E.2_PPI_MEDIC_Technical_Evaluation_Scenarios.docx

Exhibit E.2 RFP-75FCMC19R0042 PPI MEDIC Plan Program Integrity Medicare Drug Integrity Contractor Technical Evaluation Scenarios Technical Understanding and Approach:

· The Offeror will provide responses to the scenarios that follow to demonstrate technical understanding of the work required under the Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC) Statement of Work (SOW). The Offeror should address the questions asked with each scenario specifically. There may be scenarios included where the Offeror’s response should address its approach for providing the services to CMS and its understanding of the tasks in the SOW, as well as how and when the task will be performed; which personnel will be involved throughout the process; and any process performed by the Offeror to ensure that the service provided to CMS or other stakeholders is complete, accurate, effective, and timely, as well as promoting proper stewardship of the Medicare Parts C and Part D programs.

· The Offeror’s response to each scenario should be no more than 3 pages in length and should fully defend the response. If multiple scenarios are part of the evaluation, the maximum length is 3 pages per scenario response; however, when the Offeror is able to respond to a scenario in less than 3 pages, they may use the remaining space for another scenario (or scenarios). The Offeror must include the assumptions used in developing the response. If the Offeror’s response to a scenario does not address the questions asked, it will be considered non-responsive.

· The Offeror’s responses to the scenarios must demonstrate:

1. The ability to conduct plan audits, data analysis, outreach and education , and other adhoc activities required for successful program integrity outcomes;

2. Relevant knowledge of Federal/State laws and regulations that relate to Medicare Parts C and Part D program integrity; and

3. The ability to interface and build successful partnerships with CMS, Investigations MEDIC, other CMS contractors, MA, Part D plans, and other stakeholders.

Scenarios:

1. There is widespread concern regarding the rapid increase in the use of opioids in the United States and other countries. Opioid-related deaths have increased across the country. The number of opioid-related overdose deaths increased by 5,000 from 2016 to 2017. In 2017, on average, 130 Americans die every day from an opioid overdose. This number has actually increased from 116 Americans dying every day, on average, in 2016. In an effort to address this important concern, CMS has asked that you, as the PPIMEDIC, prepare a nationwide data strategy to help with auditing and educating plan sponsors to combat the opioid epidemic. (For the purposes of this scenario, please describe your global approach,)

a) Describe how you would proceed with this request from CMS by detailing the actions that you would perform; suggesting a timeline for completing tasks; and submitting recommendations.

b) What sources of data would you use and how would you determine the appropriate guidance to support the methodology?

c) Describe how you would measure the success of this analysis.

2. The PPI MEDIC shall make use of available data and apply innovative analytical methodologies, to proactively identify and mitigate FWA in the Parts C and Part D programs.

a) Identify a potential incident of FWA currently occurring in the Parts C and D Programs.

b) How would you utilize the Medicare data to proactively identify potential inappropriate payments and increase transparency among CMS and the plan sponsors?

3. The PPI MEDIC shall also proactively and reactively identify Parts C and Part D program vulnerabilities.

a) Identify potential areas of vulnerability for FWA in the Part C and D program

b) Describe the actions you would take based on the SOW requirements to proactive and/ or reactively address the program vulnerability.