Amendment_4_-_Attachment_J.5.A_Eastern_Region_Site_Verification_Services_TO_SOW.pdf

Statement of Work (SOW)

Eastern Region Site Verification Services

Version 1.0

75FCMC18R0014

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work

Statement of Work (SOW)

Vision Statement

1 Background

1.1 Assumptions

1.2 Acronyms

1.3 Scope

2 General Requirements

2.1 Non-Personal Services

2.2 Business Relations

2.3 Contract Administration and Management

2.3.1 Contract Management

2.3.2 Contract Administration

2.3.3 Personnel Administration

2.4 Subcontract Management

2.5 Contractor Personnel, Disciplines, and Specialties

2.6 Location and Hours of Work

2.7 Travel / Temporary Duty (TDY)

3 Performance Requirements

3.1 Program Management and Customer Support

3.2 Establish Request Management System

3.3 Perform Site Verification Requests

3.4 Process Daily Input and Output Data Feeds

3.5 Quality Control

3.6Bulk Migration

3.7 Inspector Training and Oversight

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work

4 Special Requirements

4.1 Transition

4.2 Government Furnished Materials

4.2.1 Government Furnished Information

4.2.2 Government Furnished Equipment

4.2.3 Government Furnished Facilities

4.3 Quality

4.3.1 Quality Control

4.3.2 Quality Assurance Surveillance Plan (QASP)

4.4 Section 508 Accessibility of Electronic and Information Technology

5 Deliverables

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work

Statement of Work (SOW)

Eastern Region Site Verification Services

Vision Statement

To utilize this task order as a part of the overall Provider Enrollment and Oversight, Indefinite Delivery, Indefinite Quantity Contract (PEO-IDIQ) to detect, prevent, and proactively deter fraud, waste and abuse in the Medicare and/or Medicaid programs. Specifically to conduct site verifications for providers / suppliers in the Eastern Region.

1 Background

The Centers for Medicare & Medicaid Services (CMS) implemented certain provisions of the Affordable

Care Act to establish additional screening requirements for providers/suppliers. The CMS Rule 6028-FC published February 2, 2011 (http://federalregister.gov/a/2011-1686) which is now implemented in 42

CFR 424.510, 424.517, 424.530 and 424.535 improves screening mechanisms to prevent questionable providers/suppliers from enrolling in the Medicare program, and requires scheduled, unscheduled or unannounced site visits to providers/suppliers. In addition to fulfilling newly implemented regulations, the site verification initiative will also address and support other collaborative efforts with the Office of

Inspector General (OIG) and other CMS program integrity initiatives.

The site visit verification process is a screening mechanism to prevent questionable providers/suppliers from enrolling in Part A and Part B of the Medicare program. The initiative described in this SOW builds upon existing site visit programs to create a more efficient, effective, national program to respond to the provisions of the Affordable Care Act, as well as meeting the site-visit requirements described in CMS

Publication 100-08, chapter 15, pertaining to independent diagnostic testing facilities (IDTFs) and suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).

Medicare

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, also referred to as ESRD). Nearly all Medicare beneficiaries access the majority of their insurance benefits through one of two health care delivery systems traditional Medicare, also known as

Medicare Fee-for-Service (FFS), or Medicare Advantage (MA). Provider enrollment is the gateway to the

Medicare program and is the key to preventing ineligible providers and suppliers from entering the program. CMS directly administers Medicare and oversees the provider enrollment and screening process for providers and suppliers participating in the Medicare FFS program. CMS uses provider enrollment information in a variety of ways, such as provider enrollment, claims payment and fraud prevention.

Currently the Medicare FFS provider and supplier universe consists of 2,068,273 enrollments and there are approximately 1.5 million enrollment transactions that are processed annually.

Medicaid

Medicaid is a joint federal-state funded health insurance program that is the primary source of medical assistance for millions of low-income, disabled, and elderly Americans. The federal government http://federalregister.gov/a/2011-1686)

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work establishes minimum requirements for the program and states design, implement, administer, and oversee their own Medicaid programs. In general, states pay for the health benefits provided, and the federal government, in turn, matches qualified state expenditures based on the Federal medical assistance percentage (FMAP), which can be no lower than 50 percent.

All states participate in the Medicaid program and, as a requirement for receipt of federal matching payments, must cover individuals who meet certain minimum financial eligibility standards. Additionally, the states must cover certain medical services, such as physician, hospital and nursing home care, and are provided the flexibility to offer a large number of optional benefits to beneficiaries. States also have the option to expand their Medicaid programs to cover additional beneficiaries who have income above the minimum financial threshold, up to statutory limits on income levels. State governments have a great deal of programmatic flexibility within which to tailor their Medicaid programs to their unique political, budgetary, and economic environments.

1.1 Assumptions

The following identifies the basic assumptions and constraints concerning this task order:

The Contractor that is awarded the Site Verification Services (Eastern Region) task order, will not be eligible for award of the Site Verification services (Western Region) task order and vice versa.

The Contractor shall furnish the Information Technology (IT) environment and any equipment required by its personnel to deliver the site visit services and reports. CMS is not acquiring the

Contractor’s IT systems used to support performance of the work. The Contractor will not authorize its representatives to perform duties relative to this task order prior to performing a background investigation encompassing local, state, and national criminal records. The results of such investigation will be made available to CMS upon request. At a minimum such background investigation shall reveal that the individual was found to be free of criminal conviction records to include the use of narcotics or dangerous drugs.

The Contractor shall provide training for all investigators prior to authorizing them to perform their duties. The Training shall include an initial training course with materials approved by

CMS.

The Contractor will not begin performing DMEPOS and Medicaid site visits until instructed by CMS.

The Contractor’s training plan and maintenance of training materials shall take into account the need for updates and any supplemental instructions required due to changes in CMS regulations, guidance, manuals, or forms.

Documentation to verify that staff training and background checks have been completed shall be made available to CMS on a quarterly basis or upon request. Documentation will include the dates of training, when the background investigation was completed, and when the two mentoring training site inspections were completed or if the training was conducted by using the training videos, and the date the individual started performing duties relative to this contract.

The training program shall educate Contractor personnel about their possible future obligations to cooperate with CMS or other authorities should a site visit they conducted become the subject of investigation by law enforcement officials.

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work

Contractor personnel must be available for investigative queries, in-person attestation, or any other in-person interviewing needed to establish a legal case. The number of these requests is not expected to exceed 1 per month in the Eastern Region.

The Contractor shall provide software and/or licenses for software as required by CMS.

The Contractor shall provide training to CMS staff on contractor unique software and tools, upon

CMS request.

CMS shall provide training to Contractor staff on CMS unique software and tools that are required for this contract, upon Contractor request.

The Contractor shall be responsible for purchasing any hardware or software needed to accomplish their tasks.

The Contractor shall be responsible for routine maintenance of their system. Maintenance is defined as the process of supporting an application and/or component after delivery to correct defects, maintain performance and/or maintain compatibility with other elements in the technical environment to ultimately ensure the existing system and/or business functionality continues to operate as already designed. The maintenance of the application and/or component is not constrained by the time and/or size of the effort.

Requested enhancements within scope but exceeding contract requirements will be supported with a contract modification. An enhancement is defined as the process of modifying an application and/or component after delivery intended to increase or decrease functionality and capability from the existing design. The change and/or addition to functionality and capability are not constrained by time and/or size of the effort.

Currently CMS is using PECOS 1.0 IT environment / platform which coincides with the above listed assumptions.

In the future CMS will be implementing PECOS 2.0 platform and will require the contractor to adhere to the requirements listed in the SOW under PECOS 2.0

Quantity Workload estimates Medicare, DMEPOS and Medicaid are as follows:

Site Visits - 30 Day site visits - 60,000 per year

15 Day site visits - 15,000 per year

7 Day site visits - 300 per year

48 Hour site visits - 45 per year.

IDTF Visits - 30 Day IDTF visits – 2,000 per year, 15 Day IDTF visits – 750 per year

7 Day IDTF visits - 50 - per year

48 Hour IDTF visits - 25 per year

1.2 Acronyms

Business Function Lead (BFL) – See IDIQ SOW IDIQ.

Contracting Officer (CO) – See IDIQ SOW

Contracting Officer’s Representative (COR) – See IDIQ SOW

Medicare Administrative Contractors (MACs) – See IDIQ SOW.

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work

Provider Enrollment and Oversight Indefinite Delivery, Indefinite Quantity Contracts (PEO-IDIQ)

See IDIQ SOW

Provider Enrollment, Chain, and Ownership System (PECOS)/Provider Enrollment System –See

IDIQ SOW

Daily Extract from PECOS

The Contractor will receive a daily extract file from PECOS with enrollment data for providers/suppliers that require a site visit. When the Contractor’s site visit process is complete, it will make the site visit report and the supporting photographic records available to the MAC enrollment specialists. In the future, CMS site visit requests and Contractor site visit reports will be exchanged directly to/from

PECOS, with all site visit records stored in a centralized CMS Provider Enrollment System.

Request Management System - The capability to be acquired by CMS from the site verification

Contractor that is described in the task order SOW. The Contractor will receive and accept work requests from MAC and CMS users that are authorized to order site visits from the Contractor. The Contractor’s system must provide an auditable record of work requests (orders) and process to prioritize and dispatch

Contractor personnel to ensure timeliness in processing site visits.

Subject Matter Expert (SME) – See IDIQ SOW

User Interface - The capability to be acquired by CMS from the Site Visit Contractor that is described in the task order SOW. The interface will allow CMS and MAC enrollment specialists to view work requests, submit ad hoc requests, submit corrections, and download the Contractor’s completed site visit reports (including photographic images).

1.3 Scope

The Contractor shall conduct site verification inspection services for Medicare and/or Medicaid providers/suppliers in the Eastern Region of the United States (see 3.3 of this SOW for details on specific states and US territories). Inspection services include visiting provider locations, conducting internal site visits, taking photographs of the locations visited, and documenting their findings.

2 General Requirements

This section describes the general requirements for this task order.

2.1 Non-Personal Services

2.2 Business Relations

See IDIQ SOW.

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work

2.3 Contract Administration and Management

The following subsections specify requirements for contract, management, and personnel administration.

2.3.1 Contract Management

2.3.2 Contract Administration

2.3.3 Personnel Administration

2.4 Subcontract Management

2.5 Contractor Personnel, Disciplines, and Specialties

In addition to the information contained in the IDIQ SOW, the Contractor shall propose appropriate personnel at the task order level who shall be designated as "key personnel". CMS considers the following titles key personnel for this task order:

Project Manager - The contractor shall provide a Project Manager (PM) responsible for managing and implementing contract requirements. The Project Manager shall organize, direct, coordinate planning, and implement all project support activities. He/she shall interact with CMS program officials regarding issues and status of the project, coordinate financial and staffing resources, procurement and record- keeping, administer security safeguards, and manage the activities of any subcontractors. He/she shall conduct special analyses, reports and presentations of budgets, performance and forecasts as required.

In addition, the PM shall be responsible for compliance, legal requirements and overall business objectives.

He/she shall also analyze workflow and assignments to ensure efficient and cost effective operations, develop and implement processes, program or service improvements to meet such needs, and provide interpretation of data and advice to management, serving as a primary contact for problem resolution and data gathering.

The PM shall possess 10 or more years of professional experience with at least 5 years of managerial or supervisory experience related to complex systems and work flow. In addition, the PM shall possess a bachelor’s degree from an accredited institution.

Site Inspector Manager - The Site Inspector Manager serves as the primary point of contact for all inspector issues related to site inspections for the contract. The Site Inspector Manager is expected to plan, organize, manage, monitor and evaluate all site verification and IDTF site visits activities. The Site

Inspector Manager must be able to manage site inspectors and be responsible for ensuring the site visit accuracy and site visit operations as well as overseeing the training of inspectors. The Site Inspector

Manager shall possess 10 years of experience working in management.

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work

Quality Assurance Manager - The Quality Assurance Manager serves as the primary point of contact for all quality issues and or matters related to site inspections for the contract. The Quality Assurance Manager is expected to ensure that all site verification and IDTF are performed with the highest level of quality, this includes but not limited to timeliness, accuracy of reports, and professionalism. The Quality Assurance

Manager shall have the necessary qualifications to provide quality control and technical support to fulfill

CMS requirements for providing quality site visits and serve as the point of contact for all Quality Assurance

Surveillance program visits. The Quality Assurance Manager shall possess 10 years of experience working in a quality control environment.

2.6 Location and Hours of Work

2.7 Travel / Temporary Duty (TDY)

3 Performance Requirements

The following sections contains requirements, performance objectives and performance elements that the Contractor is required to meet for the Eastern Region Site Verification Services Task

Order as established by CMS. When differences or conflicts occur, the order of precedence shall be the TO SOW followed by the Indefinite Delivery Indefinite Quality (IDIQ) SOW. The contractor shall contact the Contracting Officer (CO) and the Contracting Officer’s

Representative (COR) when discrepancies are identified. The contractor shall identify any budgetary concerns that may occur as a result of the conflict. Currently CMS is using the PECOS

1.0 IT environment / platform to accommodate the requirements in the SOW listed in section 3.1

– 3.7.

3.1 Program Management and Customer Support

1. The Contractor shall plan and coordinate delivery of the site visit verification support described in this task order SOW. This effort includes planning, monitoring and controlling all aspects of service delivery.

2. The Contractor shall implement management practices to ensure successful performance of CMS work requests and deliverables that meet the schedule and quality standards established for the contract.

3. CMS expects the Contractor to perform the following types of activities within this task:

Personnel recruitment and screening (background investigations)

Personnel training

Nationwide dispatch of personnel to fulfill site visit work request

Quality control and quality assurance of site visit services and reports Management reporting, to include reporting on status of visits performed and other selected metrics that measure project performance outcomes

Support ad hoc inquiries and special projects from the CMS COR and/or

BFL. These requests will remain within the current workload estimates provided in the SOW.

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work

At completion of the contract, close out the reporting and deliver certificate of data destruction

Respond to Government requests for contractual actions in a timely fashion

4. The Contractor shall designate a single point of contact between the Government and the

Contractor to support the contract or task order.

5. The Contractor will provide all program management support functions to support the site visit verifications conducted by the Contractor. At the start of the contract CMS will begin requesting site visits via an automated feed from its Provider Enrollment system, PECOS. CMS will also accept automated files of basic site visit data for loading into the

Provider Enrollment System. The automated files of site visit data will be enhanced to include all information including forms and photographs for loading into the Provider

Enrollment System.

6. The Contractor shall establish a user interface for site verification requests, request updates, a request management and prioritization system, and acquire staff to complete the actual site visits.

7. The Contractor shall provide CMS approved training for CMS users. The training session should not exceed 2 hours in duration and should demonstrate the processes and steps required for users to submit work requests and download site visit reports from the

Contractors systems. The training will help users understand the Contractors systems and capabilities. After the initial training is delivered, the Contractor shall post its web-based training for on-demand access by users. Training should be available using the same access infrastructure as the request system itself.

8. The Contractors point of contact shall be available for weekly or bi-weekly meetings with CMS staff.

3.1.1 Performance Standard

1. Standard: Contractor will be fully staffed at all times throughout the contract period.

2. Standard: Contractor personnel will be fully trained and visually presentable when in the field conducting site visits.

3. Standard: Contractor provides continuous operations without interruptions.

4. Standard: The use support help line shall be available from 8 a.m. EST 4 p.m. for the Eastern Region Monday-Friday.

5. Standard: The use support help line shall be available from 8 a.m. PST 4 p.m. for the Western Region Monday-Friday.

6.

3.2 Establish Request Management System

1. The Contractor shall establish a user interface for requests or request updates, a request management and prioritization system, and staff to complete the actual site visits.

2. The system shall be maintained throughout the life of the contract or until PECOS 2.0 is launched.

3. The system must be available to intake requests on a 6-day work week basis Monday through Saturday, excluding federal holidays. The Contractor shall process each site visit request in the turnaround time specified on the work request order.

4. The Contractor-supplied tracking system may also include capabilities for scheduling and dispatch of field personnel to perform the site visits; however, CMS sets no specifications

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work as to the Contractor’s daily work methods for scheduling and dispatch of its personnel.

5. The Contractor’s request management system shall be accessed by CMS and CMS

Contractors in order to place work requests or cancel requests. A work request on any site visit may be cancelled by CMS within 24 hours of receipt of the initial request.

TheContractor-provided system must be capable of detecting duplicate work requests

(ordered within 15 days of each other) for the same site location and same provider name.

Multiple providers using the same location are not considered duplicate site visits. When detected, duplicate site visits shall be identified and a written notice sent to the COR stating that a duplicate site visit request is not being performed. Unless the Contractor is specifically instructed to proceed with the visit by written direction from the CMS COR, the duplicate visit request will not be performed and paid.

6. The Contractor shall provide a web-based system that can be accessed by up to 500 users

(CMS and CMS Contractors) in order to retrieve the results of site visits, including completed forms, photographs, attestations, and any other supporting documents. To complete this requirement, the Contractor may give CMS access to an existing system which provides the required capabilities. The Contractor shall encrypt the data sent back and forth between a web browser and the server via standard SSL encryption.

7. The Contractor shall be responsible for user account management. The Contractor shall create, change, and delete user accounts based on user access requests for MAC and CMS users provided by the COR. The COR will send the Contractor copies of authorized user forms. The Contractor shall prepare a monthly list of active users that displays the frequency of access/use (last access date (30 days, 60 days, 90 days) for purpose of auditing authorized user accounts. The active users report may be delivered as part of the

Contractors monthly progress report.

8. The site visit report must be stored in a usable database format and also reported in a PDF file form. Photographs may be stored independently or in the PDF. If photographs are stored in the PDF, then no more than two per page may be stored and resolution must remain high enough to read text on buildings and doors. If photographs are stored in a

PDF, then photograph header information must also be extracted and stored with it.

Photos stored independently should not exceed 2MB of storage.

9. The results must be searchable by variables provided with the original site visit request, including MAC user ID, MAC (Contractor ID), Provider Enrollment ID, NPI National

Provider Identification, Name and physical site address. The site visit reports must also be accessible via a web link.

3.2.1 Performance Standard

1. Standard: Maintained throughout life of project, or until PECOS 2.0 is launched.

2. Standard: Up to 500 users at MACs and CMS must be able to place work requests.

3. Standard: New user accounts are created within 48 hours of notice from CMS.

4. Standard: Training should demonstrate the processes and steps required for users to submit work requests and download site visit reports from the Contractors systems.

5. Standard: Training will help users understand the Contractors systems and capabilities.

3.3 Perform Site Verification Requests

1. The Contractor shall have the capacity (through existing networks, systems, processes, or partnerships) to conduct site verification inspection services for Medicare and/or Medicaid providers/suppliers designated as limited, moderate and high risk, whether urban or rural, at locations in all States East of the Mississippi river and 3 US Territories as follows:

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work

Alabama

Connecticut

Delaware

Florida

Georgia

Illinois

Indiana

Kentucky

Maine

Maryland

Massachusetts

Michigan

Mississippi

New Hampshire

New Jersey

New York

North Carolina

Ohio

Pennsylvania

Rhode Island

South Carolina

Tennessee

Vermont

Virginia

West Virginia

Wisconsin

US Territories

District Of Columbia

Puerto Rico

US Virgin Islands

2. The Contractor shall have the ability to conduct nationwide site verification services at locations in all 50 States and 6 Territories, if required by CMS and with a minimum 30-day notification.

The Contractor shall be able to perform site visits in specified timeframes (e.g., within 48 hrs. (rapid response), 7, 15, or 30 business days, Monday through Friday between 9am -5pm. Rapid response site visits require the same type of data collection but require rapid reporting response due to an alert of possible fraudulent activity. However, if the provider lists operating hours that are not within that window (such as a sleep center) the Contractor may conduct site visits outside that window, as long as the provider lists those hours.

3. The Contractor shall be equipped to perform physical observational or in-depth site inspections to determine a provider/suppliers compliance with Medicare enrollment requirements. Inspection services include visiting provider locations in the designated region, conducting internal site visits, taking photographs of the locations visited, conducting provider, staff, or customer interviews, and documenting their findings.

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work

4. The site verification requests will be initiated by CMS based on CMS ad hoc orders and MAC orders.

Lists of sites requiring visits will be provided daily (via a secure environment) from CMS, along with the specification of the required turnaround time for completion of the visit and delivery of the visit report to CMS. At a minimum, the lists provided to the Contractor will include the site address, ZIP

Code, provider/supplier name and contact number, and when available the hours of operations of the site.

5. The Contractor shall conduct the site visit at the actual physical location of the provider/supplier based on the site location information provided by CMS. Under no circumstances will telephone interviews be conducted with providers in lieu of the ordered site visits. Contractor personnel conducting a site visit will have in their possession photo identification and a Letter of Authorization to conduct the site visit. The Contractor shall supply the Authorization Letter (subject to CMS approval of the contents).

6. The Contractor shall perform site visits and collect specific information based on pre-defined checklists. The Contractor shall provide suitable personnel capable of obtaining and documenting the required information contained in forms provided by CMS. Five checklist formats will be used:

o Site Visit Verification Observational Form (must be approved by CMS) o Site Visit Verification Detailed Form (must be approved by CMS) o Independent Diagnostic Testing Facility (IDTF) Form (must be approved by CMS) o DMEPOS Site Visit Verification Observational Form (must be approved by CMS) o DMEPOS Site Visit Detailed Form (must be approved by CMS)

7. The CMS/MAC shall provide as much useful information in the site visit request to assist the inspector in conducting the site visit (i.e., Doing Business As name, contact person name and number for issues finding the location). This information shall be utilized by the inspector if they encounter issues conducting the site visit.

8. The Contractor shall check the status of the provider/supplier's enrollment in the Provider

Enrollment System prior to conducting the site visit to ensure that the provider/supplier is still actively enrolled and the status hasn’t changed since requesting the site verification. If the provider/supplier is no longer actively enrolled, the Contractor shall cancel the site visit and no payment will be made to the contractor regarding the site visit request.

9. The Contractor shall perform up to two physical visits to the site during normal business hours to collect information in the required format for the report. Normal business hours are those reported on the work request sent to the Contractor from CMS and/or the hours posted by the provider/supplier at the physical site location to be verified.

10. The Contractor shall document an unsuccessful initial site visit attempt on the CMS approved site visit questionnaire, including a photograph and GPS coordinates of the location visited. Unless otherwise approved by CMS, second and subsequent site visit attempts shall not occur on the same day as the original site visit. If both the first and second attempts are unsuccessful, the Contractor will close the site visit and return the site visit results to CMS.

11. The Contractor shall report the provider/supplier visit including the date and time of visit, reason for visit, and observations made during the visit using a CMS approved site visit questionnaire and guidance received from CMS. The report will include proper completion of documentation of both the actual and attempted site visits. Under no circumstances shall the Contractor provide advance

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work notification to providers/suppliers of impending site visits, nor arrange for an appointment with any provider without the written authorization of CMS. The Contractor shall fully complete all sections of the pre-defined form during the site visit to validate the physical location of the provider/supplier, provide photographs of the door of the provider office and the sign of the office. Photos shall include a date, time, and geotag stamp. The type of device used to take the photos shall also be documented.

The Contractor shall capture GPS coordinates of the location visited and obtain any and all additional information pertaining to the application process as requested by CMS.

12. The Contractor shall be able to collect the site’s geographic coordinates and photos at the physical location via a smartphone or similar device (e.g., Blackberry, iPhone, Android) with

GPS capabilities, including the ability to geotag photos, and provide a method of recording, storing and transmitting images back to CMS.

13. The Contractor shall ensure that the contents of the work request file can be processed into its own internal management systems for appropriate prioritization and dispatch of visit requests.

14. The Contractor shall adhere to the following site verification definitions:

o Operational Site Visit - The provider’s location is open during normal business hours, with the proper signage (if required), patients and staff are present and business is being conducted.

o Non-Operational Site Visit - The provider’s location is not open during normal business hours, no proper signage (if required), patients and staff are not present and business is not being conducted. The address is not a viable address (i.e., UPS store, commercial mail receiving agency) and the residence or business appears to be vacant (i.e., empty, for rent signage, etc.).

o Observational Site Visit - A site visit with minimal contact with the staff and or patients, photos are taken, a basic walk through is conducted by the inspector and a report is filed.

o Detailed Site Visit - A site visit in which the inspector makes contact with the staff conducts a basic interview with the provider, photos are taken, a detailed walk through is conducted by the inspector and a detailed report is filed.

15. All site visits, IDTF or observational, should be unannounced for the first attempt unless asked specifically to schedule (with mobile IDTFs it’s fairly common to schedule) which is requested in the notes from the Medicare Administrative Contractor (MACs). If the first unannounced visit is unsuccessful, then the Contractor should request a contact name/number from CMS, and that info will be used to contact the IDTF prior to making the second attempt.

16. There will be a minimum 30-day overlap for the current contractor to complete any remaining 30-day site visits while the new contractor prepares for any new site visits. Any site visits pending at the end of the overlap period will be transferred to the new contractor as new site visits.

3.3.1 Performance Standard

1. Standard: Accurately identifies the site as operational or non-operational.

2. Standard: Inspection form is accurate and complete.

3. Standard: Reports submitted to CMS within the timeframes specified by CMS schedule.

4. Standard: Compliant with requirements in SOW.

5. Standard: Available to intake requests on a 6-day work week (Monday through

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work

Saturday), excluding federal holidays.

6. Standard: Include capabilities for scheduling and dispatch of field personnel.

7. Standard: Contractor personnel will be fully trained and visually presentable when in the field conducting site visits.

3.4 Process Daily Input and Output Data Feeds

1. The Contractor shall report system-to-system acknowledgement of site visit data received from CMS in a weekly or daily file as directed by CMS.

2. The feed will be provided in a standard format mutually agreeable to CMS and the

Contractor, such as XML or a flat file. The exact specifications of the file will be provided at least 60 calendar days prior to the implementation of this task or at task order signing, whichever comes last. The content of the feed will include the work request information, such as the basic identifying information required for a site visit, including the name and address of the provider, the hours reported to CMS on the provider application, and the response time required for completing each visit. In order to retrieve the file, the Contractor will establish communications with CMS using TIBCO MFT

Platform Server for secure file exchange.

3. The Contractor shall create a simple file in XML format containing data from the site visit report. File formats for site visit data and reports (text, data and images) shall be returned to CMS in a file format acceptable to both CMS and other CMS contractors. The

Contractor shall provide supporting documentation for each file transmitted prior to the first transmission; the specific documents, at a minimum, shall include a data dictionary and file structure. However, final documentation requirements will be determined post award to ensure maximum efficiency and utility of data files by the receiving entities.

The exact specifications of the file will be agreed upon at least ninety (90) calendar days prior to the implementation of this task. It is expected that photo images will be of a resolution that requires no more than 2 MB per photo.

4. The site visit reports file shall be transferred on a daily schedule. Once this task is implemented, the Contractor need only maintain results for manual extraction for 30 calendar days or until receipt of the output file is confirmed by CMS.

5. The Contractor shall provide an electronic feed of the core data elements collected in the site visit report that can be output to the Provider Enrollment System. Data transmitted shall include photographic images and text. Transmittal formats must be able to integrate with a CMS provider/supplier database following interface specifications provided by

CMS. The data shall also include a web link to the results via the results access interface.

The file shall be transferred to CMS on a nightly basis. The Contractor shall coordinate to facilitate the loading and processing of the data.

The Contractor shall continue to make all site visit information, including photographs and supporting documentation, available via an interface accessible to CMS contractors.

3.4.1 Performance Standard

1. Standard: Reports submitted to CMS within the timeframes specified by CMS schedule.

2. Standard: Must report system to system acknowledgement and report to CMS any issues.

3. Standard: Compliant with requirements in SOW.

3.5 Quality Control

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work

1. The Contractor shall provide customer support to manage quality control of site visit records, to address and troubleshoot issues as they arise, and to provide routine progress or status reporting.

2. The Contractor shall review site visits for quality control to ensure each inspection is complete and supporting documents are attached. Quality control checks include, but are not limited to, the following:

a. Ensure that 100% completion of requested fields, completion of all requested photos and site tags using staff or automated checks.

b. Validate that all quality control checks being completed prior to returning the report to CMS or its contractors.

c. An original or approved digital signature is provided on all site visit forms.

d. Deliver all site visit reports (completed forms) within the amount of time specified by CMS. All site visits will be required within 30 days, 15 days, 7 days, or 48 hours.

e. If there are multiple providers at the same location, the Contractor shall provide one record for each provider with the appropriate provider ID and provider name attached to each record.

f. If the location is found to be non-operational, the inspector shall utilize additional search tools (i.e., google maps) to identify if the provider has moved to another location. If a new location is found and is within the vicinity (within 20 miles from the inspector’s current location), the inspector shall perform a site visit at the other location that day. The new location, including any applicable suite numbers, shall be noted in the site visit report.

If the location is beyond 20 miles, a subsequent site visit shall be completed within 7 days of the initial visit. The inspector shall include the new location, including any applicable suite number, in the site visit report.

g. The Contractor shall not rebill CMS for a previously conducted site visit if the first site visit was not useable due to Contractor error.

h. If the inspector encounters and speaks with an individual providing information about the provider or its practice location (i.e., the provider moved, is no longer occupying the space, location under construction), the inspector shall note who they spoke with and include the information in the site visit report. Any applicable site visit details shall be transmitted from the

Contractor to the Provider Enrollment System and viewable by the MACs in assessing the site visit results.

i. If a sign is visible stating that the provider moved its location to another suite within the same building, the inspector shall visit the other suite and conduct the site visit. The new location, including correct suite number, shall be noted in the site visit report.

j. If a sign is visible stating that the provider moved to another location that is within the vicinity (within 20 miles from the inspector’s current location), the inspector shall perform a site visit at the other location that day. The new location, including any applicable suite numbers, shall be noted in the site visit report. If the location is beyond 20 miles, a subsequent site visit shall be completed within 7 days of the initial visit. The inspector shall include the new location, including any applicable suite number, in the site visit report.

3. The Contractor shall define and maintain a set of metrics that provide an indication of project performance and status. Reports shall include at a minimum, statistical

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work information regarding the number of site visits ordered and the number completed in a format that has been mutually agreed upon. The agreed upon metrics and performance measures may be defined as part of the PMP. The Contractor shall have the ability to produce, on request, a report that documents the site visit cost incurred as defined by the provider/suppliers address and by the speed of response. Once defined, routine reporting against the agreed to metrics shall be presented in the monthly status report. Exact formats will be mutually agreed upon between the Contractor and the COR, and will be subject to change at CMS direction.

4. Tracking reports may be delivered to CMS in a Microsoft excel spreadsheet format. At a minimum the monthly reports shall include:

Total number of site visits ordered during the month

Total number of site visits completed during the month Number of site visits completed by provider type, zip code, city, state, and provider/supplier number.

Number of site visits completed broken down by response time (30 Days, 15 days, 7 days, 48 hours)

Total number of site visits not completed within required timeliness standard

Aging report listing time elapsed from date when site visit reports are posted and when reports are retrieved by each ordering entity from the

Contractors portal (user downloads report and images)

Total number of site visits by ordering entity.

Respond to ad hoc requests. Within this activity, the Contractor shall coordinate with CMS whenever, from time to time, there are investigative inquiries related to site visits performed by the Contractor’s personnel.

3.5.1 Performance Standard

1. Standard: Capable of detecting duplicate work requests.

2. Standard: Audit records are accurate and complete.

3. Standard: Reports submitted to CMS within the timeframes specified by CMS schedule.

4. Standard: Inspection form is accurate and complete.

5. Standard: Maintain reports to track number of site visits completed per specific timeframes, site visit statuses, etc. These reports shall be available to CMS upon request.

3.6 Bulk Migration

1. The Contractor shall provide bulk migration services for all site verification documentation and files at the request of CMS.

2. The Contractor shall modify the existing collected data file in order provide an electronic feed of all data collected to the Provider Enrollment System, including photographs and supporting documentation. The Contractor shall make all modifications necessary to format the file for input into the Provider Enrollment System and shall coordinate with

CMS to facilitate the loading and processing of the data. The data shall be transmitted in an XML format. As part of this task, the Contractor will migrate its archive of completed site visit reports (from contract inception) to CMS for retention in the Provider

Enrollment System.

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work

3. The Contractor shall create an ad hoc process to support the bulk migration of pictures that are associated with site verification surveys that have been completed before the bulk migration is scheduled.

4. Data must be stored for records retention and backed up to prevent loss of data. The Contractor shall retain all completed site visit reports until CMS is ready to accept and retain the records in its Provider

Enrollment system or transition all retained records to a different contractor for storage and retention.

The Site Visit picture file structure shall be of the below layout:

Picture file name (binary file)

For historical data, Contractor shall create one file for each calendar month since the beginning of data collection;

each file will contain all the image files for each case number for the entire calendar month.

When the picture files are added or deleted from a Site Visit case, Contractor shall re-send the new set of picture files.

PECOS will compare the case number in a given response file against existing case numbers. If images already exist for a case number, PECOS will replace the existing images with the new set of images.

Contractor shall use the existing infrastructure and transfer the files to PECOS Servers.

Image files and metadata shall be transferred from Contractors servers to BDC servers using MFT.

Image files shall be transferred using MFT from BDC to APPWAS servers on CDS-VDC data center.

Required metadata fields for each site visit images will be identified by the PECOS contractor. Contractor shall provide necessary metadata fields for each site visit case. The fields will be sent over in the XML format based on the XSD schema identified.

The Contractor shall create new daily batch process to transfer the pictures associated with subsequent (i.e., after migration) Site Visit orders. This involves a new inbound/response file containing only the picture files, in addition to the current response file containing only Site Visit survey data.

The contractors File structure shall be of below layout;

Picture file name (binary file):

The contractor shall send PECOS one response file containing Site Visit picture files for each calendar day, similar to the current daily response file containing Site Visit data. The file will contain all the image files for each case number that were processed for a given day.

When the picture files are added or deleted from a Site Visit case, the Contractor shall re-send the new set of picture files. For example, if the original set for a case number contained 5 pictures, then the contractor shall remove picture 1 and replaced it with 2 new pictures, the contractor shall re-send the set of images for that case number that contains the original pictures 2 through 5 plus the 2 new pictures for a total of 6 pictures.

PECOS will compare the case number in a given response file against existing case numbers. If images already exist for a case number, PECOS will replace the existing images with the new set of images.

The Contractor shall use the existing infrastructure and transfer the files to PECOS Servers.

Image files and metadata shall be transferred from the Contractors servers to BDC servers using MFT.

Image files shall be transferred using MFT from BDC to APPWAS servers on CDS-VDC data center.

Required metadata fields for each site visit images will be identified by the PECOS contractor. The contractor shall provide necessary metadata fields for each site visit case. The fields will be sent over in the XML format based on the XSD schema identified.

3.6.1 Performance Standard

1. Standard: Compliant with requirements in SOW.

2. Standard: Maintained throughout life of project.

Amendment 0002 Exhibit E.5.A Eastern Region Site Verification Services Statement of Work

3.7 Inspector Training and Oversight

1. The Contractor shall provide CMS approved training for their employees, specifically the site verification inspectors that will engage with the public and CMS providers, at initial employment and annually thereafter.

2. The training session should include but is not limited to the following inspector conduct:

Must have Contractor’s Photo ID on person at time of site verification.

Must have a copy of the Letter of Authorization ready to present to the provider/supplier, if requested.

Must maintain a low profile, be non-challenging and non-confrontational when conducing the site verification.

Dress Code: business casual, slacks, NO-JEANS. Jacket and tie are optional

Demeanor: Do not discuss outcome of visit, do not offer an opinion.

If asked to leave provider’s premises, leave without confrontation and notate on site visit form. Contact CMS for further instructions

If environment appears threatening, leave quickly and notate on site visit form.

All visits must be conducted during posted hours of operation.

If the provider is closed during their business hours, mark the first visit unsuccessful.

The inspector must go back for a second site visit on a different day. Do not submit the case until a second visit is conducted.

If the site verification is a private residence, inspector must knock on door to verify provider’s location.

3. The Contractor shall ensure that each individual participates via in-person or Video Teleconference

(VTC) training prior to performing inspections on their own..

4. The Contractor shall ensure that all of its project personnel and site verification inspectors complete refresher training approved by CMS at least every 12 months. Refresher training may be web-based, in-person or VTC.

3.7.1 Performance Standard

1. Standard: Compliant with requirements in SOW.

2. Standard: Appropriate protocol to address inspector complaints.

3.8 Future Use of PECOS 2.0 Environment and Platform.

In the future CMS will replace the current PECOS system with PECOS 2.0. This updated version of the system will include the capability to manage site visit request, and record results directly within PECOS. As a result of PECOS 2.0 launch and is fully operational the following requirements in the SOW will be retired:

SOW section 3.2 Request Management System, will be retired when PECOS 2.0 is launched and is fully operational.

SOW section 3.4 Daily input and Output Data Feeds, will be retired when PECOS 2.0 is launched and is fully…