Attachment_J.06_Proposal_Assumptions.docx

RFP #75FCMC18R0010 Proposal Assumptions Attachment J.06

GOVERNMENT PROVIDED PROPOSAL ASSUMPTIONS

1. Contract Award Date

The Centers for Medicare & Medicaid Services (CMS) anticipations awarding the Pricing, Data and Analysis Contractor (PDAC) on or about September 1, 2018, with a contract effective date of September 1, 2018.

2. Implementation Cutover Date

The Offeror shall use the Implementation cutover date developed by CMS (see table below) when developing its proposed CLIN 0001 costs associated with its PDAC Implementation Project Plan. Completion of the movement of the PDAC contract to the incoming PDAC contract shall occur within three (3) months of award. At the implementation cutover date the outgoing PDAC contract ceases Medicare operations and the incoming PDAC contractor begins to perform Medicare business functions for PDAC.

Implementation and Base Periods 09/01/2018 – 08/31/2019

09/01/2018 11/30/2018 12/01/2018 08/31/2019

Begins

3. Joint Operating Agreements and Operational Start Dates

Joint Operating Agreements between functional contractors impacting the PDAC contract shall be executed prior to the operational start date. The operational start date is defined as the date that the PDAC contractor assumes all Medicare functions from an outgoing contract and is capable of processing and performing all major tasks of the contracts as specified in the Statement of Work (SOW).

4. Workload Figures

For estimating purposes, the workloads in the tables below shall be used by all Offerors in preparing their proposals.

Table #1: PDAC Workload Estimates and Database Sizing Estimates

PDAC CUSTOMER SERVICE CONTACT CENTER

PDAC ADVISORY ARTICLES/BULLETINS (VIA website List-serv)

DURABLE MEDICAL EQUIPMENT CODING SYSTEM (DMECS)

HCPCS CODING VERIFICATION REVIEW WORKLOAD

CHANGE REQUESTS

STATISTICAL ANALYSIS/REPORTS

DATA

NATIONDAL DRUG CODE (NDC)/HCPCS CROSSWALK FILES

FOIA REQUESTS

5. Outgoing Contractor Pending and Backlogs

For proposal purposes, Offerors should anticipate all pending workloads will be within acceptable, normal ranges.

6. Participation in Conferences

DME Coordination Meetings (DCMs) bring together parties charged with ensuring the integrity of the Medicare Fee for Service (FFS) Durable Medical Equipment Prosthetics/Orthotics, Supplies (DMEPOS) benefit. The DCM serves to facilitate coordination of Medicare FFS DEMPOS activities, including program integrity and medical review. Each party may present statistical and other findings. The Contractor shall participate and coordinate in DCMs in-person that may require travel to designated meeting locations. The Contractor shall actively participate in these DCMs 100% of the time as scheduled. Offerors shall prepare the proposal based on the above workload estimation of 2 meetings per year. See the SOW section E.6.1 for specific requirements for the PDAC in regards to DCM meetings.

7. CMS HCPCS Workgroup/Panel Support

As part of the SOW requirements, the contractor shall collaborate with the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) to develop DMEPOS coding recommendations for submittal to the CMS HCPCS Workgroup. Offerors shall prepare the proposal based on this expected collaboration for all HCPCS Workgroup Meetings.

8. HCPCS- 855S Crosswalk

The contractor shall update and maintain a process to crosswalk the HCPCS codes to appropriate accreditation product and service codes. The offeror shall prepare the proposal based on this requirement and the delivery of the crosswalk on a quarterly basis to CMS.

9. Oral Anti-Cancer Drugs (OACDs) Pricing

The offeror shall prepare the proposal based on the requirement to establish and distribute national pricing files to the DME MACs. These updated shall be associated with each OACD by the national drug code (NDC) (see workload info in the above table). This file is sent on a quarterly basis and more frequently based on Average Sales Price (ASP changes).

10. DMEPOS Related Statistical Analysis Activities

For proposal purposes, the offeror shall be aware of the involvement and statistical support to DME MACs, Zone Program Integrity Contracts (ZPICs), Unified Program Integrity Contractors (UPICs), National Supplier Clearinghouse (NSC), CMS and specific Office of the Inspector General (OIG) staff limited to personnel with the Office of Audit Services (OAS) and Office of Evaluation and Inspections (OEI). These reports will vary.