J.24 Attestations.docx

This attachment (12 total pages including this page) includes the following three attestations:

1. Key Personnel Attestation (6 pages)

2. Security Attestation (1 page)

3. Corporate Experience Attestation and Attachment 1 (2 pages and 2 page Attachment) The Offeror shall agree that each Attestation and any Attachments or addendum documenting exceptions to the Attestations become a part of the Offeror’s proposal and any resultant contract.

Attachment J.24 Attestations

RFP # 75FCMC19R0023

January 10, 2019 Page 1 of 1

Source Selection Information – See FAR 2.101 and 3.104

1. Key Personnel Attestation The Offeror understands and unconditionally assents to the requirements of the Statement of Work (SOW), section C.5.4.1, entitled Key Personnel and attests that its proposal includes individuals in the Key Personnel positions who meet all of the requirements as outlined in the SOW. Specifically, the Offeror attests that each and every individual (named below) proposed for the respective Key Personnel positions of this solicitation possesses all of the minimum work, experience, licensure, and educational requirements applicable to the specific position as reflected in the table below. Further, the Offeror attests that signed letters of commitment for proposed key personnel (indicate the positions below) not currently employed by the Offeror or subcontractor are on file. Any exceptions to this attestation shall be identified and fully explained in an addendum to this attestation.

Project Manager – Section C.5.4.1.1

Insert the name of the proposed individual for this key personnel position and indicate with a check that the candidate meets each of the following requirements of the SOW.

Shall be fully dedicated to the Medicare Administrative Contractor (MAC) contract specified in this Request For Proposal (RFP).

Possesses ten (10) or more years of professional experience with at least three (3) years as a manager responsible for managing complex systems and work flow.

Possesses a bachelor’s degree from an accredited institution.

Holds a master’s degree from a currently accredited institution, or possesses four (4) additional years of related work experience in lieu of the master’s degree.

Claims Processing Manager- Section C.5.4.1.2

Insert the name of the proposed individual for this key personnel position and indicate with a check that the candidate meets each of the following requirements of the SOW.

Shall be fully dedicated to the MAC contract specified in this RFP.

Possesses a minimum of three (3) years prior work experience with Medicare or Medicare-equivalent Fee-for-Service claims processing operations.

Possesses prior experience with both Medicare Part A and Part B claims processing operations.

Chief Financial Officer- Section C.5.4.1.3

Insert the name of the proposed individual for this key personnel position and indicate with a check that the candidate meets each of the following requirements of the SOW.

Shall not be responsible for other external third party or corporate activities.

Shall be dedicated to the Medicare line(s) of business.

Shall report to the highest official of Medicare Operations.

Shall not serve as the Compliance Officer.

Shall be responsible for meeting all the compliance requirements of the Medicare financial operations.

Possesses knowledge of and extensive practical experience in financial management practices in large organizations.

Possesses significant managerial or other practical involvement relating to financial management.

Holds an accounting degree from a four (4) year college or university.

Maintains an active Certified Public Accountant (CPA) license, or meets the eligibility requirements to sit for the CPA examination.

Compliance Officer- Section C.5.4.1.4

Insert the name of the proposed individual for this key personnel position and indicate with a check that the candidate meets each of the following requirements of the SOW.

The Compliance Officer is not required to be fully dedicated to the A/B MAC contract (i.e. the Compliance Officer may be responsible for the Medicare Title XVIII and MAC lines of business, but not responsible for other private business lines or Federal agency contracts).

Possesses a minimum of three (3) years’ experience in compliance or related activities.

Holds a bachelor’s or more advanced degree from an accredited college or university.

Provider Enrollment Manager- Section C.5.4.1.5

Insert the name of the proposed individual for this key personnel position and indicate with a check that the candidate meets each of the following requirements of the SOW.

Possesses a minimum of three (3) or more years’ experience with Medicare Fee-for-Service provider enrollment operations, and shall possess at least five years of prior supervisory/team lead experience in some aspect of Medicare Part A or Part B operations.

Holds a bachelor’s or more advanced degree from an accredited college or university. Work experience may be substituted for the bachelor’s degree with a minimum of ten years of Medicare Part A or B operations work experience.

Chief Information Officer- Section C.5.4.1.6

Insert the name of the proposed individual for this key personnel position and indicate with a check that the candidate meets each of the following requirements of the SOW.

Shall be dedicated to Medicare line(s) of business.

Possesses knowledge of and extensive practical experience in information technology (IT) practices, including security controls in large organizations.

Possesses significant managerial or other practical involvement relating to IT management.

Holds an information technology degree from an accredited four-year college or graduate program, or possesses equivalent experience, preferably as a Chief Information Officer (CIO).

Systems Security Officer- Section C.5.4.1.7

Insert the name of the proposed individual for this key personnel position and indicate with a check that the candidate meets each of the following requirements of the SOW.

Shall be full time and dedicated to Medicare line(s) of business.

Possesses three (3) years practical experience in information technology (IT) systems security policies, procedures and practices to manage security administrative duties in large organizations.

An IT degree from an accredited four-year college/university or equivalent experience. Security accreditations such as the Certified Information Systems Security Professional (CISSP) are highly desirable.

Implementation Project Director- Section C.5.4.1.8

Insert the name of the proposed individual for this key personnel position and indicate with a check that the candidate meets each of the following requirements of the SOW.

The Implementation Project Director must be fully dedicated to the A/B MAC contract specified in this RFP.

The Implementation Project Director’s activities will commence with contract award and continue through the Jurisdiction Operational Start Date until all implementation activities are completed. This position must be fully dedicated until implementation activities are complete.

Possesses a minimum of three (3) years’ experience as a Project Manager, with recent past experience managing Medicare Fee-for-Service workload transitions, systems conversions or a similar type of activity.

Provider Customer Service Program Manager- Section C.5.4.1.9

Insert the name of the proposed individual for this key personnel position and indicate with a check that the candidate meets each of the following requirements of the SOW.

Is not required to be fully dedicated to the A/B MAC contract as specified in this RFP.

Possesses a minimum of two (2) years’ experience as manager of a customer service unit. Preferably the experience will have a focus on the handling of Medicare provider customer inquiries/questions and the education of those customers.

Shall have a bachelor’s degree from a currently accredited college/university and related training in the area of customer service. Work experience may be substituted for the bachelor’s degree with a minimum of four (4) years of work experience required.

Contract Administrator- Section C.5.4.1.10

Insert the name of the proposed individual for this key personnel position and indicate with a check that the candidate meets each of the following requirements of the SOW.

Federal Acquisition Regulation (FAR) knowledge and the experience of applying such knowledge on a daily basis. This knowledge includes, but is not limited to, contract types, negotiating, contract changes/modifications, cost/price analysis, exercising options, conducting subcontract surveillance, managing contract close-out, roles, responsibilities, and authorities of Contractor and Centers for Medicare & Medicaid Services (CMS) personnel, Cost Accounting Standards, contract administration policies and procedures to sufficiently monitor and maintain uniform management controls over performance.

Possesses a bachelor’s degree from an accredited college /university authorized to grant baccalaureate degrees, with at least 24 semester hours in any combination of the following fields: Accounting, business, finance law, contracts, purchasing, economics, industrial management, marketing, quantitative methods or organization and management. In addition, the Contract Administrator shall have direct experience in administering contracts in accordance with the FAR.

Executive Contractor Medical Director (CMD) and Supporting CMDs- Section C.5.4.1.11

Insert the name of the proposed individual for this key personnel position and indicate with a check that the candidate meets each of the following requirements of the SOW.

Possesses prior clinical practice as an attending physician.

Possesses work experience in the health insurance industry, a utilization review firm, or another health care claims processing organization in a role that involved developing coverage or medical necessity policies and guidelines.

Possesses extensive knowledge of the Medicare program, particularly the coverage and payment rules.

Possesses experience working with physician groups, beneficiary organizations, and/or congressional offices (preferred).

Has never been sanctioned or excluded from the Medicare Program.

The CMDs must be a board certified Doctor of Medicine or a Doctor of Osteopathy in a specialty recognized by the American Board of Medical Specialties. The CMDs must have been board certified for at least three (3) years. All clinicians employed or retained as consultants must also be currently licensed to practice medicine in at least one U.S. state, territory, or the District of Columbia. Offeror shall ensure that the CMDs and other physician consultants have active valid and unrestricted licenses.

Audit and Reimbursement Manager/Director- Section C.5.4.1.12

Insert the name of the proposed individual for this key personnel position and indicate with a check that the candidate meets each of the following requirements of the SOW.

Shall be fully dedicated to the A/B Medicare Administrative Contractor (MAC) contract specified in this RFP.

Possesses five (5) or more years of Medicare Cost Report Audit and Reimbursement experience with a minimum of three (3) years as a manager of Medicare Cost Report Audit or Reimbursement.

Possesses a bachelor’s degree from an accredited college/university with a minimum of 24 credit hours in accounting, or a Certified Public Accountant (CPA), and knowledge of Medicare laws, regulations and Government Auditing Standards (GAS). In lieu of education, fifteen (15) or more years of significant management experience in Medicare Audit and Reimbursement.

(Insert Offeror/Company Name) agrees that this Attestation and any attached addendum documenting exceptions to this Attestation will become a part of the organization’s proposal. As an individual with authority to bind the (Insert Offeror/Company Name), I accept responsibility for this written document. Please note, should award be made to the Offeror and any of the information supporting this attestation is found to be inaccurate, repercussions to the Offeror may include but are not limited to the following: the contract may be terminated for default pursuant to FAR 52.249-6(b), the Offeror may be responsible for the government’s procurement costs and/or the Offeror may be suspended or debarred from Government contracting. Offerors are wholly responsible for verifying information provided to them by third parties including but not limited to subcontractors, employees, consultants and/or potential employees, subcontractors and/or consultants.

(Signature)_______________________ (Type full name) (Title) (Company)

January 10, 2019 Page 6 of 6

2. Security Attestation (Insert Offeror/Company Name) understands and unconditionally assents to the conditions and requirements set forth in the Business Partner System Security Manual (IOM 100-17) and section C.5.4.3 of the SOW. Specifically, (Insert Offeror/Company Name) attests to the system security requirements listed in the table below.

Information Security Requirements

1. (Insert Offeror/Company Name) has an Information System Risk Assessment developed in accordance with CMS methodology and/or National Institute of Standards and Technology (NIST) standards that accurately reflects its current environment.

2. (Insert Offeror/Company Name) has a System Security Plan that complies with CMS Methodology listed in section C.5.4.3 of the SOW and/or NIST standards that accurately reflects its current environment.

3. (Insert Offeror/Company Name) is compliant with the Health Insurance Portability and Accountability Act security requirements set forth in 45 Code of federal Regulations (CFR) Parts 160, 162, and 164.

4. (Insert Offeror/Company Name) has a Continuity of Operations (Disaster Recovery/Contingency Plan) developed in accordance with the Business Partner System Security Manual found at https://www.cms.gov/informationsecurity under “Information Security and Privacy Library”.

5. (Insert Offeror/Company Name) has baseline configuration documentation for all platforms that support the Medicare lines of business and has a configuration management program in place that was developed in accordance with NIST standards.

It is agreed upon and understood that the organization’s Attestations and disclosure documents will become a part of the organization’s proposal.

As an individual with authority to bind the (Insert Offeror/Company Name), I accept responsibility for this written document.

(Signature)

(Type full name) Vice President, Medicare Operations

(Signature)

Chief Information Officer

(Signature)

System Security Officer 3.

January 10, 2019 Page 1 of 1 Source Selection Information – See FAR 2.101 and 3.104

4. Corporate Experience Attestation [Insert Offeror (as Prime)/Company Name] understands and unconditionally attests that it has experience working on contracts similar in size and scope to the Part A and Part B MAC contracts either solely through the Offeror’s (as prime) experience, or through the collective experience of the Offeror (as Prime) and its subcontractor(s). Specifically, [Insert Offeror (as Prime)/Company Name] attests to at least one of the following:

· It has processed at least 25,000,000 (25 million) health care claims annually in every year since 2005,

· It has administered at least $1,000,000,000 ($1 billion) in payments for health care services annually in every year since 2005, or

· It has performed outreach activities with at least 20,000 (20 thousand) providers and/or suppliers of health care services annually in every year since 2005.

(Insert Offeror/Company Name) attests that this experience is demonstrated through (check one):

· The experience of the [Insert Offeror (as Prime)/Company Name], which is attested to by its Vice President of Medicare Operations (or equivalent position).

· The collective experience of the [Insert Offeror (as Prime)/Company Name] and its subcontractors, [Insert Subcontractor(s)/Company Name(s)], which is attested to by its Vice President of Medicare Operations (or equivalent position) and the Vice President of Medicare Operations (or equivalent position) of our subcontractor(s).

This experience is demonstrated through the contracts submitted under Appendix A. Please indicate the specific experience within the “description of services provided” for the applicable contracts in Appendix A.

It is agreed upon and understood that the organization’s Attestations and disclosure documents will become a part of the organization’s proposal.

As an individual with authority to bind the (Insert Offeror/Company Name), I accept responsibility for this written document. (If the individual with authority cannot be validated through the organizational charts, resumes, or other documentation submitted with the proposal, please provide a clarifying statement as to the role of the individual within the organization.)

(Signature)

(Type full name) [Insert Offeror (as Prime)/Company Name] Vice President, Medicare Operations (or equivalent position)

(Signature – if required)

(Type full name) [Insert Subcontractor(s)/Company Name(s)] Vice President, Medicare Operations (or equivalent position)

January 10, 2019 Page 2 of 2 Source Selection Information – See FAR 2.101 and 3.104 Corporate Experience Attestation - Attachment 1 The contracts listed below represent [Insert Offeror (as Prime)/Company Name]’s experience in performing requirements similar to those listed in the A/B MAC statement of work (see Attachment J.01).

1. Contract Name and Number

Person-hours of effort:

2. Contract Name and Number

Person-hours of effort:

3. Contract Name and Number

Person-hours of effort:

4. Contract Name and Number

Person-hours of effort:

5. Contract Name and Number

Person-hours of effort:

Check if applicable:

· A completed Attachment 1 is also submitted under a separately sealed package for our subcontractor(s), [Insert Subcontractor(s)/Company Name(s)].

January 10, 2019 Page 2 of 2