J.23 Government Provided Proposal Assumptions (GPPA) redline Amend 2.docx

J.23 GOVERNMENT PROVIDED PROPOSAL ASSUMPTIONS

See Request for Proposal (RFP) Section L.13

1. CONTRACT AWARD DATE

The Centers for Medicare & Medicaid Services (CMS) anticipates awarding the Part A and Part B Medicare Administrative Contractor (A/B MAC) contract award for Jurisdiction L (JL) 8-12 months from receipt of proposals. JL includes the states of Delaware, Maryland, New Jersey, and Pennsylvania, as well as the District of Columbia, including Part B services in Arlington and Fairfax counties in Virginia and the city of Alexandria, Virginia.

2. IMPLEMENTATION CUTOVER DATE

a. Implementation Cutover Date

The Offeror shall use the Implementation cutover timeframes developed by CMS (see table below) when developing its proposed CLIN 0001 costs associated with its Jurisdiction Implementation Project Plan. Completion of the movement of the Jurisdiction to the incoming MAC shall occur as specified in Table 2 below. The Offeror shall assume that CMS will assign new Medicare workload identification numbers to the JL Part A and Part B workloads, effective at cutover, consistent with Change Request (CR) #6259.

At the implementation cutover date, the outgoing MAC ceases Medicare operations and the incoming MAC begins to perform Medicare business functions (CLIN 0002) for that jurisdiction. The following table considers each individual Customer Information Control System (CICS) Production region as an individual “segment.” Table 1 below identifies all of the CICS Production regions in JL. In addition, the breakdown of User Acceptance Testing (UAT) regions for JL mirrors the configuration (the same number and breakdown) of Production regions for JL.

For proposal purposes, the Offeror shall assume that CMS will support the build-out of new CICS production and UAT regions to mirror the configuration employed by the outgoing MAC as shown in Table 1, in order to support simulation testing and the conversion of claims history to the Offeror’s own claims history edit/audit taxonomy; further, the Offeror shall assume that CMS will arrange for necessary implementation support from the maintainers of the FISS, MCS, and CWF systems as well as the Virtual Data Center and the CWF host. The Offerors shall not propose any change to the number or configuration of CICS production or CICS UAT regions for the Implementation period. Offerors may propose an alternative approach to Implementation period simulation testing and claims history build-out as permitted by (and only as permitted by) the proposal submission instructions at RFP, L.14.5.3, Tab F.

Table 1: Implementation Cutover

(Delaware, Maryland, New Jersey, Pennsylvania, District of Columbia)

(including Part B services in Arlington and Fairfax counties in Virginia and the city of Alexandria, Virginia)

b. Healthcare Integrated General Ledger Accounting System (HIGLAS)

All workloads have been converted to HIGLAS; moreover, for proposal purposes, Offerors shall assume that the JL accounting operations have already been consolidated to one HIGLAS "organization ID" for Part A and one HIGLAS “organization ID” for Part B.

c. Joint Operating Agreements (JOAs); Operational Start Dates; CLIN Start/End Dates

Joint Operating Agreements between functional contractors impacting the new MACs shall be executed prior to the operational start date. (See the Statement of Work (SOW) section C.6.1 for more information on required JOAs.) The operational start date is defined as the date that the MAC assumes all Medicare functions from an outgoing contract and is capable of processing Medicare claims for that jurisdiction. Please refer to the implementation timeframes in the chart above for proposal purposes. These timeframes are depicted in the timeline below:

Attachment J.23 Government Provided Proposal Assumptions (GPPA)

RFP # 75FCMC20R0008

January 10, 2019 Page 2 of 14 Implementation and Base Periods:

6 months for Part B

Overlapping Implementation and Base Periods are shown below:

CLIN 0001 – Implementation

Start of CLIN 0001

End of CLIN 0001

CLIN 0002 – Base Period

Start of Part A Base Period Start of CLIN 0002 Start of Part B Base Period End of Base Period End of CLIN 0002

Table 2: Periods of Performance

Part B Date of contract award - 4 months for Part A Date of contract award - 6 months for Part B

Part B 8 months for Part A and 6 months for Part B

Part B 8 months for Part A and 6 months for Part B

3. JURISDICTION L – FACILITIES POPULATION BY TYPE

Within the GPPA Audit & Reimbursement Tables, Attachment J.23A, there is a tab titled “Facilities by Type” which presents the health care facilities populations, by type, that will be served by the A/B JL MAC. The Offeror shall use these facility counts when proposing hours and costs for its provider audit and reimbursement activities (in addition to the workloads in the BOE, Attachment J.22) as well as provider education and outreach activities, when completing the BOE and the Business Proposal.

Below is a brief description of the tables that are presented on the “Facilities by Type” tab in Attachment J.23.A:

· Table 3: Hospital Population by Type

· Table 4: Other Facilities Population by Type

· Table 5: Total Freestanding Facilities

· Table 6: Hospital Based Subproviders Populations by Type

4. JURISDICTION L – FACILITIES BY STATE

Within the GPPA Audit & Reimbursement Tables, Attachment J.23.A, there is a tab titled “Facilities by State” which presents the health care facilities populations by state and type that will be served by the A/B JL MAC. For JL, the Offeror shall assume a total of 731 “out-of-jurisdiction” facility-type providers, many of which are chain affiliated providers. The Offeror shall assume that it will service all of these facilities for all periods of performance (BY, OYs 1-6). The Offeror shall use these volumes when proposing hours and costs for its provider audit and reimbursement activities as well as provider education and outreach activities when completing the BOE and the Business Proposal. The total health care facility mix of the A/B JL MAC will be comprised of the providers listed in Table #7-8.

Below is a brief description of the tables that are presented on the “Facilities by State” tab of Attachment J.23.A:

· Table 7: Jurisdiction L Facilities By State – Facilities Within Jurisdiction

· Table 8: Jurisdiction L Facilities By State – Facilities Out of Jurisdiction

5. JURISDICTION L ESTIMATED ANNUAL WORKLOADS

Within the GPPA Audit & Reimbursement Tables, Attachment J.23.A, there are tables that present additional specificity for the health care facilities populations, by type, for the states of Delaware, Maryland, New Jersey, and Pennsylvania, as well as the District of Columbia, and other facilities outside of the four states and the one federal district serviced by JL. The additional specificity is intended to relay more information relative to the level of effort required for the audit workload of the facility population for this jurisdiction. The Offeror shall use this information when proposing hours and costs for its provider audit and reimbursement activities (in addition to the workloads in the BOE, Attachment J.22) when completing the BOE and the Business Proposal.

Below is a brief description of the tables that are presented on the “Estimated Annual Workloads” tab of Attachment J.23.A:

· Table 9: Estimated Annual Workloads – Cost Report/Cost Statement Acceptance

· Table 10: Estimated Annual Workloads – Tentative Settlement

· Table 11: Estimated Annual Workloads – Full Desk Reviews

· CMS used the numbers and types of providers in this jurisdiction to estimate the reasonable number of direct labor hours expected to complete the OY1 full desk review workload as shown in the Basis of Estimate. CMS will use this estimate when reviewing proposals for this workload. Offerors that propose to adjust the CMS-estimated hours for full desk reviews must explain why the adjustment is reasonable.

· Table 12: Estimated Annual Workloads – Limited Desk Reviews

· CMS used the numbers and types of providers in this jurisdiction to estimate the reasonable number of direct labor hours expected to complete the OY1 limited desk review workload as shown in the Basis of Estimate. CMS will use this estimate when reviewing proposals for this workload. Offerors that propose to adjust the CMS-estimated hours for limited desk reviews must explain why the adjustment is reasonable.

· Table 13: Estimated Annual Workloads – Audits

· CMS used the numbers and types of providers in this jurisdiction to estimate the reasonable number of direct labor hours expected to complete the OY1 audit workload as shown in the Basis of Estimate. CMS will use this estimate when reviewing proposals for this workload. Offerors that propose to adjust the CMS-estimated hours for audits must explain why the adjustment is reasonable.

· Table 14: Estimated Annual Workloads – Number of Interim Rates

· Table 15: Estimated Annual Workloads – Reimbursement Areas

· Table 16: Estimated Annual Workloads – PIP Providers

· Table 17: Estimated Annual Workloads – Cost Report Settlements

· Table 18: Estimated Annual Workloads –Reopenings

· Table 19: Estimated Annual Workloads – Cost Report Appeals

· Table 20: Estimated Annual Workloads – Cost Report Preliminary Position Papers by Provider Type

· Table 21: Estimated Annual Workloads – Wage Index

· Table 22: Estimated Annual Workloads – S-10 Reviews

· Table 23: Estimated Annual Workloads – HITECH

· Table 24: Estimated Annual Workloads – File Maintenance

· Table 25: Estimated Annual Workloads - Special Payment Status

· Table 26: Special Audits

6. ELECTRONIC DATA INTERFACE INQUIRIES

For proposal purposes, the Electronic Data Interface Inquiries (EDI) workloads are included in the overall inquiries workloads provided in the BOE (Attachment J.22). Offerors shall prepare proposals assuming that a workload transition will generate higher EDI inquiries during the Implementation and Base Year of the contract. The Offeror shall use the overall inquiries volumes when proposing hours and costs for the overall inquiries workloads.

7. CHANGE REQUESTS

CMS updated SOW section C.5.4.8 Participation in Change Management Process to remove the specific 46,200 hours reference. The change management information provided in the Basis of Estimate (BOE) remains the same. Offerors shall use the BOE as directed for proposal purposes. CMS issues approximately 633 draft change requests (CRs) to Medicare Contractors, Shared System Maintainers (SSMs), and the Common Working File (CWF) Maintenance Contractor for review and comment each year. This is otherwise known as the Point of Contact (POC) Review period, which is described in detail in section C.5.4.8 of the SOW, Participation in Change Management Process and includes the review of corrections. On average, a draft CR will go through approximately three rounds of POC review. Annually, approximately 480 of the draft CRs are issued in final for implementation and approximately 127 corrected CRs are issued annually. Annually, approximately 325 of those issued CRs result in changes to the Part A and/or Part B Shared Systems and the Common Working File. See the BOE (Attachment J.22) for specific workload assumptions.

8. REFERENCES TO MANUALS IN THE SOW

The Offeror shall prepare their proposal based upon the version of the Manuals (both the Internet-Only Manual (IOM) and Paper-Based Manuals) as of the date of the RFP release. In the event of any conflict, the Statement of Work (Attachment J.1) has precedence over the IOM, which in turn has precedence over the Paper-Based Manuals. The Offeror shall not respond to manual changes issued after the RFP release date unless otherwise instructed by CMS.

9. RECORDS RETENTION ASSUMPTIONS

For A/B MAC Jurisdiction L the Offeror shall assume 245,447 boxes of hard copy Medicare records located in an Iron Mountain facility. The current breakout of this total by locale is provided in the chart below. All boxes are currently stored in a National Archives and Records Administration (NARA) compliant facility that is certified by CMS and approved by NARA. These boxes are not required to be moved, but they must be maintained as directed by CMS in a NARA certified facility.

For proposal purposes, the Offeror may assume that zero (0) boxes of Medicare records will need to be moved to a CMS certified NARA compliant facility. The approximately 245,447 boxes of hard copy Medicare records for this Jurisdiction may be transferred via a tri-partite agreement (or a chain of custody agreement) between the current JL contractor, their file storage subcontractor, and the incoming JL contractor. CMS will approve this subcontract agreement prior to final execution by all parties. If the Offeror is moving these files, they need to be moved prior to the end of CLIN 0002 Base Year of the new JL contract.

The Offeror shall also include in their proposal (CLINs 0002 – 0008) the ongoing costs of storing a total of 245,447 boxes of Medicare records in a NARA compliant facility. The Offeror shall also provide an estimate of additional and ongoing storage costs for boxes of any hard-copy program records to be created during the performance of this new JL contract, and include these costs in their proposal. For instance, records created during CLIN 0002 would need to be stored for the balance of CLIN 0002, as well as for CLINs 0003-0008 (to the extent required by the federal records destruction schedule), etc. For proposal purposes, Offerors shall use the conversion factor that one (1) box = 1.2 cubic feet.

Table 27: Records Storage Facilities

10. MANAGEMENT OF PAPER BILLS/CLAIMS

In the management of paper bills and claims addressed in section C.5.8 of the SOW (Attachment J.1), the electronic images from the outgoing contractor will be transferred to the incoming contractor. For proposal purposes, the Offeror shall assume that the formats of these images are compatible with their systems. Additional information regarding the images from the outgoing contractor will be provided after contract award and during the implementation period.

11. ELECTRONIC DOCUMENT AND DATA RETRIEVAL

For obtaining, reading and storing historical electronic files addressed in section C.5.3 of the SOW (Attachment J.1): for proposal purposes, Offerors shall assume that historical electronic file formats are compatible with their systems. Additional information will be provided after contract award and during the implementation period.

12. PARTICIPATION IN CONFERENCES

In accordance with section C.5.4.7 of the SOW (Attachment J.1), the contractor shall participate in conferences. For proposal purposes, Offerors shall plan for 12 conferences annually, four (4) attendees at each conference, and two (2) overnights at each conference.

In addition to the 12 conferences, the Offeror shall also propose to attend two (2) CMS Security Control Oversight and Update Training (CSCOUT) conferences annually in February and August, with three (3) overnights at each conference attended by the MAC System Security Officer (SSO).

The Offeror shall propose to the following conferences and workgroups in the Provider Customer Service (PCSP) functional area: (a) In accordance with section C.5.4.7 of the SOW, a Provider Customer Service Program Conference once a year. Three (3) contractor staff may attend from a jurisdiction. Attendees will typically include a high-level representative from provider outreach and education, provider contact center, and provider self-service (IVR system, website, portal). (b) A Monthly Provider Customer Service Program User Group teleconference. Contractor jurisdiction representatives knowledgeable about provider outreach and education activities, provider contact center operations (telephone and written inquiries), and IVR, website, and portal operations/functions may attend. (c) Periodic workgroups (about two (2) per year) with CMS staff to address PCSP issues. Generally, a contractor jurisdiction would have two (2) representatives on each workgroup (a primary and a secondary) who are familiar with the issues to be addressed. The workgroups always meet by teleconference, usually on a monthly basis.

13. PROVIDER OUTREACH AND EDUCATION – DIRECT MAILINGS

For proposal purposes, Offerors shall plan for two (2) direct mailings a year, to all enrolled providers within their jurisdiction, in accordance with the Internet Only Manual Pub 100-9, Chapter 6 located at: IOM Pub 100-9, Chapter 6 (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/com109c06.pdf)

14. HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH ACT (HITECH)

The JL A/B MAC shall perform the activities required by section C.5.11.3.6 of the SOW (Attachment J.1). For proposal purposes, Offerors shall assume that the JL MAC has successfully accomplished the initial data load activities mentioned in this SOW provision. For proposal purposes, Offerors shall include costs associated with (1) Change Requests pertaining to HITECH incentive payment and audit requirements prior to or on the date of the RFP; and (2) periodic data maintenance activities as required by the SOW provision. CMS may define further HITECH requirements and add them to the MAC SOW as a post-award contract modification. CMS Regulations pertaining to the HITECH program (CMS-0033-F) are located in the Federal Register at: Federal Register: Medicare and Medicaid Programs; Electronic Health Record Incentive Program (https://www.federalregister.gov/documents/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-program)

15. BANKING

CMS provides banking services to MACs through standard commercial banking contracts between the commercial bank and CMS. The new A/B JL MAC workload will be assigned to US Bank for their MAC Medicare Bank Account.

CMS does not provide lockbox services as part of these standard commercial banking contracts. Therefore, Offerors shall include as part of this proposal any costs associated with creating their own subcontract for lockbox services. If the Offeror utilizes lockboxes, but wishes to change their banking procedures for this contract such that lockboxes are no longer needed for MAC functions, the Offeror shall include all associated implementation costs in their proposal.

Scenario: The MAC Contractor could coordinate with CMS and its assigned bank to open a lockbox and link that lockbox with the MAC’s Medicare Bank Account. In this example, the MAC Contractor would have to form a separate subcontract with the Bank to pay for the use of the lockbox, which shall be billed as an expense to the MAC Contract for which it has been established.

16. FREEDOM OF INFORMATION REQUESTS

Offerors will note that Freedom of Information Act (FOIA) workload has been included in the BOE (Attachment J.22).

17. STATEMENT OF STANDARDS FOR ATTESTATION ENGAGEMENTS #18

CMS updated SOW section C.5.4.10.4 Statement on Standards for Attestation Engagements 18 (SSAE 18), Offerors will no longer be required to procure a contract with an audit firm for the SSAE 18 audits. All MACs will be required to comply with the Statement of Standards for Attestation Engagements #18 (SSAE 18) auditing procedures as described in the SOW (Attachment J.1) section C.5.4.10.4.

18. MEDICARE BENEFICIARY IDENTIFIER (formerly known as SOCIAL SECURITY NUMBER REMOVAL INITIATIVE) The passage of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 (PL 114-10 s.501) on April 16, 2015, legislates the replacement of the Social Security Number (SSN) based Health Insurance Claim Number (HICN) from the Medicare Card. Implementation of this law occurred in April 2019. For proposal purposes, Offerors will be aware that instructions and future direction on the New Medicare Card will be directed through the Change Request Process as necessary.

19. ALJ HEARINGS PARTICIPATION/SUPPORT

The Offeror shall provide the assumptions used to allocate the workload volume between Part A and Part B ALJ Hearings Participation/Support in Proposal Volume II, TAB C, Offeror Proposal Assumptions.

20. PARTICIPATING PHYSICIANS PART B WORKLOADS

The Base Year volume for Participating Physicians Part B Workloads is dependent on the timing of the start of operations. Offerors shall assume, for JL proposal purposes, that they will be responsible for these workloads during the Base Year (i.e., Offerors will disregard the timeline in item #2 above for this one purpose only). See the BOE (Attachment J.22) for specific workload assumptions.

21. PM & MIP PROVIDER CUSTOMER SERVICE, PROVIDER OUTREACH AND EDUCATION

For PM & MIP Provider Customer Service, Provider Outreach and Education activities, the Offeror shall reference the tables below containing the provider population for the specified jurisdiction. It is up to the Offeror to determine the workload appropriate for each type of provider outreach and education activity. There are no CMS-specified staffing or workload requirements, so the Offeror must develop their own strategy for how they can best service the provider populations identified. Based on its strategy, the Offeror shall enter its workloads and supporting direct labor resources into the BOE (Attachment J.22). Any assumptions or narrative explanations shall be included in Proposal Volume II, TAB C, Offeror Proposal Assumptions.

PM & MIP Provider Customer Part A Workload For these workloads referenced above in items #3 and #4, and found in the BOE, Attachment J.22, it is up to the Offerors to determine the workload appropriate for each type of provider outreach and education activity. There are no minimum staffing requirements for this function, as long as SOW (Attachment J.1) and IOM requirements are met. Offerors must develop their own strategy for how they can best service the provider population.

Table 28: Part A Providers

PM & MIP Provider Customer Service Part B Workload The numbers provided below represents the provider population for the specified Jurisdiction by state. It is up to the Offerors to determine the workload appropriate for each type of provider outreach and education activity. There are no minimum staffing requirements for this function, as long as SOW (Attachment J.1) and IOM requirements are met. Offerors must develop their own strategy for how they can best service the provider population.

Table 29: Part B Providers

22. WEB PORTAL INQUIRIES TRANSACTIONS

CMS has removed the Web Portal Inquiries workload subcategory from the Provider Inquiries Part A and Part B workload category in the BOE. Additional rows have been added to the BOE to provide the number of Web Portal Inquiries - Transactions Received and Web Portal Inquiries - Transactions Returned, as defined in the Instructions tab of the Basis of Estimate. Offerors have been provided the workload numbers for Part A and Part B Web Portal Inquiries - Transactions Received and Web Portal Inquiries - Transactions Returned for proposal purposes. Offerors shall apply their own local experience to determine and propose to the portion of web portal inquiries transactions that require some level manual intervention.

23. PROVIDER TELEPHONE INQUIRIES

For proposal purposes, CMS provided Attachment J.23.B, GPPA CSR-Handled Telephone Inquiries Tables, which shall be completed by all Offerors.

24. OUTGOING CONTRACTOR PENDING AND BACKLOGS

For proposal purposes, Offerors will anticipate all pending workloads will be within acceptable, normal ranges. In addition, Offerors will assume any known backlogs are included in workloads provided in the BOE (Attachment J.22).

25. HOMELAND SECURITY PRESIDENTIAL DIRECTIVE (HSPD) 12

Offerors will be aware that instructions and future direction on HSPD 12 (policies for a common identification standard for federal employees and contractors) and Personal Identity Verification (PIV) credential requirements will be directed through the Change Request Process as timeframes and related activities are determined. For proposal purposes, Offerors are required to include estimated costs to comply with solicitation section H.20 CMS Security Clause (MAY 2018) only.

26. MEDICAL REVIEW WORKLOADS

Offerors will be aware that the several Medical Review workload subcategories and numbers provided in the BOE (Attachment J.22) have been developed based on CR 9809 and CR 10249. The workload numbers provided in the new category, “Prepay and Postpay Medical Record Provider Specific Probe Review” were developed based on previous MR workload categories including Prepay Complex Reviews - Service and Provider Specific, Probe Reviews - Prepay and Postpay Complex - Provider and Services Specific, and Postpay Complex Reviews. CMS no longer requires Offerors to break out this workload by pre and post pay reviews when proposing its staffing plan in the BOE. The Medical Review (MR) One-on-One Education workloads were developed consistent with the One-on-One definition in IOM 100-8 Program Integrity Manual (PIM) Chapter 7.2.2.18 One-on-One Education and in the PIM Chapter 3.2.5 Targeted Probe and Educate (TPE). Further details for One-on-One Education as relates to the TPE is found in CR 10249 and CR 10963.

27. PROVIDER ENROLLMENT REASSIGNMENTS [855Rs] CMS has further broken out Provider Enrollment Reassignment workload on the Basis of Estimate (Attachment J.22) for the various types of Part B Reassignments. The new breakout for Reassignments is as follows: [855-R] Stand Alone Reassignments (Paper/Web), [855-R] with an 855-B or 855-I Initial Application (Paper/Web), & [855-R] with an 855-B or 855-I Revalidation (Paper/Web). The Offeror shall use this information when proposing hours and costs for its provider enrollment activities. For proposal purposes, the Offeror shall propose a level of effort for the total number of Reassignments.

28. MEDICARE HEALTHCARE PROVIDER INTERVENTION PROGRAM (MPIP)

The goal of this program is to educate providers who are engaged in behavior that is potentially fraudulent, wasteful or abusive on proper claims billing practices in order to reduce the Medicare claims payment error rate. The JL MAC shall document all provider education interactions and shall monitor claims to evaluate the effectiveness of the MAC’s education efforts. If overpayment(s) are identified during the course of this program, the JL MAC shall adhere to the requirements in CMS IOM Publication 100-06, Medicare Financial Management Manual when recovering monies owed to Medicare and will notify the business owners of MPIP, the Division of Modeling and Analytics, of their intent to recover such monies.

The activities that Offerors will undertake within MPIP are the same as activities conducted in general MAC activities such as examining data related to payment errors and the education of providers on claims accuracy. After contract award, CMS will work with the MAC to develop and control the MPIP workload volumes. The Offeror shall prepare their proposal based on the annual workload assumptions provided in the chart below.

Table 30: MPIP Workload

29. KEY PERSONNEL CHANGE

CMS updated SOW section C.5.4.1 Key Personnel to remove the UPIC Liaison Key Personnel, refine dedication requirements for the Compliance Officer, and add a Key Personnel requirement for a Provider Enrollment Manager. The Provider Enrollment Manager shall manage and oversee all provider enrollment activities specified in the Statement of Work (C.5.5) and the Internet-Only Manuals (IOM 100-08, Chapter 15). The Compliance Officer is not required to be fully dedicated to the A/B MAC but must be dedicated to Medicare business lines.

30. CONTRACTOR ADVISORY COMMITTEE – ANNUAL IN PERSON MEETING

CMS updated SOW section C.5.6.1, for proposal purposes Offerors shall anticipate that at least one of the CAC meetings will be in person.

31. PRIOR AUTHORIZATION (PA) PROCESS FOR CERTAIN HOSPITAL OUTPATIENT DEPARTMENT (OPD) SERVICES The calendar year 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center (OPPS/ASC) Final Rule (CMS -1717-FC) established a nationwide prior authorization (PA) process and requirements for certain hospital Outpatient Department (OPD) services. CR #11634 provides specific direction on this process. The Basis of Estimate, Attachment J.22, has been updated to include workloads for this activity under SOW WBS section C.5.12.

32. THREE NEW ATTACHMENTS ADDED TO RFP

CMS has added three new attachments to the RFP to be submitted by Offerors: 1) Proposal Self-Check Tool (Attachment J.21), 2) Historic & Proposed FTE, Hours & Gross Cost Instructions & Narrative (Attachment J.22.A) and 3) Historic & Proposed FTE, Hours & Gross Cost Worksheet (Attachment J.22.B). Offerors are required to fully complete all of these attachments in support of its overall proposal, both technical and business. Proposal accuracy and consistency across your technical proposal, business proposal, and Attachments J.22, J.22.A and J.22.B is very important to CMS. The Self-Check Tool, Attachment J.21, will be used by the Government to validate the accuracy of your data. Detailed instructions for completion of the new attachments are provided within the documents.

33. CMS REQUESTING ONLY ELECTRONIC PROPOSALS

Due to the Public Health Emergency (PHE), CMS is not requesting paper or CD proposal submissions. CMS has provided detailed instructions in section L.11 for Offerors to e-mail electronic proposals.

34. WORKSHEET S-10 AUDITS

The Contractor shall conduct audits of Worksheet S-10 of the Medicare cost report utilizing the most current CMS Worksheet S-10 audit program and the Medicare reimbursement principles in accordance with guidelines outlined in the CMS Provider Reimbursement Manual Pub. 15-1, and 15-2 Chapter 40 at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Paper-Based-Manuals.html and applicable regulations. Contractor will follow timelines as established in CMS guidelines.

CMS anticipates auditing all cost reports that begin during Federal FY 2018 and later for hospitals that qualify for the Disproportionate Share Hospital (DSH) payment adjustment. CMS will determine the scope of the audits and will provide instructions prior to each review cycle.

Background: Data from Worksheet S-10 of the Medicare cost report may be utilized by CMS for various purposes, including the DSH payment adjustment, per 42 CFR 412.106. Audits of Worksheet S-10 are conducted to provide reasonable assurance that program payments are based on Medicare regulations, reimbursement principles, and cost reporting instructions (CMS Provider Reimbursement Manual Pub. 15-2 Chapter 40, Section 4012).

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