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RFP # 75FCMC19R0023
Attachment J.2 – A/B MAC Deliverable Schedule Jurisdiction E V.6.0
| RFP/SOW WBS # |
| Related SOW Requirement Name |
| Deliverable Name |
| Deliverable Description |
| Deliver to |
| Deliverable Due Date |
| Frequency |
| CMS Business Owner Functional Area |
| C.5.1.1 |
| Jurisdiction Implementation Project Plan |
| Jurisdiction Implementation Project Plan |
| A detailed description of all activities required to transfer all Medicare operations from each carrier and intermediary in the contractor’s jurisdiction. |
| Contracting Officer's Representative and/or Designees |
| Baseline due within 30 days of the jurisdiction kickoff meeting, unless otherwise directed by the COR |
| Once |
| Center for Medicare (CM) / Medicare Contractor Management Group (MCMG) / Division of Medicare Administrative Contractor (MAC) Program Management (DMPM) |
| C.5.1.3 |
| Risk Management Plan |
| Risk Management Plan |
| Identifies the jurisdiction wide as well as segment specific risks, mitigation strategies, and maintenance process for the risks associated with the contractor’s segment workload transition |
| Contracting Officer's Representative and/or Designees |
| Due within 30 calendar days of the kickoff meeting. |
| Once |
| CM / MCMG / DMPM |
| C.5.1.4 |
| Cutover Plans |
| Part A Cutover Plan; Part B Cutover Plan |
| An expanded part of the Jurisdiction Implementation Project Plan that contain the day by day activities and procedures, some of which may be detailed to the hour, that the contractor will follow during the cutover period to ensure a successful cutover of a Part A or Part B workload. |
| Contracting Officer's Representative and/or Designees |
| Initial at least 45 calendar days prior to the Part A or Part B cutover date contained in the Jurisdiction Implementation Project Plan |
| Once |
| CM / MCMG / DMPM |
| C.5.1.5 |
| Test Plan |
| Test Plan |
| A plan to identify the approach to testing, types of tests, schedule, and progress for the implementation. |
| Contracting Officer's Representative and/or Designees |
| Initial within 30 calendar days after kickoff meeting |
| Once |
| CM / MCMG / DMPM |
| C.5.1.6 |
| Lessons Learned Documentation |
| Lessons-Learned Document Regarding Implementation Activities |
| Identifies the lessons learned during the implementation. |
| Contracting Officer's Representative and/or Designees |
| Within 40 calendar days after the final Part A /Part B cutover. |
| Once |
| CM / MCMG / DMPM |
| C.5.1.7 |
| Accounts Receivable Reconciliation |
| Receipt of Accounts Receivable Transmittal Document |
| Certifies receipt of transmittal document that describes the total amounts and counts of the accounts receivables of the outgoing contractor. |
| Contracting Officer's Representative and/or Designees |
| Due within 10 calendar days after receipt of the Accounts Receivable Transmittal Document. |
| Once |
| CM / MCMG / DMPM and OFM/DFRP |
| C.5.1.9 |
| Implementation Stakeholder Communication |
| Communications Plan |
| Identifies the processes and procedures the contractor will follow to ensure that all transition stakeholders are informed of the transition and its progress. |
| Contracting Officer's Representative and/or Designees |
| Due within 30 calendar days after contract award date. |
| Once |
| CM / MCMG / DMPM |
| C.5.2.1 |
| Workload Closeout Project Plan (Option that may be exercised at the End of the Contract) |
| Workload Closeout Project Plan |
| Describes the outgoing contractor’s plan for the transfer of Medicare functions and the closeout of operations at contract end. |
| Contracting Officer's Representative and/or Designees |
| Due 15 calendar days after the jurisdiction kickoff meeting. |
| Once |
| CM / MCMG / DMPM |
| C.5.2.3 |
| Workload Closeout Risk Management Plan (Option that may be exercised at the End of the Contract) |
| Workload Closeout Risk Management Plan |
| Includes a periodic assessment of new risks and mitigation and contingency planning where appropriate. |
| Contracting Officer's Representative and/or Designees |
| Initial Due within 30 calendar days of replacement contractor kickoff meeting |
| Once |
| CM / MCMG / DMPM |
| C.5.2.4 |
| Accounts Receivable Transmittal Document |
| Accounts Receivable Transmittal Document |
| Describes the total amounts and counts of the accounts receivables of the outgoing contractor. |
| Contracting Officer's Representative and/or Designees |
| 60 days prior to the effective date of the transfer. |
| Once |
| CM / MCMG / DMPM and OFM/DFRP |
| C.5.2.5 |
| Cost Accounting/Audit (Option that may be exercised at the End of the Contract) |
| Financial Audit Supporting Documentation |
| Describes the details to support the post-cutover financial activities of the outgoing contractor. |
| Contracting Officer's Representative and/or Designees |
| Within 30 calendar days after closeout end |
| Once |
| CM / MCMG / DMPM |
| C.5.4.3 |
| Security |
| Information Technology Systems Contingency Plan Report |
| Information Technology (IT) Systems Contingency Plan (See BPSSM Table 3.1 Planning Table, for 3.4) |
| Contracting Officer's Representative and/or Designees and CMS Business Owner |
| Initial within 90 days prior to the first segment cutover date and annually thereafter |
| Annually |
| CM/MCMG/DMSSOO |
| C.5.4.3 |
| Security |
| IT Security Tests And Reports |
| Contractor conducted or any other independent IT evaluation |
| Contracting Officer's Representative and/or Designees |
| 10 business days after conducted |
| As required |
| CM/MCMG/DMSSOO |
| C.5.4.3 |
| Security |
| Risk Assessment Report |
| Risk Assessment (See BPSSM Table 3.1 Planning Table, for 3.2) |
| Contracting Officer's Representative and/or Designees |
| Initial within 90 days prior to making AB payments under the contract and annually thereafter |
| Annually |
| CM/MCMG/DMSSOO |
| C.5.4.3 |
| Security |
| Statement of Security Compliance |
| Annual certification (See BPSSM Table 3.1 Planning Table, for 3.3) |
| Contracting Officer's Representative and/or Designees |
| In accordance with BPSSM |
| Annually |
| CM/MCMG/DMSSOO |
| C.5.4.3 |
| Security |
| Systems Security Plan |
| Systems Security Plan (SSP) (See BPSSM Table 3.1 Planning Table, for 3.1) |
| Contracting Officer's Representative and/or Designees |
| Initial within 90 days prior to making AB payments under the contract and annually thereafter |
| Annually |
| CM/MCMG/DMSSOO |
| C.5.4.3 |
| Security |
| Systems Security Profile Documentation |
| Systems Security Profile (See BPSSM Table 3.1 Planning Table, for 3.7) |
| Contracting Officer's Representative and/or Designees |
| Consistent with frequency |
| As required |
| CM/MCMG/DMSSOO |
| C.5.4.3.2 |
| Administer Security Program |
| Corrective Action Management Process Report |
| Report progress in correcting deficiencies or findings identified by audits, reviews, etc. in accordance with guidance provided by the BPSSM and other CMS guidance. |
| Contracting Officer's Representative and/or Designees |
| In accordance with BPSSM or as requested by CMS (Corrective Action Plans for findings identified in Section 912 Evaluations must be remedied prior to making payments). |
| Monthly |
| CM/MCMG/DMSSOO |
| C.5.4.3.4 |
| Correct Deficiencies |
| Incident Reporting and Responses Report |
| Incident Reporting and Response (See BPSSM Table 3.1 Planning Table, for 3.6) |
| Contracting Officer's Representative and/or Designees |
| As required by the CMS Incident Handling & Breach Notification Handbook, RMH Vol. III 7-1. Incidents involving individually identifiable information must be reported within 1 hour. |
| Monthly and As required |
| CM/MCMG/DMSSOO |
| C.5.4.3.5 |
| Security Review and Verification |
| FISMA Assessment |
| Contractor will examine and analyze implemented security safeguards to provide evidence of compliance with applicable laws, regulations, and requirements. |
| Contracting Officer's Representative and/or Designees |
| As part of the May 1st POA&M submission |
| Annually |
| CM/MCMG/DSSOO |
| C.5.4.3.5 |
| Security Review and Verification |
| FISMA Compliance |
| Any FISMA Compliance evidence to CMS (See H.26- FEDERAL INFORMATION SECURITY MANAGEMENT ACT (FISMA)) on completed and current CMS contracts |
| Contracting Officer's Representative and/or Designees |
| As requested by CMS |
| As requested |
| CM/MCMG/DMSSOO |
| C.5.4.4.1 |
| Quality Control Program |
| Quality Control Plan (QCP) |
| Specifies the procedures and resources applied to ensure services meet contract performance requirements. |
| Contracting Officer's Representative and/or Designees and CMS Business Owner |
| The QCP shall be submitted into the CMS ART 45 calendar days prior to the start of each contract period and within 30 calendar days of any substantive changes in the MAC's quality operations. A courtesy copy of the QCP deliverable shall be sent to CMS's QCP Mailbox at QCP@cms.hhs.gov when submitting the QCP deliverable to CMS ART. Both redlined and clean copies should be submitted. |
| Prior to start of base operational period; prior to start of each subsequent contract year; and when substantive changes occur in quality operations. |
| CM/MCMG |
| C.5.4.5 |
| Public Relations |
| Public Relations Plan-Implementation Deliverable |
| Describes the contractor’s plans for managing the programs public relations. |
| Contracting Officer's Representative and/or Designees |
| Initial within 30 calendar days of contract award |
| One month after contract award |
| CM/MCMG |
| C.5.4.5.3.3 |
| Review Written Responses for Reading Level (Fogging) Accuracy and Timeliness |
| Readability Attestation for Beneficiary Appeals Correspondence |
| Contractors are required to attest that they are issuing correspondence that satisfies the readability requirements outlined in the Federal Register. This attestation should include how contractors ensure that this requirement is being met (e.g., software programs, quality reviews, etc.). Additional information regarding the readability requirements is in IOM 100-04, Chapter 29, Section 290.3.2 -- Reading Levels. |
| Contracting Officer's Representative and/or Designees and CMS Business Owner |
| Within 30 days after cutover |
| Annual |
| CPC/MEAG/DAO |
| C.5.4.6.1 |
| Responses to Congressional Inquiries |
| Responses to Congressional Inquiries Report |
| Describes a summary of the congressional inquiry responses |
| Contracting Officer's Representative and/or Designees |
| Within 7 calendar days of month end |
| Monthly |
| OBIS/CMS |
| C.5.4.8.3 |
| Successful Implementation of Change Requests |
| Change Request Implementation Report (CRIR) |
| Describes the Change Requests (CRs) that the contractor has implemented in the quarterly period. |
| This information shall be submitted electronically to CR_IMPL_REPORTS@cms.hhs.gov. These deliverables must also be delivered concurrently to the COR in accordance with CMS technical direction regarding the contract deliverable process. |
| The due dates for the Change Request Implementation Report are as follows, per the IOM: Quarter 1-Oct, Nov, Dec (report due no later than February 28th); Quarter 2- Jan, Feb, Mar (report due no later than May 28th); Quarter 3- April, May, June (report due no later than August 28th); Quarter 4-Jul, Aug, Sep (report due no later than November 28th). |
| Quarterly |
| CM/MCMG/Division of Change and Operations Management (DCOM) CM/MCMG/ DCM; CM/Provider Billing Group (PBG)/Division of Supplier Processing (DSCP) |
| C.5.4.8.3 |
| Successful Implementation of Technical Direction Letters |
| Technical Direction Letter (TDL) Compliance Report (TCR) |
| Describes the Technical Direction Letters (TDLs) that the contractor has implemented in the quarterly period. |
| This information shall be submitted electronically to CR_IMPL_REPORTS@cms.hhs.gov. These deliverables must also be delivered concurrently to the COR in accordance with CMS technical direction regarding the contract deliverable process. |
| The due dates for the TCR are as follows, per the IOM: Quarter 1-Oct, Nov, Dec (report due no later than February 28th); Quarter 2-Jan, Feb, Mar (report due no later than May 28th); Quarter 3-April, May, June (report due no later than August 28th); Quarter 4- Jul, Aug, Sep (report due no later than November 28th). |
| Quarterly |
| CM/MCMG/Division of Change and Operations Management (DCOM) |
| C.5.4.9 |
| Business Continuity Planning and Disaster Recovery |
| Comprehensive Continuity of Operations (COOP) Plan |
| Describes the Contractor’s policies and procedures to ensure that essential business functions continue during a disaster. The COOP plan elements include protection of physical infrastructure, IT disaster recovery, business continuity (with or without system availability), and other topics |
| Contracting Officer's Representative and/or Designees |
| Initial 60 calendar days prior to cutover, thereafter annually as requested by CMS. |
| Once, then Annually |
| CM/MCMG/DMSSOO |
| C.5.4.10.2 |
| Self-Assessment Process for Internal Controls |
| Certification Package for Internal Controls (CPIC) Report |
| Attestation and documentation of the adequacy of the internal controls. |
| Contracting Officer's Representative and/or Designees. CPIC should also be delivered to CMS internalcontrols@cms.hhs.gov. |
| Initial is due within 15 business days after June 30. Update is due 5 business days after September 30. |
| Annually |
| OFM/ Accounting Management Group (AMG)/ Division of Financial Reporting, Policy & Oversight (DFRPO) |
| C.5.4.10.3 |
| Correcting Internal Control Deficiencies – CAP process |
| Corrective Action Plan (CAP) |
| Describes a plan of action to correct weaknesses, findings, gaps, or other deficiencies. |
| Contracting Officer's Representative and/or Designees. CAP reports should also be delivered to CMS CAPS@cms.hhs.gov. |
| Initial CAP reports are due within 45 calendar days of receiving a final audit report or after discovery of a material weakness; thereafter 30 calendar days form quarter end |
| Within 45 calendar days after discovery of material weakness, and quarterly |
| OIS and OFM/AMG/DFRPO |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Position Description for the Compliance Officer and other members of the Compliance Department |
| Contracting Officer's Representative and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually- End of Period of Performance/ Contract Year |
| OAGM |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Code of Conduct |
| Contracting Officer's Representative and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually -End of Period of Performance/ Contract Year |
| OAGM |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Written compliance policies and procedures |
| Contracting Officer's Representative and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually- End of Period of Performance/ Contract Year |
| OAGM |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Compliance training materials used or developed in the last year |
| Contracting Officer's Representative and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually- End of Period of Performance/ Contract Year |
| OAGM |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Names and positions of the Board of Directors and/or Compliance Committee members charged with oversight of the compliance program |
| Contracting Officer's Representative and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually- End of Period of Performance/ Contract Year |
| OAGM |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Charters for the Board and/or Executive Compliance Committees |
| Contracting Officer's Representative and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually- End of Period of Performance/ Contract Year |
| OAGM |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Conflict of interest questionnaire(s) that are completed by employees, managers, officers and Board members |
| Contracting Officer's Representative and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually- End of Period of Performance/ Contract Year |
| OAGM |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Risk assessment protocol(s) developed by the Compliance Department |
| Contracting Officer's Representative and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually- End of Period of Performance/ Contract Year |
| OAGM |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Internal audit plan |
| Contracting Officer's Representative and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually- End of Period of Performance/ Contract Year |
| OAGM |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Any reportable events to CMS (See H.18- Reportable Events) on completed and current CMS contracts |
| Contracting Officer's Representative and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually- End of Period of Performance/ Contract Year |
| OAGM |
| C.5.7.1.7 |
| Provider Service Plan |
| Provider Service Plan (PSP) |
| Describes the strategies, project activities, efforts, and approaches the contractor will use throughout the duration of its contract. |
| Contracting Officer's Representative and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| By the last day of the first month of the first year of the contract. |
| One Time |
| CM/PCG/DCPC |
| C.5.7.1.8 |
| Provider Customer Service Program (PSCP) Activity Report |
| Provider Customer Service Program (PCSP) Activity Report (PAR) |
| Summarizes and recounts the contractor's PCSP activities, process improvements, and best practices during the reporting period. |
| Contracting Officer's Representative and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| First report due on the 30th day after the first 6 months of the contract year; second report due 30 days after the last day of the contract year. |
| Semiannual |
| CM/PCG/DCPC |
| C.5.7.2.1 |
| Telephone Inquiries |
| Disaster Recovery Plan |
| Plan describing how the Medicare provider telecommunications operations will be maintained or continued in event of natural or manmade disaster |
| Contracting Officer's Representative and/or Designees and mailbox ServiceReports@cms.hhs.gov |
| End of third month of contract year |
| Annual |
| CM/PCG/DCPC |
| C.5.7.3.2 |
| Web Technology |
| Website Attestation statement |
| Statement by contractor attesting that CMS contractor website guidelines have been followed in accordance with IOM Pub. 100-9, Chapter 6, Section 50.2.2 |
| Contracting Officer's Representative and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| Within 30 calendar days after cutover; thereafter, by the end of the sixth month of the contract year. |
| Annual |
| CM/PCG/DCPC |
| C.5.7.3.2 |
| Web Technology |
| Website Attestation statement-- Current Procedural Terminology (CPT) usage |
| Statement by contractor attesting whether website adheres to requirements in IOM Pub 100-4, Chapter 23, Section 20.7 |
| Contracting Officer's Representative and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| Within 30 calendar days after cutover; thereafter, by the end of the sixth month of the contract year. |
| Annual |
| CM/PCG/DCPC |
| C.5.8 |
| Claims Processing |
| Social Security Number Removal Initiative (SSNRI) Status Report |
| A status report of the progress of MAC systems and non-systems changes for the SSNRI project, including dates of completion for each task milestone. |
| FFS_SSNRI@cms.hhs.gov with copy to Contracting Officer's Representative |
| Due by the 5th day of each month, August 2017 through April 2018 |
| Monthly |
| CM/MCMG/DCOM |
| C.5.8.2.5 |
| Payment of Claims Outside Common Working File |
| Workload Report for Payment of Claims Outside Common Working File |
| Workload Report for Payment of Claims Outside Common Working File |
| Contracting Officer's Representative and/or Designees |
| Within 20 calendar days of the month end. |
| Monthly |
| CM/MCMG |
| C.5.8.4.4 |
| The Do Not Forward Initiative |
| Do-Not-Forward (DNF) Initiative Report |
| Describes the Medicare checks and payments for professional claims returned or held to the contractor thru the DNF initiative. |
| Contracting Officer's Representative and/or Designees |
| Within 15 calendar days of quarter end |
| Quarterly |
| CM/PBG |
| C.5.10.1.9 |
| Conduct and Notice of the Redetermination |
| Readability Attestation for Beneficiary Appeals Correspondence and/or Medicare Redetermination Notices |
| Contractors are required to attest that they are issuing correspondence that satisfies the readability requirements outlined in the Federal Register. This attestation should include how contractors ensure that this requirement is being met (e.g., software programs, quality reviews, etc.). Additional information regarding the readability requirements is found in IOM 100-04, Chapter 29, Section 290.3, How to Establish Reading Level. |
| Contracting Officer's Representative and/or Designees and CMS Business Owner |
| Within 30 days after cutover, as applicable, and annually, thereafter. |
| Annual |
| CPC/MEAG/DAO |
| C.5.11.2 |
| Banking Relations |
| Copy of Tripartite Agreement |
| Describes the agreement between CMS, the contractor and its bank. |
| Contracting Officer's Representative and/or Designees |
| Upon initiation |
| Once |
| OFM / Financial Services Group (FSG) |
| C.5.11.2.3 |
| Contractor Monthly Bank Reconciliation Worksheet |
| CMBRW |
| Bank reconciliation |
| Contracting Officer's Representative, CMS Business Owner, and mailbox higlasbankrecon@cms.hhs.gov |
| On or before the 15th of the month |
| Monthly |
| OFM/AMG/DFRPO |
| C.5.11.2.3.1 |
| Cash Collection Worksheet |
| Cash Collection Worksheet |
| Reconciles the cash balance |
| Contracting Officer's Representative, CMS Business Owner, and mailbox |
| On the 15th of the month |
| Monthly |
| OFM/AMG/DFRPO |
| C.5.11.2.3.2 |
| Estimated Allowance for Uncollectible Accounts |
| Allowance Matrix |
| Calculates the allowance percentage of receivable |
| Contracting Officer's Representative, CMS Business Owner, and mailbox |
| HIGLAS Contractors: 5 business days after month end |
| HIGLAS Contractors: Monthly |
| OFM/AMG/DFRPO |
| C.5.11.2.4 |
| Letter-of-Credit Limitation |
| Letter of Credit Limitation Change Request |
| Written requests for changes to the monthly letter-of-credit limitation. |
| Contracting Officer's Representative and/or Designees |
| Consistent with frequency |
| As required |
| OFM / Financial Services Group (FSG) |
| C.5.11.3.2.5.2 |
| Audit Plan |
| Audit Plan |
| The audit plan identifies each cost report selected for an audit (in-house or field.) The audit plan lists each provider’s name, provider #, cost reporting period, issues selected for audit, and an explanation as to why the provider was chosen for an audit. |
| Contracting Officer's Representative and/or Designees |
| Initial within 30 calendar days after the cutover date; thereafter within 30 calendar days prior to the annual period end |
| Annually |
| OFM/FSG |
| C.5.11.4.2 |
| Applications for Extended Schedule |
| Extended Repayment Schedule (ERS) Report |
| In Excel format, this report identifies providers who have requested an ERS and identifies those requests that have been approved and denied and pending. |
| Contracting Officer's Representative and/or Designees |
| Within 15 calendar days of quarter end |
| Quarterly |
| OFM / FSG / Division of Medicare Overpayments (DMO) |
| C.5.11.7.1 |
| Unsolicited/Voluntary Refunds |
| Unsolicited/Voluntary Refund Check Summary Report |
| Describes a summary of the unsolicited/voluntary refund checks. |
| Contracting Officer's Representative and/or Designees |
| Upon request |
| Upon Request |
| OFM / Program Integrity Group (PIG) |
| C.5.11.8.1 |
| Administrative Freeze Payments |
| Provider Overpayment Referral Checklist |
| Describes summary of overpayment information for a Provider in bankruptcy. |
| Contracting Officer's Representative and/or Designees |
| Consistent with frequency |
| As required |
| OFM / AMG / DFO |
| C.5.11.8.2 |
| Closed Bankruptcy Case |
| Quarterly Bankruptcy Tracking Report |
| Describes the status of the discharge of bankruptcy proceedings. Builds on the information contained in the summary of detailed underpayment and overpayment information for a Provider in bankruptcy. |
| Contracting Officer's Representative and/or Designees |
| Quarterly |
| As required |
| OFM / AMG / DFO |
| C.5.11.9.1 |
| Accounts Receivable Trend Analyses |
| Accounts Receivable Trend Analysis Reports |
| Describes the results of accounts receivable trend analyses. |
| Contracting Officer's Representative and/or Designees |
| On or before January 22, April 22, July 22, and October 22. (The third and fourth quarter due dates may change due to the accelerated time periods. Medicare contractors will be notified of these changes by a Technical Direction Letter (TDL) |
| Quarterly |
| OFM / AMG / DFRP |
| C.5.12.1 |
| Development of Improper Payment Reduction Strategy (IPRS) |
| IPRS |
| Describes the operational plan for how the contractor will evaluate data and address program vulnerabilities throughout the year. |
See PIM 100-08 Chapter 7.
| Contracting Officer's Representative and/or Designees and in CMS ART. |
| The Initial strategy is due after contract award no less than 30 calendar days prior to first claims cutover date even if there are multiple cutover dates. Thereafter the strategy is due no less than 45 calendar days prior to start of each option year. If a major revision is needed to the MSR, notify the COR and MR BFL to determine if a revised strategy is required. See PIM 100-08 Chapter 7. |
| Annually |
| OFM/ Provider Compliance Group (PCG)/ Division of Medical Review and Education (DMRE) |
| C.5.12.1 |
| Development of Improper Payment Reduction Strategy (IPRS) |
| Strategy Analysis Report (SAR) |
| A once annual update to the MR Strategy Report that describes progress towards goals as defined in the strategy and any changes that need to be made to the strategy. See PIM 100-08 Chapter 7. |
| Contracting Officer's Representative and/or Designees and in CMS ART |
| The SAR is due within 14 calendar days after final cutover date and 7.5 months after option year starts. |
Where the initial SAR and Option year strategy would be due within 60 calendar days of each other the contractor shall inform the Contracting Officer's Representative of this occurrence, to address on a case by case basis.
| C.5.12.1.6.1 |
| Defending Medical Review Decisions at ALJ Hearings-Coordination |
| OMHA Contact Information |
| Level 1 appeals contact information |
| Contracting officer's Representative and Lynnsie.Doty@cms.hhs.gov |
| Shall provide updated contact information via email using the template provided under TDL-150507 if there are changes to any pertinent contact information (e.g., fax numbers, addresses, telephone numbers). Send all emails to the CMS contact, Lynnsie Doty, at Lynnsie.Doty@cms.hhs.gov, and copy the Contracting Officer’s Representatives (CORs). |
| When contact information changes |
| CPC/MEAG/DAO |
| C.5.12.2.19 |
| Monthly Reporting of Medical Review Savings |
| Medical Review Savings Report |
| Financial savings to the Trust Fund that result from performing Medical Review. Calculated as denials minus reversals. See PIM 100-8 Chapter 7. |
| CMS ART |
| Due the 20th day of every month |
| Monthly |
| OFM/PCG/DMRE |
| C.5.13.2 |
| Support of Comprehensive Error Rate Testing |
| Comprehensive Error Rate Testing (CERT) Program: Medicare Administrative Contractor |
Certification
| MACs shall submit a certification that all required information has been completely and accurately entered on the CERT Claims Status website. The MAC's Certifying Official shall sign the certification and submit it to CMS via CMS ART. |
| Contracting Officer's Representative and/or Designees |
| October 15th |
| Annually |
| Office of Financial Management (OFM) / Payment Accuracy & Reporting Group (PARG) |
| C.5.14.2 |
| Electronic Correspondence Referral System Status Inquiries |
| Number of ECRS request submitted to the BCRC |
| Provides the number of MSP prepay ECRS Requests by category (Inquiries and CWF Assistance Requests) sent to the BCRC each month. |
| Contracting Officer's Representative and/or Designees |
| Last business day of the following month |
| Monthly |
| Division of Medicare Secondary Payer Operations (DMPO)-MSP Pre-Pay |
| C.5.14.3 |
| Identification and Adjudication of Medicare Secondary Payer Claims and Application of Benefits and Processing Formula |
| Number of MSP claims processed |
| Provides the number of MSP claims processed during the given month including the number of claims processed, rejected, adjusted and denied. |
| Contracting Officer's Representative and/or Designees |
| Last business day of the following month |
| Monthly |
| OFM/FSG/ Division of Medicare Secondary Payer Operations (DMPO)-MSP Pre-Pay |
| C.5.14.3.3 |
| Medicare Secondary Payer Claims Inquiries |
| The number of inquiries and documentation received and responded to. |
| The number of inquiries and documentation the Contractor responded to from insurers and other interested parties (e.g., attorneys and/or beneficiaries, etc.) on MSP billing requirements to assist with resolving claims inquiries accurately, timely, and responsively. |
| Contracting Officer's Representative and/or Designees |
| Last business day of the following month |
| Monthly |
| OFM/FSG/ Division of Medicare Secondary Payer Operations (DMPO)-MSP Pre-Pay |
| C.5.14.4 |
| Transfer of Documentation and Phone Calls to the Benefits Coordination and Recovery Center |
| Number of phone calls and documentation transferred to the BCRC |
| Number of phone calls and documentation transferred to the BCRC |
| Contracting Officer's Representative and/or Designees |
| Last business day of the following month |
| Monthly |
| OFM/FSG/ Division of Medicare Secondary Payer Operations (DMPO)-MSP Pre-Pay |
| C.5.14.5 |
| Medicare Secondary Payer Hospital Audits |
| Hospital Audit Report |
| Describes the results of hospital audits and reviews for Medicare Secondary Payer hospitals. |
| Contracting Officer's Representative and/or Designees |
| Within 30 calendar days after each hospital audit is completed |
| Annually |
| OFM/FSG/ Division of Medicare Secondary Payer Operations (DMPO)-MSP Pre-Pay |
| C.5.14.6.1 |
| Duplicate Primary Payments |
| Unsolicited/Voluntary MSP Posted Checks Status Report (identifying associated vs. not associated with a known debt) & ECRS entry required vs. NO ECRS needed but NO A/R has been established yet) |
| Provides a listing of all Posted Provider, Physician, or Other Supplier MSP Unsolicited/Voluntary Refund Checks (identifying each entry as (1) associated to a known debt vs. (2) NOT associated to a known debt and ECRS entry required) (3) No ECRS needed But No A/R has been established yet) received by the MAC Contractor |
| Contracting Officer's Representative and/or Designees |
| Last business day of the following month |
| Monthly |
| OFM/FSG/Division of Medicare Secondary Payer Operations (DMPO)-MSP Post-Pay |
| C.5.14.6.2 |
| Inquiries Specific to Debt Collection Efforts for Providers, Physicians, and other Suppliers |
| MSP Pending Correspondence Report |
| Provides a listing of all pending MSP correspondence. |
| Contracting Officer's Representative and/or Designees |
| Last business day of the following month |
| Monthly |
| OFM/FSG/ Division of Medicare Secondary Payer Operations (DMPO) - MSP Post-Pay |
| C.5.14.6.5 |
| Misrouted Benefits Coordination and Recovery Center Medicare Secondary Payer Recovery Checks (Non-GHP checks) and/or Misrouted Commercial Repayment Center MSP Recovery Checks (GHP Checks) |
| Medicare Secondary Payer (MSP) Misrouted Recovery Checks (and Associated Correspondence) (Non-GHP = BCRC and GHP = CRC) |
| Provides a listing of all misrouted MSP - GHP or NON-GHP- checks either transferred to the BCRC for Non-GHP checks only and /or transferred to the Commercial Repayment Center (CRC) for GHP checks only (broken down by where sent - BCRC or CRC). |
| Contracting Officer's Representative and/or Designees |
| Last business day of the following month |
| Monthly |
| OFM/FSG/ Division of Medicare Secondary Payer Operations (DMPO) - MSP Post-Pay |
| C.5.14.6.6 |
| Misrouted Benefits Coordination and Recovery Center MSP Recovery Correspondence (Non-GHP) and/or Misrouted Commercial Repayment Center MSP Recovery Correspondence (GHP) |
| Medicare Secondary Payer (MSP) Misrouted Recovery Correspondence (Non-GHP = BCRC and GHP = CRC) |
| Provides a listing of all misrouted MSP-GHP or Non-GHP-correspondence that was either transferred to the Medicare Secondary Payer Recovery Contractor (MSPRC)-Non-GHP correspondence only and /or either transferred to the Commercial Repayment Center (CRC)-GHP correspondence only (broken down by where sent-MSPRC or CRC). |
| Contracting Officer's Representative and/or Designees |
| Last business day of the following month |
| Monthly |
| OFM/FSG/ Division of Medicare Secondary Payer Operations (DMPO) - MSP Post-Pay |
| C.5.15.2 |
| Review of Comprehensive Outpatient Rehabilitation Facility Billing Records |
| Aberrant Billing Practices Notification |
| Immediate written notification whenever aberrant billing practices are discovered |
| Contracting Officer's Representative and/or Designees |
| Consistent with Frequency |
| As required |
| CMSO/SCG/DCCP |
| C.5.15.3 |
| Review of Inpatient Rehabilitation Facilities and Critical Access Hospitals’ Rehabilitation Distinct Part Units (DPU) |
| Written Report of the Applicable Calculated Compliance Percentage |
| Written report of the applicable calculated compliance percentage attained by the IRF or a provider attempting to be classified as an IRF, within the contractor's jurisdiction. The contractor must determine each IRFs applicable compliance percentage prior to the start of each IRF's next cost reporting period and include the most current information for all IRFs within the contractor's jurisdiction in the written report. |
| Contracting Officer's Representative, CMS Business Owner, and the RO responsible for the geographic area where the IRF is located, and, if appropriate, to the appropriate ROs involved with the administration of the MAC contract. |
| On or before the 15th of each month. |
| Monthly |
| CM/ Chronic Care Policy Group (CCPG)/ Division of Institutional Post Acute Care (DIPC) |
| C.5.18.1 |
| Education Materials |
| Rural Health Clinic (RHC) Education Materials |
| The Contractor is encouraged to use CMS-created national education materials when training RHCs. |
| Contracting Officer's Representative and/or Designees |
| Six weeks prior to the intended use of the education materials |
| As required |
| CM / MCMG/ DMPM |
| C.5.19.1 |
| Education Materials |
| Federally Qualified Health Center Education Materials |
| The Contractor is encouraged to use CMS-created national education materials when training FQHCs. |
| Contracting Officer's Representative and/or Designees |
| Six weeks prior to the intended use of the education materials |
| As required |
| CM / MCMG/ DMPM |
| C.5.23.1 |
| Post-Award Meeting |
| Post-Award Meeting Minutes |
| Describes the results of the Post-Award meeting conducted. |
| Contracting Officer's Representative and/or Designees |
| Within 3 business days of the Post-Award meeting |
| Once |
| CM/MCMG |
| C.5.23.2 |
| Project Management Plan-Implementation Deliverable |
| Project Management Plan |
| Describes the plan for overall management of the program. |
| Contracting Officer's Representative and/or Designees |
| Initial within 30 business days after contract award, updates within 15 calendar days after quarter end |
| Quarterly |
| CM/MCMG |
| C.5.23.4 |
| Monthly Status Report (MSR) |
| Monthly Status Report (MSR) |
| Describes the monthly status of the program through a report. This deliverable is comprised of both the narrative MSR Word document and the Monthly A/B MAC Supplied Data Excel document. Please include in the file name the jurisdiction number, the MAC Name, and the month for which you are reporting. |
| Contracting Officer's Representative and/or Designees |
| Within 20 calendar days after month end. |
| Monthly |
| CM/MCMG |
| C.5.23.5 |
| Ad Hoc Reporting |
| Estimate At Completion (EAC) Report |
| Provides monthly estimate of total contract costs to be expended, by SLIN, and includes the MAC Project Manager's cost estimation of all operational changes/impacts throughout the contract year. The MAC is to use the EAC Report spreadsheet template and accompanying instructions provided by the Contracting Officer at contract modification. |
| Contracting Officer, Contracting Specialist, COR, and designees as determined by the COR |
| Monthly EAC Reports are due into CMS ART no later than 30 calendar days after the end of the reporting month. In addition to submittal to CMS ART, the MAC will send an electronic copy to the CO, CS, COR, and others as directed by the COR. |
| Monthly |
| OAGM/MCMG |
| C.5.23.6 |
| Voucher/Financial Management System |
| Monthly Cost Report |
| Submit a monthly cost report to the CMS ART System in accordance with the work breakdown structure (WBS) schedule instructions. In addition, submit a statement to the Contracting Officer's Representative via the deliverable mailbox indicating that this action has been completed. |
| Contracting Officer's Representative and/or Designees |
| Monthly cost reports are due into CMS ART no later than 30 calendar days after the end of the reporting month |
| Monthly |
| CM/MCMG |
| C.5.23.6 |
| Voucher/Financial Management System |
| Final Estimated Cost Proposal |
| The contractor shall submit the final estimated cost proposal into CMS ART once contract estimated costs have been negotiated, and a subsequent modification has been executed by the CO. For new contract awards, CMS will notify contractors when CMS ART is available for final estimated cost proposal entry and the date that submission is due. With respect to change orders, once the change order has been definitized, the contractor shall submit the final estimated cost proposal into CMS ART. In addition, the contractor shall submit a statement to the Contracting Officer's Representative via the deliverable mailbox indicating that this action has been completed. |
| Contracting Officer's Representative and/or Designees |
| For new contract awards, CMS will notify contractors when CMS ART is available for final estimated cost proposal entry and the date that submission is due. The final estimated cost proposal shall be entered into CMS ART no later than 5 business days after the contract modification has been executed. With respect to change orders, once the change order has been definitized, the contractor shall submit the final estimated cost proposal into CMS ART. In addition, the contractor shall submit a statement to the Contracting Officer's Representative via the deliverable mailbox indicating that this action has been completed. |
| As required |
| CM/MCMG |
| C.5.23.11 |
| Operational Productivity Report (OPR) |
| Operational Productivity Report (OPR) |
| The Contractor shall prepare and upload the OPR into the CMS-ART system. An electronic version in excel form should also be sent via email to the Contracting Officer's Representative (COR) and Contracting Officer (CO)/Contracting Specialist (CS) on the contract. |
| Contracting Officer's Representative, Contracting Officer/Contracting Specialist, and/or Designees |
| Monthly OPRs are due into CMS-ART no later than 30 calendar days after the end of the reporting month |
| Monthly |
| CM/MCMG |
| C.6.1 |
| Joint Operating Agreements |
| Initial Joint Operating Agreement (JOA) |
| The initial JOA defines roles and responsibilities of a mutually agreed upon methods to work with and support CMS’ mission—with each of the following parties: Unified Program Integrity Contractors (UPICs); Qualified Independent Contractors (QICs); Administrative Qualified Independent Contractors (AdQICs); Quality Improvement Organizations (QIOs); Recovery Audit Contractors (RACs); Cost Report Appeals Support Contractor; Benefits Recovery and Coordination Center (BCRC); Commercial Repayment Center (CRC); Call Center Operations (CCO); Virtual Data Center (VDC); and Supplemental Medical Review Contractor (SMRC). |
| Contracting Officer's Representative and/or Designees |
| 30 calendar days prior to cutover |
| Once |
| Office of Acquisitions and Grants Management (OAGM) |
| C.6.1 |
| Joint Operating Agreements |
| Updated Joint Operating Agreement |
| The updated JOA defines any updates to the roles and responsibilities of a mutually agreed upon methods to work with and support CMS’ mission—with each of the following parties: UPICs; Cost Report Appeals Support Contractor; QICs; AdQICs; QIOs; RACs; VDC, CCO, BCRC, CRC and SMRC. |
| Contracting Officer's Representative and/or Designees |
| Consistent with frequency updates: By January 15th, April 15th, July 15th, and October 15th. |
| First Year Quarterly; Subsequent Years Semiannually |
| OAGM |
| C.6.1.1.1 |
| Referrals to Quality Improvement Organization |
| Quality Improvement Organization Referrals |
| Describes the referrals to the QIO for quality of health care determinations. |
| Contracting Officer's Representative and/or Designees |
| Consistent with frequency |
| Every 6 months due January 1 & July 1 |
| Center for Clinical Standards and Quality (CCSQ) |
| C.6.2.1 |
| State Agencies Responsible for Licensing Institutional Providers (e.g., Survey and Certification, Licensing Authorities) |
| Health Insurance Benefits Agreement, Provider-Based Determination, or Other Institutional Provider Information |
| The Health Insurance Benefits Agreement, Provider-Based Determination, or Other Institutional Provider Information is provided in the format requested to state agencies with a copy to CMS. |
| Contracting Officer's Representative and/or Designees |
| Consistent with frequency |
| As required |
| CMSO/SCG/DACS |
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