Q&A_7-17-18.xlsx

IDIQ

Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization (QIO)

As thie requiremnet to provide workng papaer is highly unusual, please confirm that wrokppaer are indeed required. Please indicate which workpapaers should be included. This was answered in amendment 1.

"The requirement to supply work papers has been removed. Please see revised language in the amendment." See Attachment J.2-D TO 0001 pages 13 -14.

TO 1

Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization (QIO)

7. REVIEW FOR CDAC QUALITY OF CARE ( refers to Task 1.5: Review for Preventable Patient Safety Events in SOW - title of activity is revised in the redline instruction document but not SOW) This column is used for all costs directly attributable to review of preventable patient and safety events under the quality of care review as described in the Beneficiary and Family Centered Care – National Coordinating, Oversight and Review Center.

These instructions do not seem to match the calculations in the spread sheet ( attachment J.2-E).

The spread sheet ( attachment J.2-E) , line 66 columns g,h , asks for the number of reviews.

The total calculations ( column BZ) multiplies the costs in column H by the number in at G66.

Since the costs requested in column H are not single case review costs per the instructions, as are explicitly called for in cost centers Expedited Case Review and Focused Review (columns 5 and 10), but rather the total costs for all reviews, it looks as though this will result in an over estimation for the CDAC reviews. Please clarify. The instructions have been upadated so that the costs for cost center 7 REVIEW FOR CDAC QUALITY OF CARE are single case review costs per the instructions, and are explicitly called for just as are the costs in cost centers Expedited Case Review and Focused Review (columns 5 and 10)

TO2

Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization (QIO)

Question 26: Is the Intake LOE not included in the LOE estimates provided for the review types?

Answer: Intake is not included in the LOE estimates and will not be provided by CMS.

Question 39: Costs for Non-Review Activities is suggested to be 65% of total Review Costs. Please provide the list of Tasks, as described in Attachment J.3-A Case Review SOW, and the list of Cost Center Columns, as described in Attachment J.3-F – Case Review Business Proposal Instructions Case Review, that are considered Non-Review Activities.

Answer: Offeror should describe their non-review costs as a part of their business approach. Reference cost center columns that do not have volumes projected.

Question 40: Non-Review Activities is suggested to be 65% of total Review Activity. Are Case Review Intake Costs considered part of total Review Costs?

Answer: Yes, LOE is inclusive of intake costs.

Q.26 states that the LOE provided does not include Intake, which matches the Intake columns on the provided J-3 templates. Q.40 seems to state the opposite: "LOE is inclusive of Intake costs." Q.39 says that cost center columns without projected volumes should be used for the Non-review calculations, which would include Intake columns. That answer conflicts with the answer for Q.40 that states offerors should include Intake in the Review portion and not the Non-review portion of the calculation.

Please clarify whether intake level of effort and costs should be reported separately in the Business Proposal or left blank. That is, are the costs for intake part of the LOE that was provided for each case review type (and should be left blank because they are not part of the case review formula), or are the costs for intake part of the 65% non-case review activity, or are the intake costs in a separate case review bucket for which there is no CMS estimate and the contractor should determine its own estimate of hours and costs?

Answer 26 is Correct.

Answer 39 is Correct.

Answer 40 is Revised. Case Review Intake Costs are not considered part of the total Review Costs.

The costs for intake are part of the 65% non-case review activity and should be reported separately, in their specified columns in the Business Proposal.

2 Amendment 1 Q&A, TO2 In Q.4, CMS stated "CMS is not aware of the 20 hours in clinical practice requirement for physician peer reviewers, ..." This requirement is stated in QIO Manual Chapter 4, Section 4620 B., Active Practice Requirements, which states, "Your physician reviewers must either be engaged in active practice in the State or be military physicians who actively practice in a military or Department of Veterans Affairs (DVA) health care facility in your State, even though the physician's license to practice has been issued by a different State...Active practice means that the physician usually practices (on a routine basis) a minimum of 20 hours per week."

Q. Please confirm that the governing body does not need to be established at the time of proposal submission, if the proposal contains (1) a commitment to put a Board in place if the contract is awarded and (2) Letters of Commitment from all members that will comprise the Board, including the representative of healthcare providers and the representative of consumers.

A. CMS will accept an offeror’s commitment to create a governing body in compliance with the governance rules, post award. However, that commitment must also contain a time-line and milestones to be met and reported to CMS’ contracting officer. Awarding a contract to an offeror that does not qualify as a quality improvement organization ("QIO") violates law and regulation. The Social Security Act ("SSA") at Section 1153(b)(1) states that "[t]he Secretary shall enter into contracts with one or more quality improvement organizations. . ." The term quality improvement organization is defined at SSA Section 1152 to be an entity which as "at least one individual who is a representative of health care providers on its governing body" and "at least one individual who is a representative of consumers on its governing body." Therefore, CMS may only award a BFCC contract to a QIO and a QIO must meet the statutory definition of having a qualified board. Award may only be to a QIO. If the entity does not have a qualified board, it is not a QIO and cannot be awarded a BFCC contract. Additionally, FAR 9.104-1 states that for a prospective contractor to be determined responsible it must have "the necessary organization" and "[b]e otherwise qualified and eligible to receive an award under applicable laws and regulations." An entity that is not a QIO is not qualified or eligible to receive an award. FAR 9.103 states that "No .. award shall be made unless the contracting officer makes an affirmative determination of responsibility." The contracting officer cannot make an affirmative determination of responsibility if an offeror is not a QIO as defined by the SSA with a qualified governing body. Because the contracting officer cannot make an affirmative determination of responsibility to an entity that does not have a qualified board, no award can be made. Additionally, FAR 9.104-1 states that for a prospective contractor to be determined responsible it must have "the necessary organization" and "[b]e otherwise qualified and eligible to receive an award under applicable laws and regulations." An entity that is not a QIO is not qualified or eligible to receive an award. FAR 9.103 states that "No .. award shall be made unless the contracting officer makes an affirmative determination of responsibility." The contracting officer cannot make an affirmative determination of responsibility if an offeror is not a QIO as defined by the SSA with a qualified governing body. Because the contracting officer cannot make an affirmative determination of responsibility to an entity that does not have a qualified board, no award can be made. Therefore, Q&A 16 does not comply with law or regulations insofar as it allows for award to an offeror that does not qualify as a QIO and is not a responsible offeror. Furthermore, a contracting office cannot waive statute and regulation when it comes to responsiblity. CMS is accepting letters of commitment for the governing body with the expectation that offerors provide thorough assurance and planning to have the governing body in place on the day of award. The proposal and letters of commitment will be evaluated accordingly to make a determination of eligibility.