75FCMC19R0042_PPI_MEDIC.pdf

75FCMC19R0042

SOLICITATION, OFFER AND AWARD

4. TYPE OF SOLICITATION2. CONTRACT NUMBER 3. SOLICITATION NUMBER

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than Item 7)

ORDER UNDER DPAS (15 CFR 700)

6. REQUISITION/PURCHASE NUMBER

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

NEGOTIATED (RFP)

SEALED BID (IFB)

5. DATE ISSUED

1. THIS CONTRACT IS A RATED RATING PAGE OF PAGES

1 80

C. E-MAIL ADDRESS

EXT.NUMBERAREA CODE

B. TELEPHONE (NO COLLECT CALLS)A. NAME

10. FOR

INFORMATION

CALL:

CAUTION: LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

(Date)(Hour) local timeuntildepository located in copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the

SOLICITATION

9. Sealed offers in original and

PART IV - REPRESENTATIONS AND INSTRUCTIONS

OTHER STATEMENTS OF OFFERORS

EVALUATION FACTORS FOR AWARD

INSTRS., CONDS., AND NOTICES TO OFFERORS

REPRESENTATIONS, CERTIFICATIONS AND

LIST OF ATTACHMENTS

CONTRACT CLAUSES

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

I

J

K

L

M SPECIAL CONTRACT REQUIREMENTS

CONTRACT ADMINISTRATION DATA

DELIVERIES OR PERFORMANCE

INSPECTION AND ACCEPTANCE

PACKAGING AND MARKING

DESCRIPTION/SPECS./WORK STATEMENT

SUPPLIES OR SERVICES AND PRICES/COSTS

SOLICITATION/CONTRACT FORM

PART II - CONTRACT CLAUSESPART I - THE SCHEDULE

H

G

F

E

D

C

B

A

SEC. DESCRIPTION PAGE(S) (X) DESCRIPTION SEC. (X)

11. TABLE OF CONTENTS

18. OFFER DATE17. SIGNATURE

SUCH ADDRESS IN SCHEDULE.

IS DIFFERENT FROM ABOVE - ENTER

15C. CHECK IF REMITTANCE ADDRESS

EXT.NUMBERAREA CODE

15B. TELEPHONE NUMBER

(Type or print)AND

ADDRESS

OF

OFFEROR

CODE FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER15A. NAME

DATEAMENDMENT NO.DATEAMENDMENT NO.

and related documents numbered and dated):

amendments to the SOLICITATION for offerors

(The offeror acknowledges receipt of

14. ACKNOWLEDGEMENT OF AMENDMENTS

CALENDAR DAYS (%)30 CALENDAR DAYS (%)20 CALENDAR DAYS (%)10 CALENDAR DAYS (%)

(See Section I, Clause No. 52.232.8)

13. DISCOUNT FOR PROMPT PAYMENT

designated point(s), within the time specified in the schedule.

by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

OFFER (Must be fully completed by offeror)

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

28. AWARD DATE

(Signature of Contracting Officer)

27. UNITED STATES OF AMERICA

25. PAYMENT WILL BE MADE BY

26. NAME OF CONTRACTING OFFICER (Type or print)

CODE 24. ADMINISTERED BY (If other than Item 7)

ITEM

(4 copies unless otherwise specified)

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

41 U.S.C. 253 (c) ( 10 U.S.C. 2304 (c) (

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

21. ACCOUNTING AND APPROPRIATION20. AMOUNT19. ACCEPTED AS TO ITEMS NUMBERED

AWARD (To be completed by government)

CODE

10/24/2019 X

ASG - DPIFMC

CMS,OAGM,ASG,DPIFMC

7500 SECURITY BLVD., MS: B3-30-03

BALTIMORE MD 21244-1850

1100 ES 12/02/2019

Justin Menefee 410 Justin.Menefee@cms.hhs.go v786-7629

X

X

X

X

X

X

X

X

X

X

X

X

X

PAGE(S)

Michael Connors

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

Prescribed by GSA - FAR (48 CFR) 53.214(c)

2 - 3

7 - 8 9 - 19 20 - 39

40 - 48

50 - 59

60 - 77

78 - 80

12. In compliance with the above, the undersigned agrees, if this offer is accepted within _____0_________ calendar days (60 calendar days unless a different period is inserted

See Section L.8

Plan Program Integrity Medicare Drug Integrity Contractor

RFP-75FCMC19R0042

PART I – THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICES/COSTS

B.1 DESCRIPTION OF SERVICES

The overall purpose of the Plan Program Integrity Medicare Drug Integrity Contract (PPI MEDIC) is to support the Centers for Medicare and Medicaid Services (CMS) in their efforts to proactively detect and prevent fraud, waste, and abuse (FWA) in Medicare Part C and Part D. The contractor shall support CMS by conducting proactive and reactive data analysis within Medicare Parts C and D and identifying program vulnerabilities. The PPI MEDICs preliminary findings shall be provided to Medicare Advantage (MA) and Prescription Drug Plans (PDP) for further review, analysis, and corrective actions as needed to support their overall FWA monitoring efforts.

B.2 SCHEDULE OF SERVICES

The total estimated cost from the Government for full performance of this contract will be in accordance with the Contract Line Item Numbers (CLIN) identified below:

The total estimated cost of this contract is $ TBD. The total fixed fee amount for this contract is $ TBD. The total estimated cost plus fixed fee (CPFF) for this contract is $ TBD.

The following schedule delineates the estimated cost and fixed fee for each period of performance:

CLIN-

Description

Cost Fixed-Fee Total

CPFF

Period of Performance

Funded

CLIN 0001-

Base Period

$ $ $ March 20, 2020 - March 19, 2021

CLIN 0002-

Option Year 1

$ $ $ March 20, 2021 - March 19, 2022

CLIN 0003-

Option Year 2

$ $ $ March 20, 2022 - March 19, 2023

CLIN 0004-

Option Year 3

$ $ $ March 20, 2023 - March 19, 2024

CLIN 0005-

Option Year 4

$ $ $ March 20, 2024 - March 19, 2025

TOTAL $ $ $ $

B.3 CONTRACT TYPE

The contract is cost plus fixed fee (CPFF) term type. In accordance with FAR 16.306, under this CPFF Term type contract, in order to be paid fixed fee, the contractor must meet the following:

At a minimum, devote the following Level of Effort (LOE) for each performance period per Contract Line Item Number as follows:

CLIN Specified Level of Effort Definite Time Period

0001 TBD 03/20/20 – 03/19/21

0002 TBD 03/20/21 – 03/19/22

0003 TBD 03/20/22 – 03/19/23

0004 TBD 03/20/23 – 03/19/24

0005 TBD 03/20/24 – 03/19/25

The contractor will receive fixed fee based on the following chart for each CLIN for that specified time period:

Specified Level of Effort Met

Percent of Fee Received

75% - 100% 100% 60% - 74% 75% 45% - 59% 50% 30% - 44% 25% 1% - 29% 5%

0% 0%

In the event that the contractor provides more than 100% of the estimated LOE, the fixed fee of the contract shall not be adjusted.

Performance must be considered satisfactory during each time period. At the expiration of each time period the Contracting Officer, in coordination with the Contracting Officer’s Representative, will make a determination of satisfactory performance.

If both of the above are met, the Contracting Officer will authorize the contractor to bill for the fixed fee, except the 15% withhold (up to the maximum of $100,000) in accordance with FAR 52.216-8.

The contractor’s monthly voucher shall provide the current LOE utilized for both the current billed period and the cumulative LOE for that period of performance/CLIN as follows:

CLIN 000X

LOE from X/X/X to X/X/X Cumulative LOE to date

Prime X Hours X Hours Subcontractor X Hours X Hours

These terms and conditions do not supersede the requirements of either FAR clause 52.232-20 “Limitation of Cost” or FAR clause 52.232-22 “Limitation of Funds.”

(END OF SECTION B)

SECTION C - DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

C.1 STATEMENT OF WORK

Independently and not as an agent of the Government, the contractor shall furnish all the necessary services, qualified personnel, material, equipment, and facilities, not otherwise provided by the Government, as needed to perform the Plan Program Integrity Medicare Drug Integrity Contractor Statement of Work, Section J, Attachment J.1 attached hereto and made a part of this contract.

(END OF SECTION C)

SECTION D - PACKAGING AND MARKING

D.1 PACKAGING, MARKING AND SHIPPING

All deliverables required under this contract shall be packaged, marked and shipped in accordance with Government specifications. The contractor shall guarantee that all required materials shall be delivered in immediate usable and acceptable condition.

(END OF SECTION D)

SECTION E - INSPECTION AND ACCEPTANCE

E.1 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address: https://www.acquisition.gov/

Clause No. Title Date 52.246-5 Inspection of Services – Cost Reimbursement Apr 1984

E.2 INSPECTION AND ACCEPTANCE

(a) All work under this contract is subject to inspection and final acceptance by the Contracting Officer or the duly authorized representative of the Government.

(b) The Government's COR is a duly authorized representative of the Government and is responsible for inspection and acceptance of all items to be delivered under this contract.

(c) Inspection and acceptance of the contractor‘s performance shall be in accordance with the applicable FAR clauses in Section E.1 above.

E.3 APPROVALS BY THE CONTRACTING OFFICER REPRESENTATIVE (COR)

All items to be delivered to the COR will be deemed to have been approved sixty (60) calendar days after date of delivery, except as otherwise specified in this contract, if written approval or disapproval has not been given within such period. The Contracting Officer Representative’s approval or revision to the items submitted shall be within the general scope of work stated in this contract.

(END OF SECTION E)

https://www.acquisition.gov/

SECTION F DELIVERIES OR PERFORMANCE

F.1 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address: https://www.acquisition.gov/

Clause No. Title Date 52.242-15 Stop Work Order – Alternate I (Apr 1984) Aug 1989

F.2 PERIOD OF PERFORMANCE (JAN 2014)

The Period of Performance is estimated to be March 20, 2020 to March 19, 2021.

The contract includes the following Option Periods:

Option Year 1 March 20, 2021 – March 19, 2022 Option Year 2 March 20, 2022 – March 19, 2023 Option Year 3 March 20, 2023 – March 19, 2024 Option Year 4 March 20, 2024 – March 19, 2025

F.3 SCHEDULE OF DELIVERABLES

The Contractor shall submit all required reports and deliverables in accordance with the following schedule. Deliverables submitted shall be in accordance with the SOW. The following table represents the schedule of deliverables as detailed in Section IV DELIVERABLES of the SOW.

Description Method Delivery Date Project Management Plan Email to the COR;

MS Project 2007 Draft: 15 business days after contract award Final: 10 business days after receiving CMS comments on draft

Kickoff Meeting Minutes Email to COR 3 business days after the Kickoff meeting Drug Trend Analysis Report IBM Connections 20th day quarterly rolling basis (due in Oct., Jan., Apr., and July) Outlier Prescriber of Schedule II Controlled Substances Report

IBM Connections 5th day quarterly rolling basis (due in Dec., Mar., June, and Sept.)

Pharmacy Risk Report IBM Connections 20th day quarterly rolling basis (due in Nov., Feb., May and Aug.)

Pharmacy Spike Report IBM Connections 5th day quarterly rolling basis (due in Dec., Mar., June and Sept.)

Prescriber Spike Report IBM Connections 20th day quarterly rolling basis (Oct., Jan., Apr., and July)

Presentation/Presentation Materials

Email to COR; MS PowerPoint

At least 10 calendar days prior to event

Vulnerability Report IBM Connections As needed/identified CMS Mailbox Log of Correspondence with Plans

IBM Connections As needed

RFI Report IBM Connections As needed https://www.acquisition.gov/

Description Method Delivery Date Annual Lessons Learned Report CMS ARTS 30 business days prior to the end of period of performance Monthly Status Reports IBM Connections 20th day of the following month for each month of contract Monthly Cost Reports Email to COR and

CMS ARTS

20th day of the following month for each month of contract

Status Meeting agenda/materials Email to COR 2 business days prior to Status Meeting Status Meeting minutes Email to COR 3 business days after the Status Meeting FOIA Contractor Summary Sheet and FOIA log

IBM Connections As needed

System Access/Employee Roster Log

Email to COR As needed

(END OF SECTION F)

SECTION G CONTRACT ADMINISTRATION DATA

G.1 ACCOUNTING AND APPROPRIATION DATA

(To be incorporated at time of award)

Requisition Appropriation Object Class CAN Amount

G.2 PAYMENTS – VOUCHERS - COST REIMBURSEMENT AND NON-COMMERCIAL

LABOR HOUR/TIME & MATERIAL CONTRACTS (SEPT 2018)

a. GENERAL: The Contractor may submit to the Government a voucher or Standard Form 1034, Public Voucher for Purchases and Services Other Than Personal, for payment in accordance with the instructions below.

b. BANKING CHANGES: The contractor shall notify CMS’ Division of Accounting Operations of all banking and address changes made in SAM via the following email address:

CCRChanges@cms.hhs.gov.

c. CONTENT OF VOUCHER: FAR 32.905 Payment Documentation and Process, provides the required content for a proper voucher. In addition to the requirements of FAR 32.905, the following items shall also be included on the voucher to be considered proper:

Line item number (i.e. CLIN/SLIN as applicable) Contractor’s DUNS Number Period of performance or delivery date of goods or services provided.

d. VOUCHER SUBMISSION: Vouchers shall be submitted via email in electronic format as follows:

To…: InvoiceSubmission@cms.hhs.gov

Cc…:Please “Cc…” your respective Contract Specialist (CS) and Contracting Officer’s Representative (COR) as follows:

Contract Specialist – Dorota.Horton@cms.hhs.gov; and

COR - TBD.

Subject Line: The email subject line shall contain the following information: Contract Number, Task/Delivery Order Number (if applicable), Voucher Number, and Notification of Final Invoice (if applicable).

PLEASE DO NOT INCLUDE ANY ADDITIONAL INFORMATION IN THE

SUBJECT LINE, as doing so may delay internal processing of your invoice for payment.

Attachments: Voucher attachments shall be submitted in .pdf format. Only one voucher shall be attached per email. The first page of the attachment shall be the invoice, followed by any supporting documents as applicable.

mailto:CCRChanges@cms.hhs.gov https://www.acquisition.gov/sites/default/files/current/far/html/Subpart%2032_9.html#wp1032997 https://www.acquisition.gov/sites/default/files/current/far/html/Subpart%2032_9.html#wp1032997 mailto:InvoiceSubmission@cms.hhs.gov mailto:Dorota.Horton@cms.hhs.gov

e. PAYMENTS: The Government shall make interim payments on all vouchers (subject to later audit) in accordance with the following clauses, as applicable:

FAR 52.232-33 Payments by Electronic Funds Transfer – System for Award Management, FAR 52.216-7, Allowable Cost & Payment, and FAR 52.232-7, Payments under Time-and-Materials and Labor-Hour Contracts

Payment shall be made upon acceptance by the Contracting Officer’s Representative (COR) of the required supplies/services in accordance with the applicable FAR Inspection and Acceptance clause and the Contracting Officer’s approval.

Reimbursement for vouchers submitted under this contract shall be made no later than 30 calendar days after receipt of an acceptable voucher from the Contractor requested at the paying office designated above. CMS will make every effort to accelerate payments to small businesses and prime contractors with small business subcontractors.

f. INTEREST ON OVERDUE PAYMENT: The Prompt Payment Act, Public Law 97-177 (96 Stat.85.31 U.S.C. 1801) is applicable to payments under this contract and requires the payment of interest on payments made more than 30 calendar days after receipt of a proper voucher by the Division of Accounting Operations.

Determinations of interest due will be made in accordance with the provisions of the Prompt Payment Act and 5 CFR 1315.

G.3 USE OF GOVERNMENT DATA (REPORTS/FILES/COMPUTER TAPES OR DISCS)

Any data given to the contractor by the Government shall be used only for the performance of the contract unless the Contracting Officer specifically permits another use, in writing. Should the Contracting Officer permit the contractor the use of Government-supplied data for a purpose other than solely for performance of this contract and, if such use could result in a commercially viable product, the Contracting Officer and the contractor must negotiate a financial benefit to the Government. This benefit should most often be in the form of a reduction in the price of the contract; however, the Contracting Officer may negotiate any other benefits he/she determines is adequate compensation for the use of these data.

Upon the request of the Contracting Officer, or the expiration date of this contract, whichever shall come first, the contractor shall return or destroy all data given to the contractor by the Government. However, the Contracting Officer may direct that the data be retained by the contractor for a specific period of time, which period shall be subject to agreement by the contractor. Whether the data are to be returned, retained, or destroyed shall be the decision of the Contracting Officer with the exception that the contractor may refuse to retain the data. The contractor shall retain no data, copies of data, or parts thereof, in any form, when the Contracting Officer directs that the data be returned or destroyed. If the data are to be destroyed, the contractor shall directly furnish evidence of such destruction in a form the Contracting Officer shall determine is adequate.

G.4 DATA TO BE DELIVERED

a. Any working papers, interim reports, data given by the government or first produced by the contractor under the contract or collected or otherwise obtained by the contractor under the contract, or results obtained or developed by the contractor (subcontractor or consultants) pursuant to the fulfillment of this contract are to be delivered, documented, and formatted as directed by the Contracting Officer.

b. In addition, information and/or data, which are held by the contractor related to the operation of their business and/or institution and which are obtained without the use of Federal funds, shall be considered "PROPRIETARY DATA" and are not "subject data" to be delivered under this contract

G.5 PUBLICITY

Any news release, public announcement, advertisement, or publicity proposed to be released by the Contractor or subcontractor will be subject to the written approval of CMS prior to release.

G.6 SUBCONTRACT CONSENT

(a) For the purposes of this contract, consultants are considered subcontractors.

(b) To facilitate the review of a proposed subcontract, by the COR and the Contracting Officer, the contractor shall submit the information required by the FAR Clause 52.244-2 entitled, “Subcontracts,” and FAR 52.244-5 “Competition in Subcontracting” to the Contracting Officer.

The contracting officer shall review the request for subcontract approval and the COR’s recommendation and advise the contractor of his/her decision to consent to or dissent from the proposed subcontract, in writing.

(c) Consent is hereby granted to the following subcontracts:

TBD (if applicable)

G.7 SERVICE OF CONSULTANTS/SUBCONTRACTORS

For the purposes of this contract, consultants are considered subcontractors.

The contractor shall follow the procedures established in the following Federal Acquisition Regulation (FAR) clauses when requesting Contracting Officer consent to subcontract for Consultants and/or other subcontracts:

Federal Acquisition Regulation (FAR) Clauses:

52.244-2 Subcontracts (Oct 2010) 52.244-6 Subcontracts for Commercial Items (Aug 2019)

G.8 CORRESPONDENCE PROCEDURES

To promote timely and effective administration, correspondence (except for invoices), submitted under this contact shall be subject to the following procedures:

a. Technical Correspondence - Technical correspondence (as used herein, this term excludes technical correspondence which proposes or otherwise involves waivers, deviations or modifications to the requirements, terms or conditions of this contract) shall be addressed to the COR with an informational copy of the basic correspondence to the Contracting Officer.

b. Other Correspondence - All other correspondence shall be addressed to the Contracting Officer, in duplicate, with an informational copy of the basic correspondence to the COR.

c. Subject Lines - All correspondence shall contain a subject line, commencing with the contract number as illustrated below:

EXAMPLE: Contract No. 75FCMC18C0001

G.9 PROPERTY ADMINISTRATION

The CMS Property Administrator, Administrative Services Group, Office of Property and Space Management at (410) 786-6462, is hereby designated the property administration function for this contract. The contractor agrees to furnish information regarding Government Property to the Property Administrator in the manner and to the extent required by the Property Administrator, his duly designated successors, and in accordance with FAR Part 45 and Department of Health & Human Services (DHHS) Manual entitled, Contractor's Guide for Control of Government Property, (2007).

G.10 GOVERNMENT REPRESENTATIVES AND RESPONSIBILITIES (JUL 2016)

Following are the Government Representatives and their respective roles and responsibilities on this contract:

a. Contracting Officer

As defined in Federal Acquisition Regulation (FAR) 2.101, Definitions, and in accordance with FAR 1.602-1, Authority, “Contracting officers have authority to enter into, administer, and/or terminate contracts and make related determinations and findings.” There is no other authorized representative or any other Administrative Contracting Officer assigned to this contract to carry out a Contracting Officer’s duties, except for technical direction assigned to the Contracting Officer’s Representative, if applicable.

The Contracting Officer is:

Centers for Medicare & Medicaid Services Office of Acquisition & Grants Management Acquisition Support Group Division of Program Integrity and Financial Management Contracts ATTN: Michael Connors 7500 Security Blvd.

Mail-stop: B3-30-03 Baltimore, MD 21244-1850

Phone: 410-786-1554 Email Address: Michael.Connors@cms.hhs,gov mailto:Michael.Connors@cms.hhs,gov

b. Contract Specialist

Notwithstanding any of the other provisions of this Contract, the Contract Specialist will assist the Contracting Officer with his/her responsibilities as defined in the FAR.

The Contract Specialist is:

Centers for Medicare & Medicaid Services Office of Acquisition & Grants Management Acquisition Support Group Division of Program Integrity and Financial Management Contracts ATTN: Dorota Horton 7500 Security Blvd.

Mail-stop: B3-30-03 Baltimore, MD 21244-1850

Phone: 410-786-7403 Email Address: Dorota.Horton@cms.hhs.gov

c. Contracting Officer’s Representative

The Contracting Officer’s Representative (COR), as defined in FAR 2.101, Definitions, is:

Phone: TBD Email Address: TBD

Centers for Medicare & Medicaid Services Center for Program Integrity

ATTN: TBD

7500 Security Blvd.

Mail-stop: TBD Baltimore, MD 21244-1850

In accordance with FAR 1.602-2(d), Responsibilities, the COR’s delegated responsibilities are identified in the Contracting Officer’s appointment memorandum, a copy of which will be furnished to the contractor.

Technical direction must be within the general scope of the work stated in the contract. The term "technical direction" is defined to include, without limitation, the following:

(1) Directions to the Contractor which direct the contract effort, shift work emphasis between work areas or tasks, require pursuit of certain lines of inquiry, fill in details or otherwise serve to accomplish the contractual technical requirements as identified in the Statement of Work or Performance Work Statement; or

(2) Provision of information to the Contractor, which assists in the interpretation of drawings, specifications, or technical portions of the work description.

The COR does not have the authority to:

1. Make changes to contract terms and conditions;

mailto:Dorota.Horton@cms.hhs.gov

2. Direct the contractor to perform work or make deliveries not specifically required under the contract;

3. Waive or relax the Government’s rights with regard to the Contractor’s compliance with the specifications, price, delivery or any other terms or conditions of the contract;

4. Make any commitments or approve any actions that would create any financial obligation on the part of the Government; or

5. Issue direction that constitutes a “change” as defined in:

FAR 52.243-1, Changes – Fixed Price;

FAR 52.243-2, Changes – Cost Reimbursement;

FAR 52.243-3, Changes – FAR 52.243-4, Changes; or, FAR 52.243-5, Changes and Changed Conditions.

All technical direction shall be issued in writing by the COR or, if issued verbally, shall be confirmed in writing by the COR within five (5) business days after issuance.

The Contractor shall proceed promptly with the performance of technical direction duly issued by the COR within the scope of his/her authority.

If, in the opinion of the Contractor, any instruction or direction issued by a Government representative constitutes a change to the contract or constitutes a “Change Order” as defined in FAR 2.101, Definitions, the Contractor shall follow the instructions identified in FAR 52.243-7 Notification of Changes.

G.11 CONTRACTOR PAST PERFORMANCE EVALUATION(S) (OCT 2014)

a. General:

In accordance with Federal Acquisition Regulation (FAR) 42.15, Contractor Performance Information, past performance evaluations shall be prepared at least annually and at the time the work under a contract or order is completed. Additional interim performance evaluations may be prepared at Contracting Officer discretion, as necessary.

CMS will utilize the Contractor Performance Assessment Reporting System (CPARS), the Government-wide evaluation reporting tool for all past performance reports on contracts and orders, as appropriate. CPARS is a secure Internet website located at https://www.cpars.gov.

b. CPARS Process:

1. CPARS Training: Contractors may obtain CPARS training material and register for on-line training https://www.cpars.gov.

2. Post-Award Contract Registration: CMS is responsible for registering the contract in CPARS within 30 calendar days of contract award. The Contractor shall:

i. Designate at least one (1) point of contact that will be responsible for serving as the Contractor’s Representative (CR). Additional CRs may also be identified; and,

ii. Provide the CMS Contract Specialist with the name(s) and email address(es) of the CPARS point(s) of contact.

Once CMS registers the contract in CPARS, the CR(s) will receive an automated CPARS email message that contains User IDs and instructions for creating a password for future past performance evaluation processing.

3. Interim, Annual and Final Past Performance Evaluation Reports:

a. Issuing the Evaluation: Once the CMS Assessing Official (AO) issues an evaluation to the Contractor in CPARS, the CR(s) will receive an email instructing them to login to CPARS to review the evaluation.

b. Contractor Comments: The CR has the option to provide comments on the evaluation, indicate if they concur or do not concur with the evaluation, sign, and then return the evaluation to the AO. The CR has a total of 60 days following the AO’s evaluation signature date to submit comments. If the CR submits comments within the first 14 days following the AO’s signature date and the AO closes the evaluation, the evaluation will become available in Past Performance Information Retrieval System - Report Card (PPIRS-RC) within 1 day.

On day 15 following the AO’s evaluation signature date, the evaluation will become available in PPIRS-RC with or without CR comments and whether or not it has been closed by the AO.

If no CR comments have been sent and the evaluation has not been closed, it will be marked as “Pending” in PPIRS-RC.

If the CR sends comments at any time prior to 61 days following the AO’s evaluation signature date, those comments will be reflected in PPIRS-RC within 1 day. On day 61 following the AO’s evaluation signature date, the CR will be “locked out” of the evaluation and may no longer send comments.

G.12 CONTRACTOR WORK PERFORMED OUTSIDE THE UNITED STATES AND ITS

TERRITORIES (APR 2016)

To comply with requirements of Homeland Security Presidential Directive -12 (HSPD-12) and Personal Identity Verification (PIV) of Federal Employees and Contractors, CMS must achieve appropriate security assurance for multiple CMS information systems by efficiently verifying the claimed identity of individuals working on the contract. The Contractor and its subcontractor(s) shall not perform any activities under this contract, including the transmission of data or other information, outside of the United States (U.S.) and its Territories without the prior written approval of the Contracting Officer. If work must be performed outside the U.S., the Contractor shall submit a request to the Contracting Officer, in writing, at least 45 calendar days prior to the work beginning.

The Contracting Officer will consider the following factors in making a decision whether to authorize the performance of work outside the U.S. and its Territories:

1. Statement of Work requirements, which are being requested to be completed outside the U.S. and its Territories;

2. Total projected dollar value of the work to be performed outside the U.S.;

3. The desired country/location where the work will be performed;

4. FAR Part 25, Foreign Acquisitions, and all other laws and regulations applicable to the performance of work outside the United States;

5. Whether the contractor and/or its subcontractor(s) have plans in place to adequately protect and secure CMS data, as well as abide by all applicable laws and regulations when work is performed outside of the U.S. and its Territories. Plans shall include -

a. Adequate contract terms regarding system security;

b. Adequate contract terms regarding the confidentiality and privacy requirements for information and data protection;

c. Adequate contract terms that are otherwise relevant, including the requirements of the

Statement of Work;

d. The Contractor’s corporate compliance plan and internal policies and procedures designed to prevent and detect violations of applicable law, regulations, rules and ethical standards by employees, agents and others; and,

6. Whether the approval would be in best interests of the United States.

The Contractor’s request for authorization to perform work outside the U.S. shall demonstrate that the performance of the work outside the U.S. satisfies all of the above factors. Contracting Officer approval to perform work outside the U.S. may require additional Statement of Work requirements, additional contract terms and conditions and/or Federal Acquisition Regulation (FAR) clauses to be incorporated into the contract.

G.13 INDIRECT COST RATES (SEP 2014)

a. INDIRECT COST BILLING, CEILING and FINAL RATES (To be completed at time of award):

1. Billing Rates:

i. Federal Acquisition Regulation (FAR) 52.216-7(e) Billing Rates, states, “Until final annual indirect cost rates are established for any period, the Government shall reimburse the Contractor at billing rates established by the Contracting Officer or by an authorized representative (the cognizant auditor), subject to adjustment when the final rates are established.

These billing rates— (1)Shall be the anticipated final rates; and, (2)May be prospectively or retroactively revised by mutual agreement, at either party’s request, to prevent substantial overpayment or underpayment.”

Therefore, the Government shall reimburse the Contractor at the established Billing Rates, as established by the Cognizant Federal Agency (CFA) or cognizant auditor. Any change(s) to the Billing Rate(s) established, shall be approved by the CFA or cognizant auditor. In the event the Billing Rate(s) exceed any Ceiling Rate(s) established in G.13.a.2. below, the Government shall reimburse the Contractor at the Ceiling Rate(s).

ii. Interim Billing Rates: In the event that the Contractor does not have Contracting Officer or authorized representative (cognizant auditor) established Billing Rates, the following Interim Billing Rates apply to this contract:

INTERM BILLING RATES:

Rates are applied

Indirect Cost Pool Billing Rate Rate Base Contractor Fiscal Year Fringe (Ceiling N/A) TBD (a) Overhead TBD (b) G&A TBD (c) Other TBD (d) to the following rate base(s):

a. Fringe rate is applied to …

b. Overhead rate is applied to…

c. G&A rate is applied to…

The above rates shall be used for reimbursement on contractor billings, pending review of a well-supported Billing Rate proposal, which is required to be submitted to the mailbox identified below, by the Contractor within six (6) months of contract award. The proposal shall be based upon at least four (4) months of actual costs and estimated costs for the current fiscal year and out-years of this contract. If you have prior year actuals, submit at least two (2) years, if available.

For information about the proposal submission, refer to “Information for Contractors” at http://www.DCAA.Mil/Audit_Process_Overview.html.

CMS, or another CFA official or cognizant auditor, shall review the proposed rates in accordance with FAR 52.216-7(e) and FAR 42.704 Billing rates, to establish Billing rates for the current fiscal year and to provide current recommendations on the out-year rates. After receiving the established CFA or cognizant auditor Billing Rate Agreement, the Interim Billing Rates no longer apply.

Submit Billing Rate Proposals to:

AcquisitionDFSIncurredCostSubmission@CMS.HHS.Gov

2. Indirect Cost Ceiling Rate(s):

a) Indirect Cost Ceiling Rate(s) established (as applicable) for this contract are in accordance with FAR 42.707, Cost Sharing Rates and Limitations on Indirect Cost Rates, and are as indicated below in the chart.

INDIRECT COST “CEILING” RATES

Rates are applied

Indirect Cost Pool

Indirect Cost Ceiling Rate

Contractor’s Fiscal Year Rate / Allocation Base

Overhead (a) G&A (b) Other (c)

Overhead (a) G&A (b) Other (c)

Overhead (a)

Other (c)

Other

(c)

Other

(c) http://www.dcaa.mil/Audit_Process_Overview.html mailto:AcquisitionDFSIncurredCostSubmission@cms.hhs.gov to the following rate/allocation base(s):

Rate/Allocation Base a.Overhead rate is applied to … Rate/Allocation Base b.G&A rate is applied to…

b) When a ceiling rate(s) is/are established -

(1) The Government will not be obligated to pay any additional amount, should the final indirect cost rate(s) exceed the negotiated ceiling rate(s).

(2) In the event a final indirect cost rate is less than the negotiated ceiling rate, costs will be reimbursed at the final indirect cost rate.

3. Final Indirect Cost Rates: Pursuant to the provisions of FAR 52.216-7, Allowable Cost & Payment, the allowable Indirect Costs under this contract shall be obtained by applying the CFA approved Final Indirect Cost Rate(s) or the Ceiling Rate(s) (whichever are lower) to the appropriate cost base.

b. INDIRECT COST RATE (ICR) PROPOSAL: Pursuant to FAR 52.216-7, Allowable Cost and Payment, paragraph (d)(2), Final indirect cost rates, the Contractor shall submit an adequate final annual Indirect Cost Rate proposal within the 6-month period following the expiration of each of its fiscal years.

FAR 42.003(a) provides that the CFA, “…normally will be the agency with the largest dollar amount of negotiated contracts, including options.” FAR 42.703-1 further provides that a single agency shall be responsible for establishing final indirect cost rates for each business unit. This single agency is the CFA and may be DHHS, a delegated component of DHHS or another Federal Agency.

The Contractor shall submit its certified annual Indirect Cost Rate proposal to the following (both CMS and the CFA) as identified below:

CMS:

Electronic proposals shall be submitted in MS Word and Excel formats, with .pdf signed Certification, to (Do not .pdf the entire proposal):

Centers for Medicare & Medicaid Services Office of Acquisition & Grants Management Acquisition Business & Services Group Division of Financial Services at - AcquisitionDFSIncurredCostSubmission@CMS.HHS.Gov

AND

COGNIZANT FEDERAL AGENCY:

National Institutes of Health Hard Copy [Only] Submissions to:

Office of Acquisition Management and Policy OALM, OD, Director, Division of Financial Advisory Services 6100 Executive Blvd., Room 549C M/S C-7540 Bethesda, MD 20852

General questions may be submitted via email to:

DFAS-IDC@NIH.Gov

Any questions about CFA responsibilities may be submitted to the OAGM/CRG/Division of Financial Services at:

AcquisitionDFSIncurredCostSubmission@CMS.HHS.Gov.

G.14 HHSAR 352.237-75 KEY PERSONNEL (DEC 2015)

The key personnel specified in this contract are considered to be essential to work performance. At least 30 days prior to the contractor voluntarily diverting any of the specified individuals to other programs or contracts the Contractor shall notify the Contracting Officer and shall submit a justification for the diversion or replacement and a request to replace the individual. The request must identify the proposed replacement and provide an explanation of how the replacement's skills, experience, and credentials meet or exceed the requirements of the contract (including, when applicable, Human Subjects Testing requirements). If the employee of the contractor is terminated for cause or separates from the contractor voluntarily with less than thirty days notice, the Contractor shall provide the maximum notice practicable under the circumstances. The Contractor shall not divert, replace, or announce any such change to key personnel without the written consent of the Contracting Officer. The contract will be modified to add or delete key personnel as necessary to reflect the agreement of the parties.

The following individuals are considered “Key Personnel” under this task order:

Labor Category Name Phone E-Mail Address Program Director Audit Manager Chief Statistician Pharmacy Specialist Medical Director

Additional requirements are provided in the Statement of Work.

(END OF SECTION G)

mailto:DFAS-IDC@nih.gov

SECTION H SPECIAL CONTRACT REQUIREMENTS

H.1 - BUSINESS ETHICS, CONFLICT OF INTEREST AND COMPLIANCE (APR 2017)

a. General: It is imperative that the Contractor and the services provided under this contract be free, to the greatest extent possible, of all Organizational and Personal Conflicts of Interest. In this clause, all references to Organizational and/or Personal Conflicts of Interests will be referred to individually or collectively, as the text justifies, as Conflicts of Interest (COI). Except as provided below, the Contracting Officer shall not maintain a contract with a Contractor that the Contracting Officer determines has, or has the potential for, an unresolved COI. However, in accordance with FAR

9.503 Waiver, the Contracting Officer may contract with a Contractor that has an unresolved COI if the Contracting Officer determines that it is in the best interest of the Government to do so.

b. Definitions:

Actual COI– means that the COI is currently in existence as determined by the Offeror’s or Contractor’s Compliance Officer and/or as determined by CMS. This form of COI will require avoidance, neutralization or mitigation acceptable to CMS.

Affiliates – As defined in FAR 2.101 means associated business concerns or individual(s) if, directly or indirectly either one controls or can control the other; or a third party controls or can control both.

For purposes of this contract, affiliate control or influence may include, but is not limited to:

(a) Interlocking management or ownership (e.g., individuals serving in similar capacities in several companies);

(b) Identity of interests among family members such as spouse/domestic partner and/or any dependent of the respondent;

(c) Shared facilities and equipment;

(d) Common use of employees; or

(e) A business concern organized just prior to, or immediately following, the release of a solicitation or request for information, which has the same or similar management, ownership, or principal employees as the offeror or Contractor.

Any business, whether or not it is organized for profit or located in the United States or its outlying areas, or person may be found to be an affiliate. Control may be affirmative or negative and it is immaterial whether it is exercised so long as the power to control exists.

Apparent (Perceived) COI – means that the COI on first observation appears to be an actual or potential COI, but may or may not be after analysis. Even if the apparent COI is determined to be non-existent, this perception may still require further explanation.

Avoidance – means Government action taken in one acquisition that is intended to prevent a COI in that acquisition or in a future action. Methods of avoiding COIs include, but are not limited to:

Drafting the statement of work (SOW) to exclude tasks that require Contractors to utilize subjective judgment; or

Obtaining advice from more than one source on any issue on which there are concerns about an COI so that there is no area in which the Government is relying solely on the advice of any one of the sources; or

Excluding an offeror from participation in a contract award.

Financial Interests/Relationships – means a healthcare related direct or indirect ownership or investment interest (including an option or non-vested interest) in any entity that exists through equity, debt, or other means and includes any indirect ownership or investment interest no matter how many levels removed from a direct interest.

A financial interest/relationship may arise from the following non-exclusive examples:

(a) Compensation, including wages, salaries, commissions, professional fees, or fees for business referrals;

(b) Current or known future arrangements or requirements for which you are defined as an interested party, including, but not limited to, an entity that may create one or more of the three forms of COI;

(c) Consulting relationships, including commercial and professional consulting and service arrangements, scientific and technical advisory board memberships, or serving as an expert witness in litigation;

(d) Services provided in exchange for honorariums including travel expense reimbursements;

(e) Research funding or other forms of research support;

(f) Healthcare related investment in the form of stock or bond ownership, including healthcare sector investment only mutual funds;

(g) Healthcare business ownership or partnership interests;

(h) Patents, copyrights, and other intellectual property interests;

(i) Seeking or negotiating for prospective employment or business; or

(j) Gifts, including travel.

Mitigation– means action taken by the Contractor to reduce the COI risk to a level acceptable to CMS on a present contract.

Neutralization – means excluding or restricting a Contractor from offering, as a prime or subcontractor, on future contracts while allowing the Contractor to perform on the instant contract. This method protects the Government’s interests in cases where the Contractor’s work on the instant contract could be biased or impaired by virtue of its expectation of future work, or when the Contractor would have an unfair advantage in competing for award of the future work.

Organizational Conflict of Interest – In accordance with FAR 2.101 Definitions, means that because of other activities or relationships with other persons, a person is unable, or potentially unable, to render impartial assistance or advice to the Government, or the person’s objectivity in performing the contract work is, or might be, otherwise impaired, or a person has an unfair competitive advantage.

For purposes of this contract, the conflict of interest definition includes direct or indirect relationships including, but not limited to, the Contractor and its parent company, subsidiaries, affiliates, subcontractors, clients and principals.

Personal Conflicts of Interest – A situation in which a person has a financial interest, personal activity, or relationship that could impair the person’s ability to act impartially and in the best interest of the Government when performing under this contract.

(a) Among the sources of personal conflicts of interest are—

(i) Financial interests of the person, spouse/domestic partner and/or any other dependent of the person, as defined for Federal tax purposes;

(ii) Other employment or financial relationships (including seeking or negotiating for prospective employment or business) and,

(iii) Gifts, including travel.

(b) For example, financial interests referred to in paragraph (a)(i) of this definition may arise from—

(i) Compensation, including wages, salaries, commissions, professional fees, or fees for business referrals;

(ii) Consulting relationships;

(iii) Services provided in exchange for honoraria or travel expense reimbursements;

(iv) Research funding or other forms of research support;

(v) Healthcare related investments;

(vi) Real estate investments;

(vii)Patents, copyrights, and other intellectual property interests; or (viii)Business ownership and investment interests.

Potential COI – means that the COI could become an actual COI due to contingency events and/or as determined by CMS. This form of COI will require avoidance, neutralization or mitigation acceptable to CMS.

Principal – As defined in FAR 52.203-13, Contractor Code of Business Ethics and Conduct, means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager, plant manager, head of a division or business segment, and similar positions).

Three (3) Types of COIs include:

Conflict Types Definitions

Biased Ground Rules

Consists of situations in which a firm, as part of its performance of a Government contract, has helped (or is in a position to help) set the ground rules for another Government contract by, for example, writing the statement of work or the specifications, or establishing source-selection criteria. In these “biased ground rules” cases, the primary concern is that the firm could skew the competition, whether intentionally or not, in favor of itself and/or its affiliates.

Impaired Objectivity

Consists of situations where a firm has an interest (typically financial) that may conflict with the interest of the Government to whom the firm has a contractual obligation, and the firm’s work under the Government contract could give the firm the opportunity to benefit its other business interests. If the firm is providing recommendations, judgment or advice, and its other business interests could be affected by that recommendation, judgment or advice, the firm’s objectivity may be impaired. An example is where the firm was evaluating itself, an affiliate or a competitor, either through an assessment of performance under another contract or an evaluation of proposals.

Unequal Access to Information

“Unfair” access to non-public information – Consists of situations in which a firm has access to nonpublic information (including proprietary information and non-public source-selection information) as part of its performance of a Government contract and that information may provide the firm with a competitive advantage in a later competition for a Government contract. In these “unequal access to information” cases, the concern is limited to the risk of the firm gaining an unfair competitive advantage; there is no issue of bias. Note: Incumbency alone does not constitute “unequal access to information.”

c. Significant Potential Conflict of Interest: The Contracting Officer has determined that this contract may involve significant potential COIs.

1. Nature of Potential Conflict: Although not all inclusive, the Contracting Officer has determined that the following activities are considered to be an actual, potential or apparent COI with the work to be performed under this contract. The Contractor shall promptly notify the Contracting Officer of any relationships with any of the following entities:

For the purpose of identifying entities with actual, potential or apparent COIs, at a minimum, the entity is one that-

a) Would review or does review, under the contract, Medicare and/or Medicaid services furnished by a provider or supplier that is a direct competitor of the Contractor; or

b) Prepared work or is under contract to prepare work that would be reviewed under the contract; or

c) Is affiliated or has a financial relationship, as these terms are explained above, with an entity to be reviewed under the contract. This includes entities such as Medicare Advantage Organizations (MAOs), Part C/D Recovery Audit Contractors (RACs), and Medicare Prescription Drug Plans (PDPs).

2. Proposed Restraint on Future Contractor Activities: CMS is proposing to restrain future Contractor activities as follows:

While performing under the PPI MEDIC contract, the entity may not also become a contractor that may be reviewing/auditing or conducts business with or for entities that operate Medicare Parts C or D Plans. This includes entities such as MAOs, Part C/D RACs, and Medicare PDPs.

d. Contractor Business Ethics, Conflict of Interest and Compliance Program Requirements: FAR

3.10 and FAR 52.203-13, Contractor Code of Business Ethics and Conduct, identify “…policies and procedures for establishment of Contractor codes of business ethics and conduct, and display of agency Office of Inspector General (OIG) hotline posters.” (See Section I, FAR 52.203-14 fill-in information for the website where you can find the HHS OIG fraud hotline poster).

The following chart is provided to clarify requirements under this contract:

FAR 52.203-13 Requirements Applicability (X = Applicable)

Contracts < $5 Million

Contracts ≥$5 Million with a Small Business

OR for Commercial

Items (as Defined in FAR 2.101)

Contracts ≥$5 Million with a Large Business

(No Commercial Item Contracts)

CMS COI DISCLOSURES X X X

PLAN FOR

MONITORI…