260590 Sole Source Intent.pdf

Description

This is a Notice of Proposed Contract Action Synopsis: The Centers for Medicare & Medicaid Services (CMS) intends to issue a new non-competitive contract to Solventum Health Information Systems (HIS) pursuant to the authority of FAR 6.302-1, Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements. This action is subject to the availability of funds.

CMS intends to extend the unique services of Solventum HIS to continue the maintenance of the groupers, ICD-10, maintaining CMS national coverage determinations (NCDs) and enhance the editing and grouping programs listed below:

1. Medicare Severity Diagnosis Related Group (MS-DRG)

2. Medicare Code Editor (MCE)

3. Medicare Integrated Outpatient Code Editor (I/OCE) with Ambulatory Payment

Classifications (APCs)

4. Outpatient Prospective Payment System (OPPS)

5. Long Term Care Hospitals (LTCHs) Prospective Payment System (PPS) and

Inpatient Prospective Payment System (IPPS) Relative Weight Computation

6. Home Health Prospective Payment System (HH PPS) and Home Health Grouper (HHG)

Analytic and Programming Support

7. Analysis and editing of National Coverage Determinations (NCDs)

8. Maintain and update the ICD-10 Procedural Coding System (PCS) developed by Solventum under the direction of CMS

9. End Stage Renal Disease Prospective Payment System (ESRD PPS)

10. Skilled Nursing Facility Prospective Payment System (SNF PPS)

11. Federally Qualified Health Centers Prospective Payment System (FQHCs

PPS)

12. Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS)

13. Inpatient Rehabilitation Facilities Prospective Payment System (IRF PPS)

14. Rural Health Clinic Prospective Payment System (RHC PPS) development

Section 9343(g) of the Omnibus Budget Reconciliation Act of 1986 required hospitals to use the Healthcare Common Procedure Coding System (HCPCS) to bill for hospital outpatient surgical services. Since 2004, CMS has contracted with Solventum HIS (formerly 3M) to perform the validation of HCPCS codes. CMS requires this support for software systems maintenance and annual/quarterly updates to the MS-DRGs and HHG software, the I/OCE, the MCE, the LTCH PPS and IPPS relative weights. The contractor is expected to furnish all of the necessary services, software, qualified personnel, supplies, and any other materials or equipment necessary to provide support for the above critical functions.

Solventum HIS contractor support is required to enable MACs to process and edit Medicare claims to ensure proper payment. As a result, continued Solventum HIS contractor services are critical to the success of CMS’ billing, editing, and coding for the following reasons:

• Continuation of the planning and pre-development sources for all of the major payment programs listed above is required to ensure accurate payment and uninterrupted claims processing;

• Updates of the ICD-10-CM, ICD-10-PCS coding systems;

• Ensure changes to edits and logic for all of the above products required in response to multiple annual legislative mandates. This includes non-anticipated legislative mandates thus requiring analysis and implementation within a very short timeframe;

• Ensure the maintenance of the complicated MS-DRGs in ICD-10-CM as well as the ICD-

10 PCS;

• Continue to optimize all Groupers with real time ICD-10 data; and

• Continue value added improvements and expansion of remotely accessible web based interfaces for the I/OCE, the Groupers, and MCE.

In addition, CMS is continuing to modernize its grouping and code editor software. Medicare will continue ongoing efforts to perform real-time processing. This effort requires skills as currently performed by Solventum HIS.

As CMS’ programs have evolved, so has the complexity and scope of these software systems.

Due to the unique nature of CMS requirements, Solventum HIS is exclusively qualified to meet CMS’ need to continue to ensure the accurate editing and payment of Medicare claims.

It is critical that CMS have a contractor with technical skills and knowledge to maintain and update the ICD-10-PCS on a national basis. Solventum HIS has the unique knowledge and experience coupled with the necessary advanced technical skills needed to maintain the ICD-10- PCS and to map/crosswalk the system into the MS-DRG structure as well as the on-going maintenance of the groupers and editors. In short, Solventum HIS’ extensive knowledge of the computer logic of the groupers and expertise is unmatched in the industry and their continued support with the recent ongoing modernization projects is in the best interest of CMS and the healthcare industry.

The contract's period of performance will be a 12-month base year and four (4) 12-month option years. This notice is a notice of intent to negotiate and award a contract to Solventum HIS and should not be considered a request for proposals. This synopsis should not be construed as commitment by the Government for any purpose other than market research. All responsible sources may submit a capability statement that will be considered by the agency. The statement must demonstrate that the firm(s) has the capability to perform the required work. All capability statements must be submitted via email to Thaiana Rodriguez-Maciel at Thaiana.Rodriguesmaciel@cms.hhs.gov and Rachel Johnson at Rachel.Johnson@cms.hhs.gov on or before 12:00 PM EST Monday, January 5, 2026.

Voice communications will not be entertained. A determination by the Government not to compete this proposed action based upon responses to this notice is solely within the discretion of the Government. Information received will be considered solely for the purpose of determining whether to conduct competitive procurement. CMS will not reimburse costs for submission of capability information. All documentation shall become the property of the Government.

mailto:Thaiana.Rodriguesmaciel@cms.hhs.gov mailto:Rachel.Johnson@cms.hhs.gov

Please note that any firm interested in this synopsis must be proficient in JAVA computer languages, have a thorough understanding of the CMS groupers, editors and PPS, show demonstrated proficiency in ICD-10 CM coding as it applies to Medicare claims processing and be able to analyze and interpret final rule outcomes and recommend appropriate coding updates to CMS.

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