issuers offering group or individual health coverage. The NSA also directs HHS to establish a process to receive consumer complaints regarding violations by health care providers, facilities, and providers of air ambulance services regarding balance billing requirements and to respond to such complaints within 60 days.

The scope of the NSA CHD will include receiving, identifying, triaging, and managing inquiries and complaints from consumers and providers regarding alleged violations of the

NSA.

B. Required Knowledge and Experience

The following knowledge and experience are required:

• Knowledge of the NSA, Mental Health Parity Addition and Equity Act

(MHPAEA), and other Federal laws and programs related to billing disputes and alleged violations of the Public Health Service Act (PHS Act);

• Knowledge of Federal rules and regulations applicable to Federal contractors/covered entities, including Health Insurance Portability and Accountability Act (HIPAA) data transmission, data security, privacy, the Federal Information Security Management Act (FISMA), the Privacy Act, and 508 compliance;

• Experience with the intake of inquiries and complaints via multiple methods (i.e.

telephone services, web-based submissions);

• Experience with providing a multi-tiered help desk to receive and respond to complaints and inquiries;

• Experience and expertise with Salesforce or a similar Customer Relationship Management (CRM) technology;

• Experience in working with existing system solutions and external systems through application program interfaces (APIs) and supporting User Acceptance Testing (UAT) processes;

• Experience with the development of protocols for reviewing and identifying basic and complex inquiries and complaints;

• Experience with conducting reviews of basic and complex inquiries and complaints involving health insurance plans and issuers, and medical services;

• Experience with the referral of inquiries and complaints under the enforcement authority and/or jurisdiction of other state or federal resolution processes;

• Experience with developing and following ticketing and tracking protocols;

• Experience with collecting data regarding the types of inquiries and complaints received;

• Experience with providing technical assistance to the public regarding complex processes and state and/or federal requirements;

• Experience with maintaining and adhering to a schedule in order to manage multiple competing tasks;

• Experience in effective project management;

• Thorough understanding of HIPAA requirements and Protected Health Information

(PHI) rules and regulations;

• Ability to produce ad hoc reports in response to CMS inquiries and deadlines;

• Prior experience performing multiple process changes under tight timeframes;

• Experience in working with large amounts of data in various file formats and securely transferring files to Federal and State Agencies, and their contractors.

C. Capability Statement Requirements

In response to this Notice, CMS is seeking capability statements. Capability statements are NOT quotes and should not address price/cost. The contractor community is asked for information which proves that they have expertise and capacity to meet the requirements of this work.

No marketing literature should be submitted in response to this Notice. When responding to this Notice, respondents must demonstrate their experience in meeting and performing the capabilities listed below. A mere statement that the vendor has a required capability is not sufficient.

CMS requests that the respondent specifically address the requirements listed below.

Respondents should provide enough information for CMS to make an informed determination of their capability to perform the work identified below. Please remember that the potential offeror or prime contractor must be able to perform at least 50% of the labor associated with this effort. Please provide a list of contract numbers that your organization has had (if applicable) and your role on the contract (prime contractor or subcontractor). If you were a subcontractor on a particular contract, please clarify the work that you did on that contract.

Please describe your capabilities and detailed experience performing similar activities as those described below. Your responses should demonstrate your understanding of the requirements to:

1. Expertise and experience with conducting reviews of basic and complex inquiries and complaints involving health insurance plans and issuers, and medical services;

2. Expertise and experience with providing a multi-tiered help desk to receive and respond to complaints and inquiries;

3. Capacity to provide for the timely review of inquiries and complaints;

4. Capacity to collect data and documentation;

5. Expertise and experience with the referral of inquiries and complaints under the enforcement authority and/or jurisdiction of other state or federal resolution processes;

6. Experience and expertise with Salesforce or a similar Customer Relationship Management (CRM) technology

7. Demonstrated ability to collect data and provide reporting;

8. Experience in working with existing system solutions and external systems through application program interfaces (APIs) and supporting User Acceptance Testing (UAT) processes;

9. Expertise and experience regarding the NSA, Mental Health Parity Addition and Equity Act (MHPAEA), and other Federal laws and programs related to billing disputes and alleged violations of the Public Health Service Act (PHS Act);

10. Knowledge and expertise in Project Management.

D. Instructions for Submitting Responses to CMS

The following specific information is requested: (a) company descriptive literature; (b) specific related corporate experience; (c) experience with the type of capability expectations mentioned above; (d) references, to include points of contact, email addresses, and phone numbers; and (e) Business information outlined below.

a. Sources Sought Notice number, title, and date of issuance

b. SAM UEI

c. Company Name

d. Company Address

e. Company Point of Contact, Phone, and Email address

f. Validation of small business status under NAICS Code 541611 -

Administrative Management and General Management Consulting Services (size standard of $24.5 million)

g. Current GSA Schedules appropriate to this Sources Sought Notice

Please limit your documentation to the following Page Size, Font Type and Size, Spacing and Page Numbering. Responses shall be submitted using a Microsoft Word document with page size 8.5 by 11 inches. Font type shall be Times New Roman, size 10-12 using standard tabs and indent software features with no less than single spacing between lines. Responses are limited to ten (10) pages for the entire capability statement. The Cover Page is not included in the total page count and shall include the Business information listed above.

All transmitted information marked proprietary shall be treated as such. Therefore, businesses should identify any proprietary information in their responses. Proprietary materials will neither be distributed, nor discussed with, any other organization.

Information submitted in response to this will be used at the discretion of the Government. Further, the information submitted will remain confidential insofar as permitted by law, including the Freedom of Information and Privacy Act.

Respondents should be aware that this Sources Sought Notice is for market research purposes only and any responses thereto, or lack thereof, will not constitute a commitment by CMS to treat any potential offeror more or less favorably in the anticipated forthcoming solicitation and/or ultimate award. Please be advised that CMS will not respond directly to organizations submitting information in response to this Sources Sought Notice.

All capability statements can be submitted via e-mail to Megan.Famodu@cms.hhs.gov and Kelly.Housein@cms.hhs.gov. Responses must be submitted no later than 11:00 AM, Thursday, September 5, 2024.

Confidentiality mailto:Megan.Famodu@cms.hhs.gov mailto:Kelly.Housein@cms.hhs.gov H653 Highlight

No proprietary, classified, confidential, or sensitive information should be included in your response. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s).

Disclaimer and Important Notes

Respondents should be aware that this Notice is for marketing purposes only and any responses thereto, or lack thereof, will not constitute a commitment by CMS to treat any potential offeror more or less favorably in the anticipated forthcoming solicitation and/or ultimate award. This Notice does not obligate the Government to award a contract or otherwise pay for the information provided in the response. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received and will not respond directly to organizations to provide feedback with respect to any information submitted.

Teaming Arrangements

Contractors responding to this Notice as a team or that rely on subcontractors to perform any portion of the work must include the above-requested information and certifications for each entity on the proposed team or each proposed subcontractor. Responses must clearly indicate the nature of the teaming arrangement.

The contractor and any subcontractors must not have any relationships or arrangements through business operations or its employees that could be considered as lessening the company’s objectivity concerning any aspect of the proposed tasks. If such relationships or arrangements exist, contractors or subcontractors shall be required, during the procurement process, to identify potential conflicts of interest and discuss how the conflicts will be addressed and mitigated.

D. Instructions for Submitting Responses to CMS