Attachment_J.2__Sample_Task_Order_Statement_of_Work.pdf

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003

SAMPLE TASK ORDER:

DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

Beneficiary Engagement and Incentives Models (BEI)

I. PURPOSE

The purpose of this Scope of Work (SOW) is to obtain a contractor to provide implementation, monitoring and operational support for the Beneficiary Engagement and Incentives Models (BEI). The models are: (1) the Shared Decision Making Model (SDM Model), which will be operated in Accountable Care Organizations (ACOs), and (2) the Direct Decision Support Model (DDS Model) will be operated in geographically defined populations of Medicare beneficiaries by decision support organizations (DSOs).

This SOW describes the tasks that the implementation and monitoring contractor (from here on out known as the contractor or IMC) shall carry out to support the operations of two models.

II. BACKGROUND AND AUTHORITY

Section 1115A of the Social Security Act (the Act) (42 U.S.C. 1315a) (as added by Section 3021 of the Patient Protection and Affordable Care Act of 2010 (hereinafter “ACA”)) authorizes the Innovation Center to test innovative health care payment and service delivery models that have the potential to lower Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) spending while maintaining or improving the quality of beneficiaries’ care.

The Centers for Medicare & Medicaid Services (CMS) identifies strengthening beneficiary engagement as one of the agency’s goals to help achieve better care, smarter spending, and healthier people. Specifically, the “CMS Quality Strategy envisions health and care that is person-centered, provides incentives for the right outcomes, is sustainable, emphasizes coordinated care and shared decision making, and relies on transparency of quality and cost information.”1 Beneficiary engagement broadly refers to the actions and choices of individuals with regard to their health and health care, and these decisions impact cost, quality, and patient satisfaction outcomes.2,3 The focus on the BEI Models proposal is on shared decision making, including the use of patient decision aids (PDAs), tools that present information about common medical choices, providing of a variety of decision support services.

Beneficiaries make health care decisions regarding treatment options for a particular condition or procedure in a variety of ways. The BEI Models will test two Model approaches.

1 Centers for Medicare & Medicare Services. Quality Strategy, pp. 2. (2016).

<https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/qualityinitiativesgeninfo/downloads/cms-quality-strategy.pdf> 2 Greene J, Hibbard JH, Sacks R, Overton V, Parrotta CD. When patient activation levels change, health outcomes and costs change, too. Health Affairs. 2015; 34(3):431-437.

3 Oshima Lee, Emily, and Ezekiel J. Emanuel. “Shared Decision Making to Improve Care and Reduce Costs.” New England Journal of Medicine 368, no. 1 (January 3, 2013): 6–8.

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003

Shared Decision Making Model (SDM Model) The SDM Model aims to integrate shared decision making into routine clinical practice of participating Accountable Care Organizations (ACOs), resulting in informed and engaged beneficiaries who collaborate with their practitioners to make medical decisions that align with their values and preferences.

The model will directly address a number of the barriers identified in research studies in peer-reviewed scientific literature and by experts in the field of shared decision making, such as inadequate time and lack of resources to implement shared decision making in a busy clinical practice.

CMS plans that the model will be operated in 50 ACOs, with another 50 ACOs randomized as comparison sites. The Model will focus on the following preference-sensitive conditions: stable ischemic heart disease, hip and knee osteoarthritis, herniated disk, spinal stenosis, clinically localized prostate cancer (cancer that is confined to the prostate gland), or benign prostate hyperplasia (BPH).

The SDM Model will implement a structured Four Step Shared Decision Making Process in the ACO clinical practice. The four steps include:

Step 1: Identifying SDM-eligible beneficiaries, Step 2: Distributing the PDA to eligible Medicare Fee-for-Service (FFS) beneficiaries, Step 3: Furnishing the SDM Service (Shard Decision Making: Discussion, Decision and Documentation); and

Step 4: Tracking and submit SDM Reporting.

The SDM Model will pay participating ACOs $50 for each SDM Service furnished by its SDM practitioners.

The SDM Model will test if this design results in beneficiaries who believe they have made better decisions about their care while saving money for the Medicare Program or keeping expenditures neutral, while increasing quality.

For more information on the SDM model, please refer to the request for applications (RFA), found at https://innovation.cms.gov/Files/x/bei-sdm-rfa.pdf.

Direct Decision Support Model (DDS Model) The DDS Model aims to engage beneficiaries and provide them with information about their medical conditions through a DSO outside of the healthcare provider system. There are many companies that currently operate independent decision support for insurers and for health systems. The intended result is to increase beneficiary satisfaction around decision making, include beneficiaries in the decision process, and support better beneficiary decisions regarding their care.

The DDS Model will test whether beneficiaries engaged through direct decision support will become informed, empowered, and activated to make health decisions through a better understanding of available healthcare information. The DDS model will https://innovation.cms.gov/Files/x/bei-sdm-rfa.pdf

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003 accomplish these aims with evidence-based health decision support, incentives, and behavioral economic strategies to encourage beneficiaries to engage with decision support operators.

The DDS Model will include all of the core conditions included in the SDM model, plus additional acute and chronic conditions that are found in the Medicare population. Up to seven DSOs, each will serve a separate geographically defined populations of at least 100,000 Medicare FFS beneficiaries. The DSOs will reach out to beneficiaries through direct mail, phone calls, emails, texts and other methods to provide SDM and other support for health care choices and will provide information and motivation to beneficiaries to engage in disease self-management for chronic and other conditions.

For more information on the DDS model, please refer to the RFA, found at https://innovation.cms.gov/Files/x/bei-dds-rfa.pdf.

III. TASKS

CMS’ objective in testing these models is to address research questions focused on whether the models will:

• Assist participants of the SDM and DDS models in making an informed decision about their preference sensitive condition treatment options;

• Improve quality of life and patient satisfaction; and

• Result in budget neutral or budget saving outcomes to the Medicare program while increasing quality.

SDM MODEL SPECIFIC TASKS

Task 1: Administrative and Logistical Support

Task 1-1: Kick-off meeting The contractor shall schedule an Initial Meeting (Kick-off meeting) with the COR and CMS model team within two weeks of the date of award (DOA). Topics to be discussed include, but are not limited to: a step through of each task listed in the SOW, the contractor’s approaches to management of the tasks involved in this contract, content and format of reports, project goals and work plan that will guide the overall direction of the contract. When possible, this kick off meeting is a face to face meeting with the contractor and the CMS model team. The contractor shall send to the CMS COR the agenda and any material three days in advance of the kick-off meeting.

Task 1-2: Program Management The contractor shall have weekly progress meetings via conference call with the CMS COR and the Model team. The contractor shall submit all material for the weekly meeting three days in advance. Part of program management is for the contractor to report separately on the cost for SDM and DDS tasks on monthly bases as part of the invoicing (refer to Task 1-7).

Task 1-3: Pre-Implementation activities for Shared Decision Making Model.

https://innovation.cms.gov/Files/x/bei-dds-rfa.pdf

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003

During the pre-implementation period (which is defined as the 6 months prior to the model go-live date of January 1, 2018, the contractor shall be responsible for the following: Pre-implementation activities which will occur in year 1 only.

The contractor shall:

• Develop and implement a template for participating ACOs to submit/update their implementation plan. The contractor shall send the template to CMS for approval 30 days after contract award.

• Work with project officers in reviewing and approving the updated implementation plan of the ACOs.

• Facilitate the selection of a standard set of PDAs for each preference sensitive condition for use across all SDM practices within the participating ACO. This will be a one-time task to occur during the pre-implementation activities. CMS estimates the universe of potential PDAs to be approximately 20-25. The selection of the PDAs will be in collaboration with the participating ACOs. The contractor shall review and approve the submitted PDAs from the ACOs using the IPDAS guidelines. Develop, finalize and implement the ICD 9/10 inclusion/exclusion criteria for each preference sensitive condition. CMS has done preliminary work in this area that includes ICD 9/10 codes that map back to the preference sensitive conditions listed in Appendix 1. The contractor shall work with the ACOs and their practices in finalizing the ICD 9/10 codes to be used for inclusion/exclusion criteria. The contractor shall submit a list of the ICD 9/10 inclusion/exclusion codes to CMS for approval 90 days after the preliminary list of ICD 9/10 codes are given to the contractor.

• Support and develop webinars for all aspects of Model operations. The contractor shall also prepare PowerPoint slides (with content as directed by CMS for webinars and other communication streams as requested by CMS). All material must be approved by the CMS Model team. The contractor shall record and make available all the webinars to be viewed at a later date. The contractor shall keep track of all training attended by the ACO, their practices and practitioners. All material must be 508 compliant. The pre-implementation webinars will be monthly (for a total of six webinars). The training topics may include the following, but is not limited to the following:

o How to submit the claim outside of the traditional billing system for payment; required fields o Required documentation for the clinical record o Reporting requirements (SDM reporting, beneficiary questionnaire, operational data, quality measures and performance metrics) o Four Steps of the SDM process o Model Participant Agreement – compliance and monitoring activities o Other topics as necessary

Task 1-4: Ongoing quarterly webinar After the pre-implementation activities are finished, the contractor shall develop quarterly webinars for the participating ACOs, their practice staff and practitioners. These

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003 webinars will deal with the model operations. These webinars may be influenced by data that is coming into the contractor from the ACO reporting.

Task 1-5: Collaboration with other contractors The contractor shall engage and collaborate with participating ACOs, the Innovation support contractors (i.e. Evaluation Contract, Learning and Diffusion (LDG), Innovation Center Payment Contractor (IPC), CMMI’s Methods and Analytics for Compliance Support Contractor etc.) and other CMS components, at the direction of the CMS COR.

The contractor shall also collaborate with CMS partners in using CMS data systems and regarding sharing data.

Task 1-6: Quarterly Operations and Implementation Reports The contractor shall submit quarterly administrative progress reports outlining all work accomplished during the previous months. At a minimum such reports shall cover the following items:

• Activities during the months (data collection activities, problems encountered and potential future problems and recommendations, actual and possible delays in deliverables, etc.)

• Activities planned for the forthcoming months.

Task 1-7: SDM Monthly Itemized Invoice Report and Burn Rate The contractor shall submit to CMS monthly itemized invoice report relating to the performance month for SDM activities. The contractor shall track and report SDM operational cost separately. This report is due 10 days following the performance month, along with a summary report of the burn rate relating to the operational cost.

Task 2: Technical Assistance

Task 2-1: General Technical Assistance The contractor shall identify ACO practices that are not meeting the program requirements of the SDM Model. For example, understanding the requirements of the MPA, requirements of the Four Step SDM Process, how to do monthly SDM Reporting.

The contractor shall report to CMS on a bi-monthly basis the number of ACOs that needed technical assistance. If there are a large number of ACOs having the same issue, the contractor shall develop and host a webinar on this topic.

Optional Task 2-2: Preference Sensitive Conditions CMS recognizes that the science and research around shared decision making and preference sensitive conditions is constantly evolving and being revised. In recognition of this fact, the contractor shall review the CMS approved list of preference sensitive conditions (Refer to Appendix 1) at the end of option year one of this contract. This review shall be done in collaboration with the participating ACOs and physician leadership at their SDM practices, to ensure consistency with evidence-based practice and treatment options and report back to CMS. CMS may consider modifications to the preference-sensitive conditions, however such changes would be applied to all participating ACOs and would be implemented through modifications or addendum to

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003 the MPA (and preferably before the start of a performance year). CMS estimates that no more than one to two conditions would change during the course of the Model. This optional task, if exercised by CMS, would begin in Option Year one and end in Option Year two.

Task 3: SDM Beneficiary Questionnaire The purpose of the SDM beneficiary questionnaire in the SDM Model is to capture information about the beneficiary experience with the model intervention (i.e. the Four Step Shared Decision Making Process) and the quality of the intervention. This questionnaire will include process, outcome and demographic questions. A paper-based beneficiary questionnaire will be offered to each beneficiary by the practitioner (after Step 3 of the Four Step Shared Decision Making Process) while the beneficiary is in the office. The contractor will be responsible for developing this paper-based questionnaire from pre-selected CMS questions, performing testing and validation, supporting participating ACOs in their administration of this questionnaire, and collecting and compiling the questionnaire data for use in this project.

CMS will provide the contractor with a pre-selected set of questions, additional specifications (i.e., proposed questionnaire length, etc.) and an assumption list that was developed by the CMS workgroup, following the award of the contract. The contractor shall review these materials and recommend a final set of questions that align with the goals and targets of the SDM Model. Included in this final recommendation should be the contractor’s proposal for sequencing the questions, introductory/lead-in text, and information that CMS would find beneficial (i.e. estimates of amount of time to complete, considerations of questions taken from existing or previously validated surveys, demographic questions that may not be needed because other sources of the information are available, etc.). CMS will accept minimal modifications to the questions, based on technical input provided by the contractor. The contractor shall forward these recommendations to CMS 75 days after they receive the pre-selected questions. After these recommendations are approved by CMS, the contractor shall finalize the beneficiary questionnaire for the SDM Model.

The contractor shall create a paper version of the questionnaire. The collection tool must be paper, and needs to be formatted in a manner that will be easy for the Medicare beneficiary to read and complete. CMS will provide the contractor with additional specifications and an assumption list that was developed by the CMS workgroup, following the award of the contract. In addition to the paper questionnaire, the contractor shall develop a process to extract information from the questionnaire, in order to compile it with data acquired from other sources. (See task 6 for more detail on the data collection process within this model).

CMS assumes that approximately 90% of the questionnaires will be completed in the clinical practice and will be submitted (batched and mailed) to the contractor by the ACO; 10% will be filled out at home and returned to the contractor. CMS assumes a response rate for this survey slightly above other CMS paper surveys as the survey will be administered while the beneficiary is in the physician’s office. The questionnaire will contain personally identifiable data (PII), and the contractor shall adhere to all applicable laws and contractual requirements in protecting this data. The contractor shall provide to

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003 the participating ACOs hard copies of the questionnaire and self- addressed stamped envelopes. The contractor shall also support the ACOs administration of the questionnaire by providing a brief protocol (or supporting materials, such FAQs, instructions) that will inform ACOs as to how CMS intends for the questionnaire to be administered consistently across ACOs and with the intended effect.

Within 90 days of contract award, the contractor shall detail the type of test/validation that these questions will need to go through to ensure the validity and reliability of the beneficiary questionnaire and how this will be accomplished. Once CMS approves the plan the contractor shall implement their plan for testing/validation of the questions to be used in the beneficiary questionnaire.

The contractor shall analyze the beneficiary questionnaire data, clean the data, and develop bi-monthly report for CMS that contains insight into the questionnaire response rate, patterns of non-response and overall questionnaire performance.

The contractor may, on a limited basis, recommend to CMS any questions that they recommend be removed (or modified) from the questionnaire. CMS will approve/deny the recommendations presented by the contractor before any changes can be made.

Task 4: SDM Quality and Performance Measures CMS will provide the contractor with a proposed set of quality and performance measures to be used in the SDM Model. These measures will mainly be drawn from beneficiary questionnaire data, CMS administrative data and data reported from the ACOs monthly and quarterly reporting. The contractor shall review the measures and recommend a final set of measures/metrics that will align with the goals and targets of the SDM Model.

Within 90 days of contract award, the contractor shall submit a plan that details how the quality and performance measures will be operationalized. The contractor’s recommendations should include details on source data, measure operationalization (i.e., benchmark or comparison group), technical specifications (numerator, denominator, period or performance, etc.), quality control, etc.

The contractor shall develop and implement a process and template to collect and report the quality measures and performance metrics, clean the information, and develop reports that will be sent to CMS and the ACOs on a quarterly basis for the SDM Model (see Task 6 for more detail on the data collection processes within this model). The contractor’s application shall suggest a general approach and process for creating and operationalizing the measures for CMS and the ACO audiences. The contractor shall report this process to CMS for approval 90 days after the contractor receives the quality and performance measures.

The contractor shall report to CMS on a quarterly basis any outliers/trends they are seeing. This data will be used for quality improvement and development of future webinars.

Task 5: Monitoring, Auditing and Compliance

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003

The contractor shall monitor each of the participating ACOs and their practices and practitioners to ensure their adherence to all applicable requirements of the SDM model, including the Model Participation Agreement (MPA) and the obligations imposed on practices and practitioners through their contractual relationship with a participating ACO. The contractor will be required to work with CMMI’s Methods and Analytics for Compliance Support Contractor, to accomplish this task. The contractor shall conduct targeted (or ad-hoc) audits when necessary. The need for such audits will be determined by the results of queries and/or algorithms proposed by the CMMI’s Methods and Analytics for Compliance Support Contractor. The contractor shall report this information to CMS on a bi-monthly basis. Examples of this monitoring might include but are not limited to the following:

• Ensuring that the participating ACO has adequate safeguards in place to ensure program integrity and monitoring of the SDM model;

• Ensuring that the practitioners that furnished the SDM Service and the practices and practitioners that completed SDM Activities report this information to the participating ACO;

• Ensuring that the participating ACO has and maintains a contractual relationship with each SDM practice and practitioner so that CMS can enforce upon the ACO, conditions of payment that must be met by its SDM practices and practitioners;

• Ensuring that the ACO has and maintains a contractual relationship with each SDM practice and practitioner so that the ACO is responsible for the actions of the practitioners who furnished/engaged with beneficiaries in the SDM Service.

• Ensuring that the participating ACO has and maintains a contractual relationship with each SDM practice and practitioner so that CMS can receive data for assigned and non-assigned beneficiaries;

• Ensuring that the participating ACO has a compliance plan in place that includes self-monitoring of completing SDM Activities and SDM reporting requirements.

Detailed information concerning the applicable requirement will be defined in the MPA.

The MPA will be available to the contractor at a later date.

The contractor shall monitor aspects of model operations using data collected from various sources (Refer to Appendix 2). Operations monitoring will consider data submitted in response to the initial request for award (RFA) by the participating ACOs, in addition to operational reports submitted from each of the participating ACOs, patient questionnaire data, monthly telephone conferences with the participating ACOs. Data submitted by the participating ACO to CMS must be certified for truthfulness and accuracy by its SDM practices and practitioners who submitted data to the ACO. In addition, the data submitted to the contractor must be submitted by a legally authorized individual at the participating ACO. The contractor shall analyze the data for issues (e.g., incompleteness, internal and/or external consistency, etc.) and will alert CMS project officers, who will consider solutions.

The contractor shall propose sample auditing to ensure that data reported to the contractor, mainly monthly SDM reporting, has been certified and reported accurately.

The contractor shall verify payments and create a historical payment repository, which will provide a record of all SDM payments and processes completed by each

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003 participating ACO. The contractor will work with CMMI’s Methods and Analytics for Compliance Support Contractor in order to prevent health care fraud and model abuse.

The contractor shall run specific queries or algorithms; proposed by the CMMI Methods and Analytics for Compliance Support Contractor, against the historical payment files, in conjunction with claims data and other administrative data housed at CMS, to alert CMS to suspicious or fraudulent activity. These queries could, for example, target potential areas such as billing for services not provided, duplicative payment, up coding the level of service provided, preferential referral or beneficiary inducement. The results produced through this process will determine where and when audits are needed.

The contractor shall include a proposed monitoring, auditing and compliance plan in their application for review. Selected applicant shall finalize and submit a final plan to CMS within 120 days following contract award.

Task 6: Data Management and Reporting The contractor shall include a proposed data management and reporting plan in their operational plan during application phase. The contractor shall submit a final data management and reporting plan to CMS 30 days following contract award.

The data management component of this approach should address data collection, combination and storage. The reporting component should speak to data and/or summary information provided to CMS, participating ACOs, or other parties involved with the SDM Model. Please reference Appendix 2: Data Streams, which provides an overview of each data stream within the SDM Model. All data produced and acquired through the duration of this model will be the sole property of CMS.

The contractor shall implement the approved data management and reporting approach by NLT 120 days after contract award.

Task 6-1: Data Collection, Combination and Storage As part of the data management and reporting approach for the SDM Model, the contractor shall propose a process to collect and/or acquire data from the “data streams” listed in Appendix 2. The contractor’s approach to data collection shall consider and/or address the following:

• Is the amount of data being collected sufficient to accomplish the tasks defined in the contract (i.e. minimum necessary)? Is the data necessary already captured by CMS through another program/source?

• What file format and necessary fields/data elements should be specified?

• What is the appropriate frequency of data collection?

• What processes, such as data cleaning and validation, will be necessary after collection in order to prepare collected data for analysis?

• How will the contractor successfully operate within any guidelines and/or standards required by CMS (e.g. DUAs, Administrative, Onboarding, Privacy and Security Requirements)?

Participating ACOs will submit Monthly SDM Reporting to the contractor. This reporting will form the basis for SDM quarterly payments from CMS. When proposing

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003 the final set of data elements the contractor shall consider the CMS 1500 (Part B Claims) form and select a similar level of detail for reporting on the SDM Services being provided. Data Elements proposed should be similar to those in Appendix 4. The contractor shall also consider burden to the ACO in developing the final layout/format for Monthly SDM Reporting.

The contractor shall load and/or access electronic data via an Administrative Data Mart (ADM) in the Integrated Data Repository (IDR) or CCW. The contractor’s approach shall therefore consider the necessary specification needed to set up this ADM in coordination with CMS and its IDR contractors. The contractor shall be required to use CMS’ EFT to securely transfer sensitive data to and from model participants, or other CMS contractors, and in and out of the IDR. The contractor shall work with CMS IT contractor to set up an EFT mailbox with participating ACOs that will allow sensitive data to be exchanged and loaded into the ADM.

The contractor shall be required to carry out all post-collection data processes (e.g. data manipulation and analysis) within the IDR ADM, unless otherwise indicated by CMS.

The contractor’s data management and reporting approach should address the various intricacies of all required tasks. For example, what data will need to be combined and reconciled in order to meet SDM Model design and operations requirements? The contractor’s proposed approach for data combination and storage should account for all relevant tasks in this statement of work, such as payment, monitoring and compliance, quality and performance, and reporting. In addition, the contractor shall propose a data storage plan that allows for potential audits, enrollment or payment reconciliation, and any other needs of the model. Finally, the contractor shall be required to create and maintain a historical payment file to assist in the audit process. All completed data files and documentation must be provided to CMS 30 days after the end of each month. The contractor shall provide a Methodology and Technical Specifications for providing support to any recipients of data, documentation or deliverables established through the activities described in this scope of work.

Task 7: Calculate SDM Payment to the ACO CMS proposes to make payments to the participating ACO outside of the standard FFS claims system, neither the participating ACO nor its SDM practices and practitioners will submit traditional Medicare claims for any of the activities performed or services furnished in relation to the SDM Process. The contractor shall use data collected/housed as part of Task 7 and Task 4 to verify eligibility and payment appropriateness, calculate ACO-level payment, and transmit this information to the Innovation Payment Contractor (IPC){for more information on the IPC refer to task 8-2} and the CMMI COR for payment each quarter. These data elements will provide a claim or record of the SDM service and activities. The contractor shall monitor these data elements for monitoring and compliance activities.

Task 7-1: Verify Eligibility or Appropriateness for SDM Payment The contractor shall, at minimum, be required to verify eligibility or appropriateness for ACO SDM payment at three levels: service level (i.e. where all requirements of payment for SDM Service met, was the SDM service already provided and paid for, etc.), Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003 beneficiary level (i.e. was the beneficiary eligible for SDM), and ACO/practitioner level (i.e. is the practice/practitioner eligible to provide SDM services and receive payment).

Refer to Appendix 4. The contractor shall calculate a quarterly payment amount for all eligible beneficiaries for each Participating ACO. The contractor shall also prepare a summary report for the ACO of how this payment was calculated based on the data submitted. If a participating ACO submits a monthly SDM report requesting payment for a beneficiary and they do not meet eligibility requirements, or the SDM Service was offered by a non-qualified practitioner, the contractor must keep a record and provide a high-level summary of this in the quarterly report back to the ACO. Following the award of this contract, the contractor shall receive information on tools that CMS may have available to assist in communicating these monthly payment reports back to participating ACOs (i.e. CMS portal that be accessed remotely which cannot hold PII/PHI information).

Task 7-2: Payment file for IPC contractor:

The contractor shall work closely with CMS’ Innovation Payment Contractor (IPC), who will be tasked with distributing payments through CMS to the ACOs. After the contractor has verified and calculated ACO-level payments, they will prepare a payment file (this file will contain the ACO’s legal name and address, EIN/TIN, and payment amounts) to be sent to the CMS COR for review. After review by the CMS COR, this file will be sent to the Innovation Center Payment Contractor (IPC) for processing of the payment to the participating ACOs, which will be a lump sum quarterly payment. The contractor shall maintain a historical file of payment (also part of task 7-1), which consists of all payments made to each participating ACO. This is key to the “service level” verification of future claims for SDM payment.

Task 7-3: Recovery of SDM Payment If recoupment is necessary (if a payment error, or correction is noted), the contractor shall calculate the amount of SDM recoupment and send the recoupment file to the IPC and the CMS COR for review. The CMS COR will submit the certifying memo to the IPC so that the payment file can be processed. This information will also be stored/updated in the historical file of payment.

Task 7-4: Payment Reporting for Shared Savings and/or Total Cost of Care Models On a yearly basis, the contractor shall calculate all SDM payments per participating ACO TIN, per beneficiary, per practitioner NPI and practice TIN under the SDM Model.

These payments will be included in the ACOs total cost of care and will count as non-claim payments under the SDM Model. This calculation will include ACO assigned beneficiaries. Only assigned beneficiaries will count towards the participating ACOs total cost of care.

The Contractor shall load/report quarterly payment information into the appropriate data repository (i.e. the ADM for this project and/or other CMS databases) for access to CMS and/or other contractors working on the SDM Model.

Task 8: Reporting

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003

Task 8-1: Annual reports:

The contractor shall submit an annual report that describes the activities completed during the performance year. The contractor shall develop an annual report that details and integrates findings for the year including historical site performance; key issues addressed during a production cycle, the adequacy of the standard analytic files, adequacy of the performance measures updates and future modifications; and implications for subsequent implementation and operations. This report should include results reported in the previous monthly reports, as well as findings based upon analyses of the base year period of the model. Issues concerning the generalizability of the sites’ experience should be raised, as well as possible refinements to the methodology and implementation that could improve implementation.

Task 8-2: Final Project Report at Model Conclusion (occurs only in Final Option Year in lieu of annual report).

The contractor shall develop a final report that details and integrates findings for the entire model operating period. This report will integrate the findings of all previous reports. The final report will be due 90 days following the end of the model.

Task 8-3: Ad hoc issues reports.

The contractor shall identify any urgent operational problems and quickly share the information with CMS by email. The contractor shall focus efforts on improving the effectiveness of the CMS project officers through timely and effective identification of issues that require the attention of the project officers. The contractor shall respond to the COR’s request for short and rapid cycle reports on operational issues. We estimate that CMS will require about 6 such reports per year.

DDS MODEL SPECIFIC TASKS

Task 9: Administrative and Logistical Support

Task 9-1: Kick-off meeting The contractor shall schedule an Initial Meeting (Kick-off meeting) with the COR and CMS model team within two weeks of the date of award (DOA). Topics to be discussed include, but are not limited to: the contractor’s approaches to management of the tasks involved in this contract, content and format of reports, project goals and work plan that will guide the overall direction of the contract. This kick off meeting is a face to face meeting with the contractor and the CMS model team. This meeting shall be a face to face meeting at the CMS Innovation Center located at 2810 Lord Baltimore Drive, Baltimore, Maryland. The contractor shall send to the CMS COR any material three days in advance of the kick-off meeting.

Task 9-2: Program Management and Logistics Support During the Base Year, the contractor shall have weekly one-hour progress meetings via conference call with the CMS COR and the Model team. During the Option Years, the frequency will be reduced to every other week. The contractor shall submit all material for the meeting two days in advance. Part of program management is for the contractor

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003 to report on the cost for DDS tasks on monthly bases as part of the invoicing (refer to Task 9-7).

Task 9-3: Pre-Implementation activities for Direct Decision Support Model During the pre-implementation period (which is defined as approximately 3 months prior to the model live date, of April 1, 2018), the contractor shall be responsible for the following:

The contractor shall:

• Develop and implement a template for participating DSOs to develop and update their implementation plan.

• Provide review of DSO websites and materials to include PDAs. Recommend improvements and approval of these materials to CMS prior to implementation.

• Develop 2 webinars for all aspects of Model operations. The contractor shall prepare PowerPoint slides with content for these webinars and other communication streams as requested by CMS. All material must be approved by the CMS Model team. The contractor will assure all webinars are 508 compliant.

The contractor shall record and make available all the webinars to be viewed at a later date and stored on the CMS provided website. The contractor shall keep track of all training attended by the DSO to include recording of all questions received during and after the webinar. The contractor, in collaboration with CMS, shall provide responses to the questions captured. The recording of the questions will be accompanied by responses to be delivered to the DSOs. The training topics may include, but are not limited to, the following:

o Required documentation for CMS records o Reporting requirements (DDS reporting, beneficiary questionnaire, operational data, quality measures and performance metrics) o Steps of the DDS process o MPA – compliance and monitoring activities o Provide limited support for another three webinars, which will be led by CMS staff. The contractor shall provide limited consultation on the slide deck for these webinars and support CMS in finalizing the document (i.e. formatting and 508 compliant processing).

o

The contractor shall include a training plan for the DSOs in the application. The contractor shall submit a final plan to CMS for review and approval within 45 days following contract award. The training plan will provide implementation of the plan to train the DSO’s on the model and its requirements and expectations to include expectations outlined in the MPA. The training will include forms, flows, processes and submission dates for deliverables.

Task 9-4: Ongoing Quarterly webinar and technical assistance to DSOs After the pre-implementation activities are finished, the contractor shall develop webinars as necessary for the participating DSOs. These will occur quarterly (at most) and will be at the direction of the CMS COR. These post-implementation webinars will deal with the model operations, such as monthly reporting from the DSO to CMS. These webinars

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003 may be influenced by data that is collected from DSOs, ongoing DSO feedback or issues reported through reporting as well as any operational data gathered.

Task 9-5: Collaboration with other contractors The contractor shall engage and collaborate with participating DSOs, the Innovation support contractors (i.e. LDG, IPC, etc.) and other CMS components, at the direction of the CMS COR. The contractor shall also collaborate with CMS partners in using CMS data systems and regarding sharing data.

Task 9-6: Monthly Operations and Implementation The contractor shall submit monthly administrative progress reports outlining all work accomplished during the previous month. At a minimum such reports shall cover the following items:

• Activities during the month (data collection activities, problems encountered and potential future problems, actual and possible delays in deliverables, etc.)

• Activities planned for the forthcoming month

Templates for monthly reports are due to CMS 45 days after contract award.

Task 9-7: DDS Monthly Itemized Invoice Report and Burn Rate The contractor shall track and submit to CMS monthly itemized invoice report relating to the performance month for DDS operational activities. This report is due 10 days following the performance month, along with a summary report of the burn rate relating to the operational cost.

Task 10: DDS Beneficiary Questionnaire The contractor shall use a predetermined set of questions, provided by CMS, to validate and ensure consistent implementation across the DDS Model. This questionnaire will include process, outcome, and demographic questions. The purpose of the questionnaire is to capture information about the beneficiary experience with the model intervention (i.e. the three step process) and the quality of the intervention. The beneficiary questionnaire will be offered/administered to beneficiaries by the DSO, subsequent to the beneficiary’s engagement with the DSO and interaction with the DSO’s decision support tool(s). Each DSO may have a different mode of administration, however all DSOs will administer the same set of questions, in the same order, and using standard guidelines.

The contractor shall prepare a protocol on how the questionnaire will be administered by the DSOs. The contractor’s protocol should provide guidelines to DSOs on key areas of questionnaire implementation, such as (but not limited to) how the questionnaire is to be administered (i.e. ordering of questions, question orientation, etc.), what format questionnaire responses should be provided in when sent back to CMS or the contractor, and any data cleaning or coding that should be carried out by the DSO to minimize this work by the contractor or CMS. The questionnaire will be formatted in a manner that will be easy for the Medicare beneficiary to read and complete. The questionnaire will be short, not to exceed 5 minutes in total (1 minute for the demographic questions). Within 60 days of contract award, the contractor shall propose to CMS a preliminary protocol for

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003 implementation of the questionnaire in DSOs, and a plan to collect and store the data from the questionnaire responses that addresses all steps that will be taken to protect this information. CMS will review this protocol and plan prior to final implementation by the contractor.

CMS will provide the contractor with a pre-selected set of questions, additional specifications (i.e., proposed questionnaire length, etc.) and an assumption list that was developed by the CMS workgroup, following the award of the contract. The contractor shall review these materials and recommend a final set of questions that align with the goals and targets of the DDS Model. Included in this final recommendation should be the contractor’s proposal for sequencing the questions, introductory/lead-in text, and information that CMS would find beneficial (i.e. estimates of amount of time to complete, considerations of questions taken from existing or previously validated surveys, demographic questions that may not be needed because other sources of the information are available, etc.). CMS will accept minimal modifications to the questions, based on technical input provided by the contractor. In addition, the contractor shall recommend and detail the type of test/validation that these questions will need to go through to ensure validity and reliability. The contractor shall forward these recommendations to CMS 75 days after they receive the pre-selected questions. After these recommendations are approved by CMS, the contractor shall finalize the beneficiary questionnaire for the DDS Model.

Once CMS approves the contractor’s recommendations around final questionnaire content and how to test/validate, the contractor shall implement their plan for testing/validation of the questions to be used in the beneficiary questionnaire and develop the questionnaire protocol for DSOs. Note, these questionnaire will contain personally identifiable data (PII), and the contractor shall adhere to all applicable laws and contractual requirements in protecting this data.

The contractor shall analyze the beneficiary questionnaire data, develop a quarterly report for CMS that contains insight into the questionnaire response rate, patterns of non-response and overall questionnaire performance. The contractor may, on a limited basis, recommend to CMS any questions that they recommend be removed (or modified) from the questionnaire. CMS will approve/deny the recommendations presented by the contractor before any changes can be made.

Task 11: DDS Quality and Performance Measures CMS will provide the contractor with a proposed set of quality and performance measures to be used in the DDS Model. The contractor shall review the measures and recommend a final set of measures/metrics that that align with the goals and targets of the DDS Model. The contractor shall use the proposed set of measurements to set thresholds for the incentive performance payments. The contractor shall forward these recommendations to CMS 60 days after they receive the proposed set of measures/metrics. The contractor’s recommendations should include details on source data, measure operationalization (i.e., benchmark or comparison group), technical specifications (numerator, denominator, period or performance, etc.), quality control, etc. The contractor shall develop and implement a process to collect and report the final quality measures and performance metrics for the DDS Model. The contractor shall

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003 report this process to CMS for approval 60 days after the contractor receives the proposed measures/metrics.

The IMC shall develop and implement a process and template to collect the quality and measurement information, clean the information, and develop a report that will be sent out to the DSOs on a quarterly basis. The Project Officers (POs) shall be responsible for sending the reports to DSOs. The IMC shall propose to CMS the process they will use to monitor the data. The design shall make use of the data collected and reported from the DSOs, as well as other CMS data that is pertinent. This process is further outlined and defined in Task 13: Data Management and Reporting.

The contractor shall report to CMS on a quarterly basis any outliers/trends they are seeing.

Task 12: DDS Monitoring, Auditing and Compliance The contractor shall provide CMS with a proposed process for monitoring, auditing and assessing compliance with the MPA, and model compliance throughout the duration of the DDS portion of the BEI model during solicitation. The contractor shall submit to CMS the draft plan within 120 days following contract award.

Task 12-1: Monitoring and Compliance The contractor shall be responsible for developing a plan to regularly assess the compliance of all participating DSO’s within the DDS portion of the model. A DSO shall be considered in compliance if it is operating within the guidelines of the participant agreement, Implementation Plan, the RFA, DDS model guidelines, and the processes outlined in its application for the DDS model. The contractor shall establish guidelines, and propose screening methods to detect inappropriate or fraudulent behavior. The IMC will provide review of DSO websites and materials to assure compliance and report non-compliance to CMS for correction by the DSO.

The contractor shall work with CMS to develop workflows that demonstrate a step-by-step process for the identification of adverse behavior and a process of notifying CMS and appropriate law enforcement agencies as needed. The contractor shall run specific queries or algorithms; proposed by CMS against the historical payment files, in conjunction with claims data and other administrative data housed at CMS, to alert CMS to suspicious or fraudulent activity.

The contractor shall produce a Manual of Procedures (MOP) that captures the methodological approach and instructions for implementing any of the selected recommendations. This manual should also include the metrics to be used to determine improvements to future versions of the MOP. The contractor shall provide updates to the MOP following each use, incorporating lessons learned from the fielding of the procedures.

Task 12-2: Design of Audit Process The contractor shall, in conjunction with CMS, develop and implement an audit process.

The contractor will assist in the development of the criteria for when, how, and where audits will occur. Furthermore, the contractor will work with CMS to determine what information will be collected during the audit process, and how such information will be

Attachment J.2 Sample Task Order Statement of Work 75FCMC19R0003 acquired. For the purposes of this application, CMS requests that applicants propose areas of concern that may need to be monitored during the compliance processes of this model.

The contractor will be required to conduct…