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Attachment J.2 DME MAC Deliverable Schedule
RFP # 75FCMC19R0041
Jurisdiction C V.12.0
| Item Number |
| Business Function Area |
| Deliverable |
| Description |
| Delivered To |
| Frequency |
| Statement of Work Section |
| 01-01 |
| Appeals |
| Appeals Annual Report |
| Based on circumstances during the year, advise CMS of instances where revisions to the appeals portion of the IOM could result in improvements or efficiencies to the appeals process. |
| Contracting Officer's Representative and/or designees |
| Annually, due by September 30. |
| Program Management - D.2.5 |
| 01-03 |
| Appeals |
| 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 |
| Annual--Within 30 days after cutover, as applicable, and annually, thereafter. |
| Program Management - D.2.1.2 and G.13 |
| 01-04 |
| Appeals |
| DME MAC Activities in Support of the DME QIC Demonstration Report |
| Contractors shall submit a monthly report including information and data regarding provider/supplier education activities and effectuation activities resulting from or related to the DME QIC formal discussions demonstration. |
| Contracting Officer's Representative and/or Designees and CMS Business Owner |
| Report due on the 20th of each month. |
| C.7.3. DME QIC Demo SOW |
| 01-05 |
| Appeals |
| Establish Joint Operating Agreement (JOA) with the QDEC |
| Establish a JOA with the QIC Demonstration Evaluation Contractor (QDEC) within 60 days of CMS notice of award of the QDEC. |
| Contracting Officer's Representative and/or Designees and CMS Business Owner |
| 60 calendar days after notice of award of the QDEC |
| C.7.3. DME QIC Demo SOW |
| 03-01 |
| Claims Processing |
| Problem Logs |
| Problem logs--In addition to established reporting, report all priority 1 problems immediately to the Contracting Officer's Representative |
| Contracting Officer's Representative and/or designees |
| As required. |
| Program Management - D.1.2.3. |
| 03-02 |
| Claims Processing |
| 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. |
| Reporting Requirements G.6 |
| 03-03 |
| 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 |
| D.1 Bills/Claims Payment |
| 04-01 |
| VDC |
| Joint Operating Agreement (JOA) with the Virtual Data Center (VDC) |
| The contractor shall submit a copy of the final JOA to CMS. |
| Contracting Officer's Representative and/or designees |
| Final JOA due 30 calendar days from the implementation kickoff meeting. Updates due annually on contract operational start date. |
| Interface Requirements - F.2.7 |
| 05-01 |
| Financial Management |
| (1) Overpayment Refund Form (2) Unsolicited/Voluntary Refund Checks Summary |
| (1) Overpayment Refund Form-required information needed to research (2) Unsolicited/Voluntary Refund Checks Summary-reporting requirements refund checks |
| Contracting Officer's Representative and/or designees |
| Upon Request. |
| General Contract Requirements -C.5.6.1. |
| 05-02 |
| Financial Management |
| 1522 Reconciliation (Funds Expended Reconciliation) |
| Monthly reconciliation with claims tape activity. This information shall be submitted electronically to 1522recon@cms.hhs.gov. These deliverables must also be delivered concurrently to the Contracting Officer's Representative in accordance with CMS technical direction regarding the contract deliverable process. |
| Contracting Officer's Representative and/or designees |
| 15th of each month (June and September reconciliations due per TDL). |
| General Contract Requirements - C.5.2.3. |
| 05-03 |
| Financial Management |
| Monthly Cash Collections Worksheet |
| Monthly reporting of cash deposited in the Medicare Trust Funds. This information shall be submitted to CashCollections@cms.hhs.gov. This deliverables must also be delivered concurrently to the Contracting Officer's Representative in accordance with CMS technical direction regarding the contract deliverable process. |
| Contracting Officer's Representative and/or designees |
| 15th of each month (September worksheet due per TDL). |
| General Contract Requirements - C.5.2.3. |
| 05-04 |
| Financial Management |
| Accounts Receivable Transmittal Document |
| Accounts Receivable Transmittal document that identifies the major categories (separating non-MSP and MSP) |
| Contracting Officer's Representative and/or designees |
| Due once, 10 calendar days after the date of transfer. |
| General Contract Requirements - C.1.1.7 and C.1.2.4. |
| 05-05 |
| Financial Management |
| Allowance Matrix |
| Allowance for Uncollectible Accounts Matrix. This information shall be submitted electronically to allowmatrix@cms.hhs.gov. These deliverables must also be delivered concurrently to the Contracting Officer's Representative in accordance with CMS technical direction regarding the contract deliverable process. |
| Contracting Officer's Representative and/or designees |
| Semi-annual April 21/Oct 21. |
| General Contract Requirements - C.5.8. |
| 05-06 |
| Financial Management |
| Certification Packages for Internal Controls (CPIC) |
| Certification Packages for Internal Controls. This information shall be submitted electronically to internalcontrols@cms.hhs.gov. These deliverables must also be delivered concurrently to the Contracting Officer's Representative in accordance with CMS technical direction regarding the contract deliverable process. |
| Contracting Officer's Representative and/or designees |
| Due 15 business days after June 30th (for period October 1-June 30). Update due 5 business days after September 30th (for period July 1-September 30). |
| General Contract Requirements - C.3.3.2. |
| 05-07 |
| Financial Management |
| Currently Not Collectible (CNC) Reports |
| Report of all receivables requested for CNC Approval |
| Contracting Officer's Representative and/or designees |
| Quarterly (Nov. 1, Feb.1, May 1, Aug. 1). |
| General Contract Requirements - C.5.8. |
| 05-08 |
| Financial Management |
| Corrective Action Plans (CAP) |
| Initial and quarterly Corrective Action Plan reports. This information shall be submitted electronically to CAPS@cms.hhs.gov. These deliverables must also be delivered concurrently to the Contracting Officer's Representative in accordance with CMS technical direction regarding the contract deliverable process. |
| Contracting Officer's Representative and/or designees |
| Initial CAP report is due 45 days after receiving final audit report. Quarterly CAP Reports due on or before Jan. 30, Apr. 30, Jul 30, and Oct.30. |
| General Contract Requirements - C.5.1.3. |
| 05-09 |
| Financial Management |
| Corrective Action Plans |
| Corrective Action Plans are required for findings found in Section I of the SSAE-18 report and shall be submitted electronically to CAPS@cms.hhs.gov. Initial and quarterly CAP reports must also be delivered concurrently to the Contracting Officer's Representative in accordance with CMS technical direction regarding the contract deliverable process. |
| Contracting Officer's Representative and/or designees |
| Initial CAP report is due 45 days after receiving final SSAE-18 report. Quarterly CAP Reports due on or before Jan. 30, Apr. 30, Jul 30, and Oct.30. |
| General Contract Requirements - C.3.3.3. |
| 05-11 |
| Non-MSP Debt Management |
| Extended Repayment Schedule (ERS) Report |
| Quarterly report detailing all ERS requests -- Detailing denials, approvals, and pending requests in accordance to Publication 100.06, Chapter 4 Section 50. |
| Contracting Officer's Representative and/or designees |
| Due on the 30th of the month after the end of the quarter (April 30th, July 30th, October 30th, January 30th). |
| General Contract Requirements - C.5.4.2. |
| 05-14 |
| Financial Management |
| Letter-of-Credit Limitation Change Request |
| Written requests for changes to monthly letter-of-credit-limitation. |
| Contracting Officer's Representative and/or designees |
| As required consistent with frequency. |
| General Contract Requirements - C.5.2.4. |
| 05-16 |
| Financial Management |
| Accounts Receivable Trend Analysis |
| Quarterly trend analysis. |
| Contracting Officer's Representative and/or designees |
| Quarterly on Jan. 22, Apr. 22, Jul. 22, and Oct. 22 (3rd and 4th qtr. due dates could change due to accelerated time periods via a TDL) |
| General Contract Requirements - C.5.8.1. |
| 05-17 |
| Financial Management |
| Bankruptcy Data |
| Detailed underpayment and overpayment data. |
| Contracting Officer's Representative and/or designees |
| Upon notification of provider bankruptcy. |
| General Contract Requirements - C.5.7.1 and C.5.7.2. |
| 05-18 |
| Financial Management |
| Copy of Tripartite Agreement |
| Describes the agreement between CMS, the Contractor, and its Bank |
| Contracting Officer's Representative and/or designees |
| Once: Upon initiation of new banking contract (within 1st month of contract award) |
| General Contract Requirements - C.5.2 |
| 05-19 |
| Financial Management |
| Bank Account Analysis |
| Bank Processing Charges (Schedule of Itemized Bank Services Provided Report) |
| Contracting Officer's Representative and/or designees |
| Monthly; within 15 calendar days after the end of each month in Excel to Banking2009@cms.hhs.gov |
| General Contract Requirements - C.5.2.1 |
| 05-20 |
| Financial Management |
| Bank Account Analysis |
| List of Daily Closing Bank Balances (Recap of Daily Available Balances) |
| Contracting Officer's Representative and/or designees |
| Monthly; within 15 calendar days after the end of each month in Excel to Banking2009@cms.hhs.gov |
| General Contract Requirements- C.5.2.1 |
| 05-21 |
| Financial Management |
| 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 |
| Annually, October 15th |
| E. MEDICARE INTEGRITY PROGRAM (MIP) –E.1 |
| 07-01 |
| Medical Review |
| Improper Payment Reduction Strategy |
| Describes the operational plan for how the contractor will evaluate data and vulnerabilities throughout the year. Details for this report are found in the PIM 100-08 Chapter 7. |
| Contracting Officer's Representative and/or designees, and CMS ART |
| The initial strategy is due after contract award and no later than 30 calendar days prior to the first claims cutover date, even if there are multiple cutover dates. Thereafter, the strategy is due no less than 45 calendar days prior to the start of each Option Year. If a major revision is needed to the IPRS, notify the COR and MR BFL to determine if an additional strategy is required. See PIM 100-08 Chapter 7. |
| Medicare Program Integrity Requirements E.4. |
| 07-02 |
| Medical Review |
| Strategy Analysis Report (SAR) |
| An 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. Details for this report are found in the PIM 100-08 Chapter 7. |
| Contracting Officer's Representative and/or designees, and CMS ART |
| The SAR is due within 60 calendar days after the final cutover date, and annually 7.5 months after the start of each subsequent Option Year. Where the initial SAR and Option Year strategy would be due within 60 days of each other, the contractor shall inform the Contracting Officer’s Representative of this occurrence to address on a case by case basis. |
| Medicare Program Integrity Requirements E.4. |
| 07-03 |
| Medical Review |
| Monthly Status Report |
| Monthly status report shall outline all work accomplished related to the prior authorization of PMD demonstration, including status of the prior authorization request reviews. Any problems or issues related to the demonstration shall be documented and reported to the COR/MR BFL via CMS ART. |
| Contracting Officer's Representative and MR BFL |
| First report due 30 days after start of the demonstration; on the 20th of each month thereafter. |
| PA Demo SOW |
| 07-04 |
| Medical Review |
| Ad-hoc Reports |
| Ad hoc reports as requested by CMS shall be reported to COR/MR BFL via CMS ART. |
| Contracting Officer's Representative and MR BFL |
| As requested |
| PA Demo SOW |
| 07-06 |
| Medical Review |
| Yearly report |
| The contractor shall submit a yearly report that summarizes the PA activity and workload for the previous period of performance. In addition, any outstanding problems or issues related to the demonstration shall be documented and reported. The report is to be submitted to CMS ART 30 days after the end of each year of demonstration. |
| Contracting Officer's Representative and MR BFL |
| Annually, October 1st. |
| PA Demo SOW |
| 07-07 |
| Medical Review |
| Final Report |
| The Final Report shall be submitted to the COR/MR BFL via CMS ART following completion of the six year demonstration. Report elements shall include, but not be limited to: Identify problems and findings; lessons learned; strengths and weaknesses; potential innovations based on outcomes; other significant information and final summary; and return on investment. If an incumbent DME MAC transitions out of their current jurisdiction prior to the end of the demonstration (August 2018), the outgoing contractor shall submit a final report for all activity related to the demonstration through the end of their period of performance, to both CMS and the incoming contractor. The incoming contractor shall incorporate this information into its final report for the jurisdiction at the end of the demonstration. |
| Contracting Officer's Representative and MR BFL |
| Due no later than 30 days after the completion of the six years of the demonstration. |
| PA Demo SOW |
| 07-08 |
| Medical Review |
| MR Savings Report |
| Financial savings to the Trust Fund that result from performing Medical Review. Calculated as denials minus reversals, shall be submitted to CMS ART. |
| Contracting Officer's Representative and MR BFL |
| Report due on the 20th of each month. |
| Medicare Program Integrity Requirements E.4.7.21. |
| 07-09 |
| Medical Review |
| IRR Summary |
| The contractor shall submit quarterly IRR Summary Report to the COR/MR BFL via CMS ART. The summary shall be a joint/combined report indicating 1) the percentage of consensus among the DME MACs and decision for each prior authorization request review, and 2) whether CMS should consider issuing a directive to clarify an issue that would lead to greater consensus. |
| Contracting Officer's Representative and MR BFL |
| Report is due quarterly January, April, July and October on the 20th of each month. |
| PA Demo SOW |
| 07-10 |
| Medical Review CPC/MEAG/DAO |
| OMHA Contact Information |
| Level 1 appeals contact information. The Contractor shall ensure that CMS has the most up-to-date contact information for Level 1 appeal in order to support the successful coordination of the appeals process with Levels 2, 3, and 4. The contractor shall provide updated information via email using the template provided under TDL-150507 if there are changes to any pertinent contact information (e.g., fax numbers, addresses and telephone numbers). Send all emails to the CMS contact, Lynnsie Doty at Lynnsie.Doty@cms.hhs.gov and copy the Contract Officer's Representative. |
| Contracting Officer's Representative and Lynnsie.Doty@cms.hhs.gov |
| Due when contact information changes. |
| Defending Medical Review Decisions at ALJ Hearings- Coordination E.4.12.1. |
| 07-11 |
| Medical Review |
| Prior Authorization of Certain DMEPOS Items Activity Reporting |
| The Contractor will report all activities and metrics related to the prior authorization program for certain DMEPOS items. The content and format of this report will be determined by CMS, and shall be submitted to CMS ART. |
| Contracting Officer's Representative and MR BFL |
| Report due on the 20th of each month. |
| Medicare Program Integrity Requirements E.4.7.23 |
| 07-12 |
| Medical Review |
| Prior Authorization of Certain DMEPOS Items Activity Reporting |
| The Contractor will report all activities and metrics related to the prior authorization program for certain DMEPOS items. The content and format of this report will be determined by CMS, and shall be submitted to CMS ART. |
| Contracting Officer's Representative and MR BFL |
| A summary report due on November 30 of each year for the previous fiscal year. |
| Medicare Program Integrity Requirements E.4.7.23 |
| 08-01 |
| MCMG |
| Monthly Status Report |
| Describes the monthly status of the program through a report. This deliverable is comprised of both the narrative Monthly Status Report Word document and the Monthly Status Report Excel (MSRE) 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 |
| Report due on the 20th of every month for the preceding month’s activities. |
| General Contract Requirements - C.6.2. |
| 08-02 |
| MCMG |
| Quality Control Plan |
| Specifies the procedures and resources applied to ensure services meet contract performance requirements. |
| Contracting Officer, Contracting Officer's Representative and/or designees |
| 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. |
| Quality Assurance Requirements - H.1. |
| 08-03 |
| MCMG |
| Ad Hoc Reports |
| The Contractor shall prepare and submit ad hoc reports as directed by the Contracting Officer's Representative and/or designees. The content and format of these reports will be determined by the Contracting Officer's Representative and/or designees. |
| Contracting Officer's Representative and/or designees |
| As needed. |
| General Contract Requirements - C.6.4. |
| 08-04 |
| MCMG |
| Final, signed updated or revised JOA |
| The contractor shall submit an electronic copy of the final, signed updated or revised JOA with the Unified Program Integrity Contractor (UPIC); Qualified Independent Contractor (QIC); Recovery Audit Contractor (RAC); 1-800-Medicare/Contact Center Operations (CCO); Pricing, Data Analysis and Coding (PDAC); Common Electronic Data Interchange (CEDI); the National Supplier Clearinghouse (NSC), the Commercial Repayment Center (CRC), the Benefits Coordination and Recovery Center (BCRC), and the Supplemental Medical Review Contractor (SMRC). |
| Contracting Officer's Representative and/or designees |
| For the first year, quarterly by January 15th, April 15th, July 15th and October 15th. In subsequent years, semi-annually by January 15th and July 15th. If there are no updates or revisions, submit a statement indicating that there are no changes to the current JOA. JOAs should be updated and submitted at least annually. |
| Interface Requirements F.1.1 |
| 08-05 |
| MCMG |
| 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. |
| CMS Reporting Requirements - G.3. |
| 08-06 |
| MCMG |
| 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 the 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. |
CMS Reporting Requirements - G.3.
| 08-07 |
| MCMG |
| CR Implementation Reports |
| Quarterly CR Implementation Reports. This information shall be submitted electronically to CR_IMPL_REPORTS@cms.hhs.gov. These deliverables must also be delivered concurrently to the Contracting Officer's Representative in accordance with CMS technical direction regarding the contract deliverable process. |
| Contracting Officer's Representative and/or designees |
| Quarterly; due February 28th for Quarter 1 (Oct, Nov, Dec); May 28th for Quarter 2 (Jan, Feb, Mar); August 28th for Quarter 3 (Apr, May, Jun); November 28th for Quarter 4 (Jul, Aug, Sep). |
| General Contract Requirements C.4.1.3 |
| 08-08 |
| MCMG |
| Payment of Claims Outside of Common Working File |
| Workload report for payment of claims outside Common Working File (CWF) |
| Contracting Officer's Representative and/or designees |
| Report due on the 20th of each month. |
| Program Management D.1.2.6.3. |
| 08-09 |
| MCMG |
| Final Proposal Revision Business Proposal Reporting |
| Upon award, awardee shall submit Attachments J-10 and J-11, in their entirety, into CMS ART System |
| Contracting Officer's Representative and/or designees |
| One time: Business Proposal due into the CMS ART System no later than five (5) days after contract award |
| N/A |
| 08-10 |
| MCMG/OAGM |
| 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. MAC is to use the EAC Report spreadsheet template and accompanying instructions provided by the Contracting Officer at contract modification. Submit report into CMS ART and send electronic copy to the CO, CS, COR and others as directed by the COR. |
| Contracting Officer, Contracting Officer Representative, Contracting Specialist and/or designees |
| Monthly EAC Reports are due to CMS ART no later than 30 calendar days after the end of the reporting month. |
| C.6.4. Ad Hoc Reporting |
| 08-11 |
| MCMG |
| 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 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). |
| General Contract Requirements C.4.1.3 |
| 08-12 |
| MCMG/OAGM |
| 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 |
| C.6.5. Operational Productivity Report |
| 09-01 |
| OSORA--Files Maintenance |
| Annual Report of Medicare Records |
| Annual Report of Medicare Records reporting the previous year's holdings. Due to CMS in accordance with IOM Pub 100-1, Chapter 7, Section 30.6 This information shall be submitted to the CMS resource mailbox at Records_Retention@cms.hhs.gov. These deliverables must also be delivered concurrently to the Contracting Officer's Representative in accordance with CMS technical direction regarding the contract deliverable process. |
| Contracting Officer's Representative and/or designees |
| Due Annually, no later than September 30th. |
| Section H - Special Contract Requirements, H.19 Record Retention. |
| 10-01 |
| POE |
| Provider/Service Plan (PSP) |
| Describes the strategies, project activities, efforts, and approaches the contractor will use throughout the duration of its contract. |
| COR 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) |
| Program Management - D.5.1.7. |
| 10-02 |
| POE |
| 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. |
| COR and/or Designees and mailbox ProviderServices@cms.hhs.gov. |
| Semi-annually, the first report due on the 30th calendar day after the first six months of the contract year; second report due 30 calendar days after the last day of the contract year. If the contract period is six months or less, the contractor should only submit one report 30 calendar days after the last day of the contract period. |
| Program Management - D.5.1.8 |
| 10-03 |
| POE |
| Website Attestation Statement - website guidelines |
| Statement by contractor attesting that CMS contractor website guidelines have been followed in accordance with IOM Pub. 100-09, Chapter 6, Section 50. |
| COR and/or Designees and mailbox ProviderServices@cms.hhs.gov. |
| Annual - Within 30 calendar days after cutover; thereafter, by the end of the sixth month of the contract year. |
| Program Management - D.5.3 |
| 10-06 |
| POE |
| Website Attestation Statement - guidance on Current Procedural Terminology (CPT) usage |
| Statement by contractor attesting CMS contractor website compliance with IOM Pub. 100-04, Chapter 23, Section 20.7. |
| COR and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| Annual. Within 30 calendar days after cutover; thereafter, by the end of the sixth month of the contract year. |
| Program Management - D.5.3 |
| 11-01 |
| Provider Inquiries -- Telephone |
| Disaster Recovery Plan |
| Plan describing how the Medicare provider telecommunications operations will be maintained or continued in the event of a natural or manmade disaster. |
| COR and/or Designees and mailbox ServiceReports@cms.hhs.gov. |
| End of third month of contract year. (Annual) |
| Program Management - D.5.2. |
| 12-01 |
| Systems Security |
| Plan of Actions and Milestones |
| Submit a monthly Plan of Actions and Milestones (POA&M) to the Division of Performance Assessment in accordance with the BPSSM instructions. In addition, submit a statement to the Contracting Officer's Representative via the deliverable mailbox indicating that this action has been completed. Include the date of your submission and the mail delivery tracking number. The annual FISMA evaluation is submitted as a part of the May POA&M deliverable submission. |
| Contracting Officer's Representative and/or designees |
| Monthly- 1st of each month or as requested by CMS (Corrective Action Plans for findings identified in Section 912 Evaluations must be remediated prior to making payments). In accordance with BPSSM or as requested by CMS. |
| General Contract Requirements - C.3 4.1.2. |
| 12-02 |
| Systems Security |
| Incident Reporting and Response Report |
| Incident Reporting and Response (See BPSSM Table 3.1 Planning Table, for 3.6) All reportable incidents and any incident follow up activity must be reported to the Contracting Officer's Representative. Submit a statement monthly indicating whether or not any reportable incidents have occurred during the previous month. |
| Contracting Officer's Representative and/or designees |
| As required by CMS Incident Handling and Breach Notification Handbook RMH vol. 111 7-1 Incidents involving individual identifiable information must be reported within one hour of occurrence. |
| General Contract Requirements - C.3.1.1. |
| 12-03 |
| Systems Security |
| System Security Information Technology Systems Contingency Plan Report (Disaster Recovery) and Tests of the Contingency Plan |
| Information Technology Systems Contingency Plan to be developed in accordance with IOM Pub 100-17 (See BPSSM Table 3.1 Planning Table, for 3.4) and Federal Preparedness Circular 65. |
| Contracting Officer's Representative and/or designees |
| Annually, 90 days prior to operational start date and annually thereafter or when a significant change occurs within the IT environment. |
| General Contract Requirements - C.3.1.1. |
| 12-04 |
| Systems 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. |
| General Contract Requirements - C.3.1.1. |
| 12-05 |
| Systems Security |
| Risk Assessment Report |
| Risk Assessment (See BPSSM Table 3.1 Planning Table, for 3.2) |
| Contracting Officer's Representative and/or designees |
| Annually, 90 days prior to operational start date and annually thereafter or when a significant change occurs within the IT environment. |
| General Contract Requirements - C.3.1.1. |
| 12-06 |
| Systems 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 |
| 90 days prior to operational start date under the contract and annually thereafter or when a significant change occurs in the IT environment. |
| General Contract Requirements - C.3.1.1. |
| 13-01 |
| Implementation |
| Communication Plan |
| Identifies the processes and procedures the Contractor shall follow to ensure that all transition stakeholders are informed of the transition, its status and progress, and how changes may affect them. |
| Contracting Officer's Representative and/or designees |
| As prescribed by the RFP or directed by CMS. Baseline due within 30 calendar days of contract award. |
| General Contract Requirements - C.1.1.4. |
| 13-02 |
| Implementation |
| Cutover Plan |
| Identifies the daily, to the hour, processes and procedures the contractor shall follow during the cutover period to ensure a successful cutover. |
| Contracting Officer's Representative and/or designees |
| Submitted at least 45 days before the CMS agreed upon cutover date. |
| General Contract Requirements - C.1.1.2. |
| 13-03 |
| Implementation |
| Jurisdiction Implementation Project Plan |
| A detailed description of the activities required to transfer the appropriate DME regional workload to the DME MAC. Subject to CMS approval. |
| Contracting Officer's Representative and/or designees |
| As prescribed by the RFP or directed by CMS. Baseline due within 30 calendar days of jurisdiction kickoff meeting. |
| General Contract Requirements - C.1.1.1. |
| 13-04 |
| Implementation |
| Implementation Risk Management Plan |
| Identifies the risks associated with the implementation and mitigation and contingency planning where appropriate. |
| Contracting Officer's Representative and/or designees |
| As prescribed by the RFP or directed by CMS. Baseline due within 30 calendar days of jurisdiction kickoff meeting. |
| General Contract Requirements - C.1.1.3 |
| 14-01 |
| Closeout |
| Closeout Project Plan |
| Provides detailed tasks reflecting the activities necessary for the contractor to provide all Medicare data, records, and information to the incoming contractor, and to maintain operational standards during the transition. Coordinated with the incoming contractor's implementation project plan. |
| Contracting Officer's Representative and/or designees |
| Due within 15 days of the jurisdiction kickoff meeting. |
| General Contract Requirements - C.1.2.1. |
| 14-02 |
| Closeout |
| 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 |
| Due within 30 days of jurisdiction kickoff meeting. |
| General Contract Requirements - C.1.2.3. |
| 15-01 |
| OAGM |
| Annual Conflict of Interest Certification Audit |
| Conflict of Interest Certificate |
| Contracting Officer (CO) |
| Annually, on the anniversary date that the contract became fully operational |
| N/A |
| 15-02 |
| OAGM |
| Final Indirect Cost Rate Proposal |
| Incurred Cost Proposal of Contractor Fiscal Year costs |
| CO and Director, Division of Financial Advisory Services, Office of Acquisition Management and Policy, National Institutes of Health, 6100 Building, Room 6, 6100 Executive Blvd. MSC-7540, Bethesda, MD. 20892-7540 |
| Annually, 6 Months Following End of Contractor’s Fiscal Year |
| N/A |
| 15-03 |
| OAGM |
| Contractor Performance Evaluation Self-Assessment |
| Contractor provides self-assessment of performance during Award Fee Evaluation period based on Award Fee Plan |
| CO and COR |
| As required, Within 30 days of completion of the award fee evaluation period |
| N/A |
| 15-04 |
| OAGM |
| Semi-Annual Individual Subcontracting Report (ISR) |
| Report all subcontract awards to small, small disadvantaged, women-owned, HUBZones, veteran-owned and service-disabled veteran-owned small business concerns using eSRS for the period October 1 through March 31 |
| Via the internet at www.esrs.gov to the CO |
| Annually, within 30 days after end of reporting period |
| N/A |
| 15-05 |
| OAGM |
| Annual Individual Subcontracting Report (ISR) |
| Report all subcontract awards to small, small disadvantaged, women-owned, HUBZones, veteran-owned and service-disabled veteran-owned small business concerns using eSRS for the period April 1 through September 30 |
| Via the internet at www.esrs.gov to the CO |
| Annually, within 30 days after end of reporting period |
| N/A |
| 15-06 |
| OAGM |
| Annual Summary Subcontract Report (SSR) |
| Report all subcontract awards to small, small disadvantaged, women-owned, HUBZones, veteran-owned and service-disabled veteran-owned small business concerns using eSRS for the period October 1 through September 30 |
| Via the internet at www.esrs.gov to the CO |
| Annually, within 30 days after end of reporting period |
| N/A |
| 15-07 |
| OAGM |
| Inventory of Accountable Government Property |
| Inventory of Accountable government property items acquired, furnished, rented and/or leased under the contract for period ending September 30 |
| CO and Government Contract Property Administrator |
| Annually, October 31 |
| N/A |
| 15-08 |
| OAGM |
| Compliance Documents |
| Position Description for the Compliance Officer and other members of the Compliance Department |
| Contracting Officer's Representative and/or designees |
| Annually (end of the period of performance/contract year) and only when changes to previous submission have been implemented. |
| N/A |
| 15-09 |
| OAGM |
| Compliance Documents |
| Code of Conduct |
| Contracting Officer's Representative and/or designees |
| Annually (end of the period of performance/contract year) and only when changes to previous submission have been implemented. |
| N/A |
| 15-10 |
| OAGM |
| Compliance Documents |
| Written compliance policies and procedures |
| Contracting Officer's Representative and/or designees |
| Annually (end of the period of performance/contract year) and only when changes to previous submission have been implemented. |
| N/A |
| 15-11 |
| OAGM |
| Compliance Documents |
| Compliance training materials used or developed in the last year |
| Contracting Officer's Representative and/or designees |
| Annually (end of the period of performance/contract year) and only when changes to previous submission have been implemented. |
| N/A |
| 15-12 |
| OAGM |
| 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 |
| Annually (end of the period of performance/contract year) and only when changes to previous submission have been implemented. |
| N/A |
| 15-13 |
| OAGM |
| Compliance Documents |
| Charters for the Board and/or Executive Compliance Committees. |
| Contracting Officer's Representative and/or designees |
| Annually (end of the period of performance/contract year) and only when changes to previous submission have been implemented. |
| N/A |
| 15-14 |
| OAGM |
| Compliance Documents |
| Conflict of interest questionnaire(s) that are completed by employees, managers, officers and Board members |
| Contracting Officer's Representative and/or designees |
| Annually (end of the period of performance/contract year) and only when changes to previous submission have been implemented. |
| N/A |
| 15-15 |
| OAGM |
| Compliance Documents |
| Risk assessment protocol(s) developed by the Compliance Department |
| Contracting Officer's Representative and/or designees |
| Annually (end of the period of performance/contract year) and only when changes to previous submission have been implemented. |
| N/A |
| 15-16 |
| OAGM |
| Compliance Documents |
| Internal audit plan |
| Contracting Officer's Representative and/or designees |
| Annually (end of the period of performance/contract year) and only when changes to previous submission have been implemented. |
| N/A |
| 15-17 |
| OAGM |
| 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 |
| Annually (end of the period of performance/contract year) and only when changes to previous submission have been implemented. |
| N/A |
| 17-01 |
| MSP |
| 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 |
| Due Monthly by the 15th |
| Electronic Correspondence Referral System (ECRS) Status Inquiries E.3.3.3 |
| 17-02 |
| MSP |
| The number of inquiries and documentation received and responded to. |
| The number of inquiries and documentation (correspondence) 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 |
| Due Monthly by the 15th |
| MSP Claims Inquiries E.3.1.4.3 |
| 17-03 |
| MSP |
| 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 |
| Due Monthly by the 15th |
| Transference of Documentation and Phone Calls to the BCRC E.3.1.4.4 |
| 17-04 |
| MSP |
| Duplicate Primary Payments |
| Provides a listing of all Posted 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 |
| Due by the 15th of each month for the preceding month's activities |
| Supplier Duplicate Primary Payments E.3.2.1 |
| 17-05 |
| MSP |
| 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 and correspondence 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 |
| Due by the 15th of each month for the preceding month's activities |
| Misrouted BCRC MSP Recovery Checks (Non-GHP checks) and/or Misrouted CRC MSP Recovery Checks (GHP checks) E.3.2.2 |
| 17-06 |
| MSP |
| 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 Benefits Coordination & Recovery Contractor (BCRC) - Non-GHP correspondence only and/or either transferred to the Commercial Repayment Center (CRC) - GHP correspondence only (broken down by where sent - BCRC or CRC). |
| Contracting Officer's Representative and/or Designees |
| Due by the 15th of each month for the preceding month's activities |
| Misrouted BCRC MSP Recovery Correspondence (non-GHP) and/or Misrouted CRC MSP Recovery Correspondence (GHP) E.3.2.3 |
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