PEO_Info_Session_Presentation_FINAL.pdf

Provider Enrollment and Oversight

Welcome and

Opening Remarks

Zabeen Chong Director, Provider Enrollment & Oversight Group

Center for Program Integrity

Provider Enrollment and Oversight Remarks from Leadership

Theresa Schultz Director, Acquisition Support Group

Office of Acquisition & Grants Management

Purpose and Expectations

Contract Overview

Gina Romano Contracting Officer

Division of Program Integrity and Financial Management Group

Office of Acquisition and Grants Management

Topic Speaker Time

Welcome & Opening Remarks Theresa Schultz, Director, ASG Zabeen Chong, Director, PEOG 1:00 PM – 1:10 PM

Purpose and Expectations/ Contract Overview Gina Romano, Contracting Officer 1:10 AM – 1:30 PM

Organizational Conflict of Interest Greg Gesterling, Contractor Compliance Officer 1:30 PM – 1:45 PM

Accounting Systems Bridget Rineker, Division of Financial Services Audit & Workforce Group 1:45 PM – 2:00 PM

BREAK 2:00 PM – 2:15 PM

Technical Overview Zabeen Chong, Director, PEOG Charles Schalm, Deputy Director, PEOG 2:15 PM – 2:45 PM

Evaluation Criteria Dennis Adams, Contracting Officer Rep. 2:45 PM – 3:15 PM Task Orders Alisha Sanders, Director, DEO 3:15 PM – 3:45 PM

Agenda

General Information

• Restrooms located down the hallway on the left. Restrooms also located in the hallway between the cafeteria and the seating area.

• Cafeteria is located on the lower level; a small snack bar is located just outside the seating area of the cafeteria.

• Please turn your cell phones to “Off” or “Silent” mode during our sessions.

• Session is being recorded - live webinar; No unauthorized photography or recording of this Information Session is permitted.

• No information provided will be considered official or binding on behalf of the Government

Contract Overview Procurement Timeline

CMS anticipates the following procurement timeline:

RFP Release Date - Summer 2018

Proposal Due Date - 30 - 45 days after release of RFP

IDIQ and 2 Task Order Awards - December 2018

Future Task Orders - CMS anticipates competing a minimum of two more task orders by September 2019

Multiple Award IDIQ

Multiple Award Indefinite Delivery Indefinite Quantity Contract (MA IDIQ)

Provides for an indefinite quantity of services for a fixed time utilizing a broad Statement of Work (SOW) specific to Provider Enrollment and Oversight

Multiple awards

• Multiple contracts entered into pursuant to the same solicitation (FAR

16.504)

• Small business reserve for IDIQ – NAICS 541990, All Other Professional, Scientific, and Technical Services, small business size standard of $15M.

Full and Open Competition

• All vendors, large and small, are eligible to compete for the IDIQ

Period of performance

• Anticipating 10 Years – 5-year base and one 5-year option

IDIQ Contract Award Process

MA IDIQ

Source Selection Approach – “Best Value” to the Government

• Must receive an Overall Technical Rating of Satisfactory or better and have a reasonable cost on the sample task order to be considered for award

On/Off Boarding may occur during the fifth year

Offeror’s must be selected for award of the MA IDIQ in order to be considered for a Site Verification Services’ Task Order award.

MA IDIQ

In order to be eligible for award, Offerors are required to comply with the terms and conditions of the solicitation and must be deemed responsible in accordance with FAR Part 9.

An Offeror’s demonstrated ability or inability to meet the requirements of the IDIQ Technical and Business Proposal will assist in determining whether or not that Offeror is awarded an IDIQ contract. Offerors must demonstrate, through their technical and cost proposal, a technically sound and competitively, reasonably priced approach.

Must have acceptable or adequate accounting system

Section L Highlights

Volume I – Contract Documentation

All Offerors shall submit as required by the solicitation instructions

– Large Businesses are required to complete Sections A – J

– Small Businesses are required to complete Sections A – H

Volume II – MA IDIQ – Technical Proposal

Factor 1 – Sample Task Order

• All Offerors must bid to the sample task order - CPFF

• For evaluation purposes only, will not result in a task order award

Volume II – MA IDIQ – Technical Proposal

Factor 2 – Demonstrated Capability Narrative

• Large Businesses must propose to the four anticipated unrestricted requirements.

• Small Businesses can propose to as many requirements (anticipated unrestricted and anticipated small business) as they are capable of performing. However, two of those must be from the anticipated small business requirements.

The Contracting Officer will weigh the risks associated with Offerors whose performance requirement narrative(s) were deemed unacceptable for any requirement when making awards. Offerors shall only propose on requirements they are capable of performing.

Volume II – MA IDIQ – Technical Proposal

Factor 3 – Program Management

• All Offerors shall propose

– The Offeror’s proposed organization shall have the capacity to accomplish the management and oversight of the PEO IDIQ requirements.

Factor 4 – Past Performance

• Large Business – past performance evaluations from 8 contracts from the

Prime

• Small Business: Provide past performance evaluations from 6 contracts for the Prime

Volume II – MA IDIQ – Technical Proposal

Factor 5 – Small Business Participation Plan Large Businesses only

Volume III – IDIQ Business Proposal

Sample Task Order

• Cost Narrative

• Business Proposal Spreadsheet

Volume IV - Conflict of Interest and Compliance Program

Volume V and VI – Site Verification Services

Technical and Business Proposals

A) Eastern Region B) Western Region

• Future Competition: Offerors who demonstrate the ability and willingness to be able to compete on multiple task orders may be considered favorable due to perceived increase in competition for future task orders.

• In addition, the Contracting Officer will take into consideration awarding MA IDIQs to small businesses who offer the most capability for requirements under the PEO IDIQ in order to allow for maximum competition.

Task Orders

Task Order Competition among MA IDIQ holders and in accordance with FAR Part 16 Best Value – approach based on complexities of each task order Small business or a specific socioeconomic status set-aside will be determined at the task order level

Multiple task order pricing arrangements

• Firm Fixed Price

• Cost Reimbursement Period of Performance of Task Orders

• 5 years

• Base plus four option periods

Frequently Asked Questions

1) Consent to Subcontract at IDIQ Level?

2) Small Businesses Subcontracting to Multiple Primes?

3) Large Businesses Subcontracting under Small Businesses for Anticipated Small Business Requirements?

Organizational and Personal Conflict of Interest

(OCI)

Theresa Schultz

OCI Agenda

• OCI Introduction

• Personal Conflict of Interest

• Types of Conflict of Interest

• What Is Expected of the Contractor

• Compliance Program

• Potential Conflicts

What is an Organizational Conflict of Interest (OCI)

• FAR 2.101 Definition: Organizational conflict of interest means that because of other activities or relationships with other persons, a person is unable or potentially unable to render impartial assistance or advice to the Government, or the person’s objectivity in performing the contract work is or might be otherwise impaired, or a person has an unfair competitive advantage.

The two underlying principals are:

• Preventing an unfair competitive advantage pre-award.

• Preventing biased and subjective performance not in the government’s best interests post-award.

An OCI can exist with respect to existing procurement, or with respect to a future procurement. But all OCIs, current or future, MUST be resolved for the instant requirement pre-award.

What Is a Personal Conflict of Interest

• Organizational conflicts of interest at FAR 9.5 has broad application.

FAR 9.5 only mentions “organizations” but the definition at FAR

2.101 talks about “Persons”.

“Persons” is defined broadly to include entities such as corporations and partnerships, as well as natural persons.

Thus, the same terms and principals in FAR 9.5 apply.

• As a result, CMS includes personal conflicts as part of the FAR 9.5 conflicts analysis.

This is primarily due to the fact that natural persons run entities and make decisions that could be biased or subjective not in the government’s best interests.

CMS has developed a specific Form for disclosure of personal conflicts. However, this form is NOT filed with the proposal.

Three Forms of OCIs

Unequal Access to Information

• Think secret information no other offeror has – similar to

“insider trading”.

• This is an unfair competitive advantage conflict.

Biased Ground Rules

• Think self interest when a contractor helps CMS develop a new program, SOW, etc.

• This is an unfair competitive advantage conflict.

Only CMS can resolve unfair competitive advantage conflicts through exclusion or limitation (e.g., can’t develop and test the same system, tool, etc.)

Three Forms of OCIs Continued…

Impaired Objectivity

• Think financial, business or other interests influencing decisions.

• Can exist pre-award and/or post-award depending on the facts.

• But, this is a post-award business performance risk.

Both CMS and the offeror can resolve

• If pre-award, CMS through exclusion/limitation.

• If post-award, Offeror through mitigation.

Type of Information We May Look for You to Disclose:

– FAR 3.10 Code of Business Ethics and Conduct

– Requires a formal Compliance Program and

Compliance Officer

– Board of Directors

– Organization/Affiliates

– Financial and Contractual Relationships

Compliance Program

• In accordance with FAR 3.10 this solicitation will include FAR clause 52.203-13 Contractor Code of Business Ethics and Conduct (OCT 2015)

• Guidance/Recommendations for Establishing an Effective Compliance Program can be found at:

www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-

Contractors/Downloads/compliance.pdf.

• Applies to All Primes and Subcontractors.

• All Large Businesses must have a Compliance Program meeting FAR 3.10 with special attention to CMS’ Compliance Program Guidance.

• All Small Businesses must have, at the minimum, a Code of Business Ethics and Conduct.

For this procurement, CMS highly recommends consideration of the CMS’ Compliance Program Guidance.

Compliance Program Elements

1. Code of Conduct and Written Compliance Policies and Procedures

2. Compliance Officer and Compliance Committee

3. Employee Training and Education

4. Process to Receive Complaints Including the Ability to Report Anonymously

5. Monitoring and Auditing

6. Enforcement and Discipline

7. Investigation and Prevention of Problems and the Development of Policies to Address Sanctioned Persons

PEO Potential Conflicts

Under the PEO IDIQ award, there are certain CMS policy exclusions:

Nature of Potential Conflict: Although not all inclusive, the Contracting Officer has determined that the following activities are considered to be an actual, potential or apparent COI with the work to be performed under this contract:

Contractor/Subcontractor is an entity that—

• Would review or does review, under the contract, Medicare or Medicaid services furnished by a provider or supplier that is a direct competitor of the Contractor/Subcontractor; or

• Prepared work or is under contract to prepare work that would be reviewed under the contract;

or

• Is affiliated or has a financial relationship with a provider or supplier to be reviewed under the contract; or

• Is a Medicare enrolled provider or supplier providing services to a Medicare beneficiary enrollee or any individual or organization associated to a Medicare enrolled provider or supplier; or

• Is currently operating as a Recovery Audit Contractor (RAC)

PEO IDIQ Potential Conflicts

Under the PEO IDIQ award, there are certain CMS policy exclusions

• Proposed Restraint on Future Contractor/Subcontractor Activities:

CMS is proposing to restrain future Contractor/Subcontractor activities as follows:

• CMS considers it a conflict to become a Medicare enrolled provider or supplier providing services to a Medicare beneficiary enrollee or any individual or organization associated to a Medicare enrolled provider or supplier at any time.

• CMS considers it a conflict to become a RAC at any time.

Offerors should be aware that performing the same or similar functions as the RAC programs at any time where it holds a PEO IDIQ contract will also be considered a conflict.

Accounting Systems

Bridget Rineker Division of Financial Services Audit & Workforce Group

ACCOUNTING SYSTEM

REQUIREMENTS

• FAR 16.301-3: A cost-reimbursement contract may be used only when the contractor’s accounting system is adequate for determining costs applicable to the contract or order

• ONLY applies to cost-reimbursement and non-commercial time & material (T&M) type task orders

• Applies to all business sizes (large and small)

• Two types:

Preaward – Acceptable

Postaward - Adequate Required for

Contract Award

PREAWARD ACCOUNTING

SYSTEM AUDIT

Applicable to

An offeror that is otherwise eligible for award, AND Accounting system has never been audited by the Federal Government or accounting system was previously determined to be unacceptable

Objectives

To determine if the DESIGN of the contractor’s system is ACCEPTABLE for the award of a prospective, flexibly-priced Government contract Supports the Contracting Officer's (CO) Responsibility Determination

Who Preforms it Typically a Government Auditor

When is it Performed

Typically performed when an Offeror submits a proposal in response to a Federal Government solicitation

Prior to contract or task order award

How is it Performed

SF 1408, Preaward Survey of Prospective Contractor, Accounting System

POSTAWARD ACCOUNTING

SYSTEM AUDIT

Applicable to Contractor that receives a flexibly-priced contract or task order A follow-up accounting system audit is typically performed every 5 years, as long as the contractor maintains flexibly-priced contracts

Objective To determine if the contractor's accounting system is ADEQUATE for accumulating and billing costs on Government contracts

Who Performs it Government Auditor or Government-contracted audit services The CO will issue a written determination of adequacy considering the Government Auditor's recommendation, see FAR 42.302(a)(12)

When is it Performed

Typically within 6 months of the contractor receiving a contract or task order award, OR The Contracting Officer determines that an accounting system audit is required to support contract requirements

How is it Performed Typically a follow-up to a preaward accounting system

Defense Contract Audit Agency (DCAA) Accounting System audit program

ACCOUNTING SYSTEMS

USEFUL FAR REFERENCES AND

RESOURCES

FAR Subpart 9.1, Responsible Prospective Contractors

SF 1408: Preaward Survey of Prospective Contractor Accounting System http://www.dcaa.mil/Content/Documents/sap/17740_ap_na.pdf

DCAA Accounting System Audit Program http://www.dcaa.mil/Content/Documents/sap/11070_ap_na.pdf

DCAA Information for Contractors Manual http://www.dcaa.mil/Content/Documents/DCAAM_7641.90.pdf http://www.dcaa.mil/Content/Documents/sap/17740_ap_na.pdf http://www.dcaa.mil/Content/Documents/sap/11070_ap_na.pdf http://www.dcaa.mil/Content/Documents/DCAAM_7641.90.pdf

ACCOUNTING SYSTEMS

KEY TAKE AWAYS

• Two Types: Preaward (acceptable) and Postaward (adequate)

• An Offeror’s accounting system must be determined ACCEPTABLE before contract or task order award

• A contractor must maintain an ADEQUATE accounting system, as determined by a Government CO, while performing cost-reimbursement contracts

Break

15 Minutes

Provider Enrollment & Oversight Group Technical Overview

Zabeen Chong Director, Provider Enrollment & Oversight Group

Center for Program Integrity

Charles Schalm Deputy Director, Provider Enrollment & Oversight Group

Center for Program Integrity

Provider Enrollment & Oversight Group

(PEOG)

Division of Enrollment Operations (DEO)

Division of Enforcement Actions

(DEA)

Division of Compliance &

Appeals

(DCA)

Division of Enrollment Systems (DES)

(PEOG)

“Through vigilant screening and enforcement, we safeguard our beneficiaries and protect the integrity of our programs.”

PEOG Mission

Division of Enrollment Systems (DES)

Systems Data Management

• Oversees the Medicare provider enrollment systems as business owners

• Provider Enrollment Chain &

Ownership System (PECOS)

• National Plan and Provider

Enumeration System (NPPES)

• Advanced Provider Screening

(APS)

• Provides system customer service

(i.e. MACs, providers, CMS, states)

• Facilitates provider enrollment data requests

• Provides access to provider enrollment data

• Ensures data quality

• Performs enrollment data analysis

• Continuous vetting of Medicare

FFS Enrollment information with partners

• Oversees the Medicare Administrative Contractor’s (MAC) provider enrollment operations and supports the state Medicaid agency enrollment operations

• Facilitates and ensures resolution of Medicare & Medicaid provider enrollment issues

• Develops and issues general Medicare provider enrollment operating policies and procedures through the Medicare Program Integrity Manual (PIM) Chapter 15, used by MACs to process Medicare enrollment applications

• Develops and issues Medicaid provider enrollment operating policies and guidance via the Medicaid Provider Enrollment Compendium (MPEC) which is used by states to screen and enroll providers into Medicaid FFS

• Provides education on Medicare & Medicaid provider enrollment policy through one-on-one customer service outreach, conferences, and webinars, to the MACs, States, and provider community

Division of Enrollment Operations

(DEO)

Division of Enforcement Actions (DEA)

• Administers administrative actions such as revocations and deactivations within the Medicare program

• Develops and issues general policy and procedures for administrative actions through the Program Integrity Manual (PIM) Chapter 15

• Coordinates with the Unified Program Integrity Contractors (UPICs) and MACs to execute administrative actions

• Conducts Medicare adverse legal action disclosure reviews and renders determinations for Medicare provider and supplier enrollment

• Analyzes for cause state Medicaid terminations for potential Medicare revocation

• Reviews and renders decisions on corrective action plans (CAPs) and appeals for providers/suppliers who are denied or revoked from the Medicare program

• Tracks, reviews, and analyzes appeal decisions determined at the 1st level of appeal and at the Administrative Law Judge (ALJ) level of appeal

• Performs contractor oversight through the annual Quality Assurance Surveillance Plans(QASPs) and maintains contractor accountability for each MAC

Division of Compliance & Appeals (DCA)

Dennis Adams Contracting Officer Representative Division of Enrollment Operations

Provider Enrollment & Oversight (PEO) IDIQ Vision

Establish a selection of pre-qualified bidders that are capable of performing enrollment and screening services

Create an overarching contract umbrella that would encompass all current and future provider enrollment and screening contracts

Streamline the enrollment and screening processes

Address new requirements quickly and efficiently

PEO IDIQ Requirements

How does a contractor become eligible for the

IDIQ?

Respond to sample Task Order

Respond to demonstrated capabilities/narrative

Program management

Provide past performance

Small business participation (Large businesses only)

PEO IDIQ Evaluation Ratings

Technical Evaluation Factors and Relevance

1 Sample Task Order Adjectival Rating

2 Demonstrated Capability Narrative Acceptable/Unacceptable

3 Program Management Adjectival Rating

4 Past Performance Adjectival Rating

Small Business Subcontracting Plan (Large

Business Only) Acceptable/Unacceptable

Sample Task Order (TO)

All Offerors must bid to the sample task order Offeror’s must be selected for award of the PEO IDIQ in order to be considered for a TO award Large Business proposing Small Business proposing

Evaluation Criteria

TECHNICAL FACTOR 1 – Sample Task Order Technical Understanding and

Approach Staffing Plan Risk

TECHNICAL FACTOR 2 – Demonstrated Capability Narrative Demonstrate technical capabilities 5 page summary 5 pages per requirements

Demonstrated Capability – Anticipated Unrestricted

The Offeror shall demonstrate their technical capabilities that address and cover all performance requirements that are identified as unrestricted at this time

Demonstrated Capability – Anticipated Unrestricted

• Site Verification Services

• National Provider Enrollment Services (Parts A, B, C, DMEPOS and/or Medicaid)

• Provider Enrollment Education and Outreach

Services

• Competitive Bidding Implementation Contractor

(CBIC) – License Verification Services

Anticipated Small Business

The Offeror shall demonstrate their technical capabilities for any of the performance requirements (anticipated as unrestricted or small); however, a small business shall propose to a minimum of two of the performance requirements that are identified as small business at this time.

Anticipated Small Business

• Fingerprinting Services

• Provider Enrollment Data Analysis Services

• Provider Enrollment Systems Testing Services

• Provider Enrollment Requirements Services

• Adverse Legal Action Services

• Provider Enrollment State Oversight Services - **8(a) Only

• Provider Enrollment Accreditation Services

• Enrollment Waiver for Moratoria Services

• Provider Enrollment Appeals and Rebuttals

TECHNICAL FACTOR 3 – Program Management Capacity to accomplish the management of oversight of the PEO IDIQ requirements Manage multiple task orders effectively

TECHNICAL FACTOR 4 – Past Performance Large business must provide 8 evaluations

(Prime only, no subcontractors) Small business must provide 6 evaluations

(Prime only, no subcontractors)

TECHNICAL FACTOR 5 – Small Business Participation Plan (Large Business Only) Demonstrate use of small businesses in performing subcontracts

Alisha Sanders Director, Division of Enrollment Operations

Anticipated Small Business Task Orders

Fingerprinting Services Perform provider enrollment fingerprint-based background checks for providers enrolling in Medicare and/or Medicaid

Review and interpret criminal history reports received from the Federal Bureau of Investigation (FBI) and report results to CMS

Provider Enrollment Data Analysis Services

Facilitate analytical requests of provider enrollment systems

• Medicare/Medicaid provider enrollment data

• health care claims

• administrative and partner data

Support data analytic needs for Medicare enrollment program operations such as program monitoring, policy support and program evaluation

Provider Enrollment Systems Testing Services Perform user acceptance testing for enhancements to CMS systems Performs usability and quality assurance testing

• Ensures that the design, layout, and organization of the system is intuitive and user-friendly

Provider Enrollment Requirements Services Gather and define program or system requirements for CMS provider enrollment systems Ensure requirements capture the intent of requested changes, stated requirements from users and reflect the use of industry best practices

Adverse Legal Action Services

Investigate adverse legal actions disclosed on the enrollment applications

• Revocation/suspension of medical license

• Felony convictions

• Exclusions/debarments

Research adverse legal actions via data search engines, state medical licensing boards, and the Public Access to Court Electronic Records (PACER)

Provider Enrollment State Oversight Services - **8(a) Only

Perform onsite assessments of the Medicaid State Agency’s (SMA’s) provider screening and enrollment activities and their compliance with federal requirements

Review, assess, and document existing state policies, procedures, and business processes as related to provider screening and enrollment

Present non-compliance with federal requirements, vulnerabilities, and opportunities for improvement of provider screening and enrollment policies, procedures, and business processes

Provider Enrollment Accreditation Services Verify and track DME supplier accreditation requirements by establishing relationships with the accrediting organizations

Verify and track all product accreditation requirements and identify suppliers that are not meeting the accreditation and make recommendations to CMS

Enrollment Waiver for Moratoria Services

Assess the effectiveness of the moratoria demonstration using CMS data and independent data analyses

Analyze any provider movement beyond the moratoria areas, in an attempt to circumvent the moratoria

Monitor beneficiary access to care issues

Analyze CMS’ current heightened screening processes and advise of any potential improvements to the process

Provider Enrollment Appeals and Rebuttals

Conduct a legal analysis of corrective action plans (CAPs) and reconsideration requests

• Factual summary that led to the initial determination

• Review of all relevant documentation

• Relevant regulations and sub-regulatory guidance

Anticipated Unrestricted Task

National Provider Enrollment Services

Single or multiple contractors that perform all provider enrollment functions nationwide

• Process enrollment applications from providers enrolling in Medicare Parts A, B, C, DME and/or Medicaid

• Verify and screen the enrollment data contained on the enrollment applications

• Process denials, revocations and deactivations

Provider Enrollment Education and Outreach Services

Develop training material to provide education on current provider enrollment regulatory, sub-regulatory guidance and PECOS

Hold regular teleconferences and webinars open to the provider/supplier community

Coordinate the annual in-person National Provider Enrollment Conference (NPEC)

DMEPOS License Verification Services

Coordinate with all states quarterly to obtain updates to their state licensure requirements

Ensure suppliers are maintaining an active license to remain in compliance with the competitive bidding requirements and provider enrollment requirements

Continuously monitor and tracks changes in state licensure requirements and the suppliers who are no longer in compliance with these requirements

Site Verification Services

Conduct site verification inspections for Medicare and/or Medicaid providers to verify practice location information to determine compliance with enrollment requirements

Two site verification contracts (Eastern and Western region)

• Must have the ability to conduct nationwide site verification services at locations in all states

Site Verification Services

In-depth and observational site visit capabilities

• Internal site visits based on pre-defined checklists

• Photos

• Provider, staff and/or customer interviews

Maintain a request management system

Ability to interface with PECOS

Store photographs and site verification reports

Frequently Asked Questions

Next Steps

• Information Session Slides will be posted to Federal Business Opportunities (FBO) within the next week

• Questions resulting from the Information Session can be sent electronically to PEO2018@cms.hhs.gov no later than 4:00 PM Eastern Time (local, Baltimore, MD) on May 31, 2018

• Responses to relevant questions received will be posted to

FBO

• Pre-Solicitation/Solicitation Release mailto:PEO2018@cms.hhs.gov

IDIQ

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