E.2_MRAC_Q&As.docx

E.2. – MRAC Q&As MRAC - Questions and Responses – 75FCMC23R0015_Amendment 0001

REQUEST FOR PROPOSAL QUESTIONS (RFP)

1. (Question #) Section (i.e., RFP, SOW): RFP Title and Number (including subparagraph designations): E.10 PROPOSAL ORGANIZATION, Electronic Proposals Page Number: p. 79 Question: MS Word can alter text fonts and spacing when viewed on different systems, leading to shifts in layout that may affect page count. The language provided appears to suggest that the Technical Proposal (with the exception of the Organization Chart and Factor 5, Past Performance) should be submitted in MS Word .docx format. Is it acceptable to submit these sections in PDF format to ensure that text and page count remain stable?

CMS Response: Yes.

2. (Question #) Section (i.e., RFP, SOW): RFP Title and Number (including subparagraph designations): E.13 508 COMPLIANCE & CONFLICT OF INTEREST PROPOSAL SUBMISSION INSTRUCTIONS (VOLUME IV), Section A: 508 Compliance Page Number: p. 87 Question: The referenced section states, “The Offeror shall demonstrate Section 508 compliance by submitting the applicable completed HHS Accessibility Checklist(s)” and references a website that contains 5 different checklists. Which of those checklists are “applicable” for the proposal submission?

CMS Response: Each Microsoft application has a corresponding HHS Accessibility Checklist that must be completed to ensure that the document is 508 compliant. The Offeror should submit the appropriate HHS Accessibility Checklist that is applicable for the type of document(s) that they will be using for their proposal submission.

3. (Question #) Section (i.e., RFP, SOW): RFP Title and Number (including subparagraph designations): B.2 Continuation of Block 18a, Schedule of Payments Page Number: pp. 3-6 Question: Blocks for Task 4 - Standard Medical Review, Task 4 - Program Integrity Medical Review, Task 5 - Agreement/Disagreement Worksheets – Standard Workload, and Task 5 - Disagreement Worksheets - PI Workload are all marked with “**”, indicating that “Those prices are per each work product and will be paid after the final deliverable for each work product is accepted by the Government.” According to the pricing sheet, there are up to 20,200 of these deliverables per year, or 1,650+ separate deliverables per month. Per the timeline provided in the SOW, it could take at least a month or more to complete each deliverable and submit them to CMS. There is no timeline given for Government approval of these deliverables, which would force an 8(a) contractor to carry significant costs for a long period of time before receiving payment. It would also require significant administrative costs tracking each deliverable separately to determine when each could be billed and paid. Will the Government amend this invoicing structure to allow the contractor to bill the government for 1/12 of the annual cost of the contract each month?

CMS Response: No. This is a firm-fixed price contract, where the prices for each deliverable will be agreed upon before the award of the contract. The Government anticipates the acceptance of deliverables within approximately one week after the submission to the COR. The contractor will be able to bill monthly for each deliverable completed and accepted during the previous month. Therefore, as long as acceptable deliverables are provided, there should be no long delays posing hardship for an 8(a) contractor.

4. (Question #) Section (i.e., RFP, SOW): RFP Title and Number (including subparagraph designations): B.2 Continuation of Block 18a, Schedule of Payments Page Number: pp. 3-6 Question: Blocks for Task 4 - Standard Medical Review, Task 4 - Program Integrity Medical Review, Task 5 - Agreement/Disagreement Worksheets – Standard Workload, and Task 5 - Disagreement Worksheets - PI Workload are all marked with “**”, indicating that “Those prices are per each work product and will be paid after the final deliverable for each work product is accepted by the Government.” According to the pricing sheet, there are up to 20,200 of these deliverables per year, or 1,650+ separate deliverables per month. Per the timeline provided in the SOW, it could take at least a month or more to complete each deliverable and submit them to CMS. There is no timeline given for Government approval of these deliverables, which would force an 8(a) contractor to carry significant costs for a long period of time before receiving payment. Will the Government please provide a definition of “Government acceptance” of deliverables and a specific, guaranteed period of time (e.g., 5 business days) within which the government will accept deliverables, so an 8(a) contractor can receive prompt payment for its work?

CMS Response: The Offeror should anticipate receiving approval of reports, dashboards, and other deliverables within approximately one week after the submission to the COR.

5. (Question #) Section (i.e., RFP, SOW): RFP Title and Number (including subparagraph designations): C.11 PAYMENTS - INVOICES – (AUG 2020), b. CONTENT OF INVOICE Page Number: p. 23 Question: What attachments to the monthly invoices are being requested? Individual reporting of reviews could be very onerous on small business.

CMS Response: No attachments are needed, as long as the invoice provides current and cumulative reporting per each SLIN.

6. (Question #) Section (i.e., RFP, SOW): RFP Title and Number (including subparagraph designations): B.2 Continuation of Block 18a, Schedule of Payments; C.11 PAYMENTS - INVOICES – (AUG 2020), b. CONTENT OF INVOICE Page Number: pp. 3-6; 23 Question: Administrative Cost SLINs are billed monthly as FFP and are not based on medical review work units that need to be accepted by the Government before payment. Is it acceptable to provide separate monthly invoices (1/12 of period total) for Administrative Costs from the billings for the medical reviews to prevent holding up any payment not related to the reviews, due to unacceptability, which could be difficult for a small business?

CMS Response: One invoice can be provided for more than one SLIN, so it is possible to bill the Government on one invoice for administrative SLINs, as well as for completed units of reviews performed during the previous month. For each of the SLINs corresponding to medical reviews, the contractor will bill for the number of units completed during the prior month and multiply it by the agreed upon price per unit. For each of the administrative SLINs, the contractor will bill the agreed upon monthly amount.

7. (Question #) Section (i.e., RFP, SOW): RFP Title and Number (including subparagraph designations): B.2 Continuation of Block 18a, Schedule of Payments; C.11 PAYMENTS - INVOICES – (AUG 2020), d. PAYMENTS Page Number: pp. 3-6; 24 Question: What becomes the process should there be unacceptable reviews in the monthly invoice? For example, if 1,000 reviews are billed and the Government determines 10 to be unacceptable, what is the disposition of the invoice – returned to contractor for reduction to 990 reviews, Government pays 990 and informs contractor of unacceptable reviews, etc.?

CMS Response: The Table in Section B.2 (see “**”) has been updated to provide greater clarification. Based on your example, 1,000 reviews will be billed and paid, as submitted. Ten of those found to be unacceptable will require correction but the Contractor may retain payment.

8. (Question #) Section (i.e., RFP, SOW): RFP Title and Number (including subparagraph designations): B.2 Continuation of Block 18a, Schedule of Payments; C.11 PAYMENTS - INVOICES – (AUG 2020), d. PAYMENTS Page Number: pp. 3-6; 24 Question: How long is the Government’s acceptance process? How long will it take to notify the contractor, and will the Government indicate the nature of unacceptability?

CMS Response: See replies to Questions 3, 4, and 7 above.

9. (Question #) Section (i.e., RFP, SOW): RFP Title and Number (including subparagraph designations): B.2 Continuation of Block 18a, Schedule of Payments; C.11 PAYMENTS - INVOICES – (AUG 2020), d. PAYMENTS Page Number: pp. 3-6; 24 Question: Extended payments on invoices due to small volumes of unacceptable reviews is onerous on small business. What float time is anticipated prior to payment? And would the Prompt Payment Act (PPA) be invoked in all situations similar to this?

CMS Response: See reply to Questions 6 and 7 above.

10. (Question #) Section (i.e., RFP, SOW):

Title and Number (including subparagraph designations): B.2 Continuation of Block 18a, Schedule of Payments; C.11 PAYMENTS - INVOICES – (AUG 2020), d. PAYMENTS Page Number: p.24 Question: This solicitation contains FAR 52.212-4 Contract Terms and Conditions – Commercial Items. Please confirm that the Government assumes that the products and services provided are considered commercial products and services and will therefore not be subject to separate inspection and acceptance provisions. Acceptance of the products and services provided hereunder will defer to the contractor’s commercial processes as other acceptance procedures will be considered inappropriate.

It is understood per FAR 12.402 (b) that other acceptance procedures may be more appropriate for the acquisition of complex commercial products or commercial services, or commercial products or commercial services used in critical applications. In such cases, the contracting officer shall include alternative inspection procedure(s) in an addendum and ensure these procedures and the post award remedies adequately protect the interests of the Government. The contracting officer must carefully examine the terms and conditions of any express warranty with regard to the effect it may have on the Government’s available post-award remedies. Please confirm the services being acquired under the solicitation are not considered complex commercial products or services and therefore subject to separate inspection and acceptance terms.

CMS Response: FAR 52.212-4, Contract Terms and Conditions – Commercial Items (Dec 2022), FAR 52.246-4, Inspection of Services- Fixed-Price (August 1996), and PAYMENTS - INVOICES – (AUG 2020) are all applicable to this requirement.

11. (Question #) Section (i.e., RFP, SOW): RFP

Title and Number (including subparagraph designations): Section E.6, Proposal Submission

Page Number: 77

Question: Will the government consider extending for 2 weeks to aid in enhancing proposal strategy?

CMS Response: It is not clear which part of the process the requestor would like to see extended. CMS believes that the timeline for submission of each phase of the proposal is adequate considering what needs to be prepared for each phase. The due dates are as stated in the Amendment 0001 to the solicitation.

STATEMENT OF WORK (SOW) QUESTIONS

12. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): C, General Assumptions and Constraints; Standard workload:

Page Number: 3 Questions:

1. Can you provide the review type(s)/issue(s) which be reviewed for each of the MRCs?

CMS Response: For standard workload, the review claim types are Medicare Part A, B, DME, Prior authorization, Medicare Administrative Contractor (MAC) award fee and Targeted Probe and Educate (TPE) claims.

2. Can you provide estimates of time to complete claims/review types?

CMS Response: Please refer to SOW Task 4.1 which states, “Upon receipt of the medical records and related documents, the MRAC shall acknowledge receipt via email and complete the medical review within 20 business days unless otherwise specified by the MRAC COR/ACOR (i.e., an assigned special study.)”

3. Case rates versus hourly rates? - Or is this Cost Reimbursement?

CMS Response: This is a Firm-Fixed-Price. The Contractor will be paid a fixed-price for the completion of each deliverable identified in Solicitation Section B.2.

4. Are Physician Reviewers required?

CMS Response: Please refer to the Key Personnel requirements identified in the SOW.

5. Is this Nurse review only; physician review only; both?

CMS Response: Please refer to the Key Personnel requirements identified in the SOW.

6. How many claims/reviews will be included in the “entire pool” of related claims as a whole for FWA patterns and/or trends?

CMS Response: The “entire pool” phrase used in the SOW does not apply to the standard workload.

7. Will there be claims/reviews focused only on coding/billing which do not require clinical judgement, but review should be completed by only the use of coding guidelines?

CMS Response: No.

8. The reviews will be completed in the CMS system, or the information can be transitioned into the vendors system?

CMS Response: The medical records/documentation will be stored in the MRAC’s system upon award of the contract. Once the CMS systems are operational, the Contractor will use them to document and conduct the medical review processes, as well as, to store the medical records.

9. Monthly Cost Report and Monthly Workload Tracker Dashboard/Report states within 10 business days of the start of each month. Are these reporting on the prior month?

CMS Response: Yes. For example, the April monthly report, which will be submitted on May 10th, would show claims received in February and March but completed in April. The report shall also show the remaining claims to be completed by month. For example, the April report would show that there are still five claims to be reviewed for February and 20 for March at the end of April.

10. What are the case mix types that will/could make up the standard workload monthly?

CMS Response: The monthly standard workload claim types will consist of Medicare Part A, B, DME, Prior Authorization claims, MAC award fee, and TPE claims.

11. Is there a cap on the number claims/reviews that will be in the ‘entire pool ‘of claims? or limit by case type?

CMS Response: The “entire pool” phrase used in the SOW does not apply to the standard workload.

12. What is the productivity expectations? Turnaround times?

CMS Response: Please refer to SOW Tasks 4.1 for specific timeframes.

13. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): C: General Assumptions and Constraints; Program Integrity workload.

Page Number:3 Question:

1. What are the possible case mix types that make up this workload?

CMS Response: For Program Integrity workload, the review claim types are Medicare Part A, B and DME and Medicaid.

1. Are Physician Reviewers required?

CMS Response: Please refer to the Key Personnel requirements identified in the SOW.

1. Is there a cap on the number claims/reviews that will be in the ‘entire pool ‘of claims? or limit by case type?

CMS Response: The “entire pool” term used in the SOW refers to the number of claims associated with an investigation and the number and type of claims varies from one investigation to the other.

1. What is the productivity expectations? Turnaround times?

CMS Response: Please refer to SOW Tasks 4.2 for specific timeframes.

14. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): 2. Information Security Requirements Page Number: p.4 Question: Regarding the requirement to “Obtain and maintain the Authority to Operate (ATO) for a Secure File Transfer Protocol (SFTP) data server and/or other methods approved by CMS to receive medical records/documentation from the MRC’s”:

· The SOW does not contain any requirement to build or host an SFTP data server, only to obtain an ATO for one. What are the requirements for the SFTP data server?

CMS Response: Please refer to Section II.2 Information Security Requirements of the SOW.

· How long does the MRAC contractor need to operate the temporary SFTP data server?

CMS Response: Until the CMS systems are operational. There is no estimated timeline.

· Can the MRAC contractor propose to build and host an SFTP data server in the CMS AWS Cloud Enclave, with the AWS costs being directly borne by CMS and not MRAC?

CMS Response: Please refer to Section II.2 Information Security Requirements of the SOW. CMS is not acquiring the contractor system.

· Are non-SFTP solutions acceptable?

CMS Response: CMS will review any solution proposed by the contractor, the solution must be FISMA compliant and have the ability to obtain an ATO.

· Are FedRAMP certified data/document storage solutions acceptable?

CMS Response: CMS will review any solution proposed by the contractor, the solution must be FISMA compliant and have the ability to obtain an ATO.

· Can the existing SFTP data server solution be temporarily utilized until the Recovery Audit Contract Data Warehouse (RACDW) and the Unified Case Management (UCM) MR capabilities are operational?

CMS Response: No, the SFTP data server is owned by the current MRAC, not the Government. Please refer to Section II.2 Information Security Requirements of the SOW.

· What is the current timeline for when the Recovery Audit Contract Data Warehouse (RACDW) and the Unified Case Management (UCM) MR capabilities will be operational? Are they on the same timeline or two different ones?

CMS Response: Both systems are on different timelines. CMS does not have an estimated date when they will be operational.

15. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): B. Specific Requirements, Task 1 – Transition-In Period Page Number: p. 8 Question: The SOW states that “no later than 60-days after contract award,” the Contractor must “Obtain and maintain the ATO for a Secure File Transfer Protocol (SFTP) data server and/or other methods approved by CMS to receive medical records/documentation from the MRCs.” Are all CMS components (CPI, OIT, TRB, ISPG, etc.) and its independent security and penetration testing contractors able to commit to delivering all critical path tasks necessary to obtain an ATO within 60 days?

CMS Response: CMS is prepared to expedite the process so the server can receive an ATO within the allotted time.

16. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): Task 4 – Accuracy Medical Review Process for the Standard and PI Workload Page Number: p. 12 Question: Please provide the volume of cases that go to a specialty panel by Standard and PI Workload. If available, what is the breakdown of cases within each workload that go to specialty physicians, dieticians, or therapists?

CMS Response: This is unknown because it is dependent on the universe submitted by the Medical Review Contractors (MRCs). The claim types submitted in the universe by the MRCs to be sampled and reviewed by the MRAC depends on the type of medical reviews that were completed the month prior.

17. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): Task 4.1 – Standard Medical Accuracy Reviews for MACs, SMRC, and RRB SMAC

Page Number: p. 12 Question: Does CMS have any historical data regarding the average time to complete a standard accuracy review?

CMS Response: Please refer to SOW Task 4.1 for the timelines.

18. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): Task 4 – Accuracy Medical Review Process for the Standard and PI Workload; General Requirements

Page Number: 13 Question: Does CMS have any historical data for the past three years regarding the leading rationale/reasons for disagreements and the agreement/accuracy rate?

CMS Response: The main reason for the disagreements is either the MRAC disagrees with the MRC’s payment decision or with the rationale provided. In addition, for Program Integrity, medical review includes whether claims contain FWA patterns and/or trends, which may support the allegation of potential FWA.

19. (Question #) Section (i.e., RFP, SOW):

Title and Number (including subparagraph designations): Task 4 – Accuracy Medical Review Process for the Standard and PI Workload; General Requirements

Page Number: p. 12 Question: Using the incumbent contractor’s historical information, what percentage of each workload category does CMS anticipate will involve a complex review?

CMS Response: All the medical reviews are complex reviews. The MRAC is reviewing all the information used by the MRC to determine if the MRC made the correct decision.

20. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): Task 1.4 –Quality Control/Quality Assurance (QC/ QA) Plan

Page Number: p. 9 Question: Does CMS have a standard inter-rater reliability (IRR) protocol, or will the contractor be expected to propose a methodology?

CMS Response: In accordance with SOW Task 1.4, IRR protocol is part of the contractor’s QC/QA plan.

21. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): 3. Key Personnel, B. Contract Medical Director (CMD)

Page Number: p. 5 Question: Based on the past several years, what percentage of cases is reviewed by the Contract Medical Director (CMD)?

CMS Response: Please refer to the Key Personnel requirements identified in the SOW. The CMD is an integral part of the contract, and their involvement is at the discretion of the contractor.

22. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): Task 1.4 –Quality Control/Quality Assurance (QC/ QA) Plan

Page Number: p. 9 Question: What is the frequency of reporting the MRAC inter-rater reliability (IRR) to CMS? Is there a minimum required IRR agreement rate?

CMS Response: In accordance with SOW Task 6.3, the IRR should be included as part of the QC/QA plan in the monthly report. The rate should be determined by the Contractor when establishing the QC/QA plan, which must be approved by the COR.

23. (Question #) Section (I.e., RFP, SOW): SOW Title and Number (including subparagraph designations): Task 1.4 –Quality Control/Quality Assurance (QC/ QA) Plan

Page Number: 9 Question: Does the government have minimum sample sizes they expect the contractor to use for calculating IRRs for the standard and PI workloads? Does the government have expectation of the proportion of the IRR sample selected from the various programs?

CMS Response: The sample size should be determined by the Contractor when establishing the QC/QA plan, which must be approved by the COR.

24. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): Task 4.2 – PI Medical Accuracy Reviews for UPICs, SMRC PI and SMRC HFPP

Page Number: p. 14 Question: Does CMS have any historical data regarding the average time to complete a program integrity review?

CMS Response: In accordance with the SOW, Task 4.2, “Upon receipt of the medical records and related documents, the MRAC shall acknowledge receipt via email and complete the medical review within 20 business days unless otherwise specified by the MRAC COR/ACOR (i.e., an assigned special study.)

25. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): Task 4 – Accuracy Medical Review Process for the Standard and PI Workload, General Requirements “The purpose of the MR process is to measure the accuracy rate for each MRC by medically reviewing a representative sample of claims that each MRC has previously reviewed.”

Page Number: p. 12 Question: Is the contractor expected to describe/submit the methodology it uses to determine representative samples? Or, will CMS set the parameters of what constitutes "a representative number of claims (based on the universe)" CMS Response: The Contractor is expected to describe/submit the methodology it will be using to ensure the sample is randomly selected as part of their Project Plan (SOW Task 1.2).

26. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): I. Scope, B. Background Page Number: p. 2 “In addition, the evaluation includes whether claims contain FWA patterns and/or trends, which may support the allegation of potential FWA.”

Question: Is the contractor expected to describe/submit the methodology it uses to determine Fraud, Waste, and Abuse (FWA)?

CMS Response: The Offeror’s response shall describe their understanding and approach to conducting accurate medical reviews for Program Integrity Workload in accordance with the SOW and applicable rules and regulations.

27. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): Task 4 – Accuracy Medical Review Process for the Standard and PI Workload, General Requirements Page Number: p. 12 “CMS/CPI is operationalizing the RACDW for the Standard workload and UCM for the PI workload to be the MR system of record for the MRCs and the MRAC.”

Question: Will the MRAC be expected to maintain two separate Secure File Transfer Protocols (SFTPs) until the Recovery Audit Contract Data Warehouse (RACDW) and Unified Case Management (UCM) are operational?

CMS Response: It is at the Contractor’s discretion as to whether or not they divide their SFTP server. As a reminder, CMS is only providing one ATO.

28. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): I. Scope, A. A. Purpose of Contract Page Number: p. 2 Question: Can CMS please specify what they mean by “additional documents” in the following statement, “MRAC’s claim reviews require the use of clinical review judgment in the evaluation of medical records and related documents to determine whether the MRCs made accurate claim decisions”?

CMS Response: The MRAC will review all the documentation used by the Medical Review Contractor (MRC) in their medical review evaluation to determine if the MRC made the correct payment decision. The additional documentation is any information/system screenshots used by the Medical Review Contractor in their medical review of a Medicare Part A, B, DME, PARs, MAC award fee, and TPE claims and/or Medicaid claim review.

29. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): I. Scope, A. Purpose of Contract Page Number: p. 2 Question: Can CMS please provide information on the data formats expected for “additional documents” to be reviewed by the contractor?

CMS Response: The additional documentation is any information/system screenshots used by the Medical Review Contractor in their medical review of a Medicare Part A, B, DME, PARs, MAC award fee, TPE, and/or Medicaid claim review.

30. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): I. Scope, C. General Assumptions and Constraints Page Number: p. 3 Question: Can CMS please provide information on where and how the MRCs send/upload the mix of claim types for sampling? Is there a standard data format used by the MRCs?

CMS Response: The specifics of what data is uploaded by the MRCs is specified in the JOAs. The information varies especially for the standard MRCs. The Program Integrity contractors have a standardized Excel spreadsheet. A copy of the JOAs will be provided upon contract award.

31. (Question #) Section (i.e., RFP, SOW): SOW Title and Number (including subparagraph designations): I. Scope, C. General Assumptions and Constraints Page Number: p. 3 Question: Is there a standard data format and or method used by the MRCs to send/upload the mix of claim types for sampling?

CMS Response: The specifics of what data is uploaded by the MRCs is specified in the JOAs. The information varies especially for the standard MRCs. The Program Integrity contractors have a standardized Excel spreadsheet. A copy of the JOAs will be provided upon contract award.

32. (Question #) Section (I.e., RFP, SOW): SOW Title and Number (including subparagraph designations): B. Specific Requirements, Task 1 – Transition-In Period Page Number: p. 8 Question: Can CMS please confirm that they expect the incoming contractor to have access to the Common Working File (CWF), within 60 days of the contract start date? The process for executing a Data Use Agreement and then getting the require access to covered systems will often take longer than 60 days and is, to some extent, out of the control of the contractor.

CMS Response: The MRAC is not given access to the CFW because access to CFW is not necessary to review the claims. All the documentation/screenshots required for review should be provided by the Medical Review Contractors.

33. (Question #) Section (I.e., RFP, SOW): SOW Title and Number (including subparagraph designations): B. Specific Requirements, Task 1 – Transition-In Period Page Number: p. 8 Question: Will CMS confirm the maximum number of reviews that the incoming contractor will be responsible for during the transition period once the incoming contractor is fully operational?

CMS Response: In accordance with SOW Task 1, the contractor is unable to perform any reviews during the transition period since work cannot be performed by the incoming contractor until all of the JOAs are in place. The expectation is that the incoming contractor will not be responsible for conducting any reviews during the 60-day transition period. If the JOAs are in place sooner than the 60-days, it is at the Contractor’s discretion whether or not they want to begin conducting reviews and shall be agreed upon by the COR.

34. (Question #) Section (I.e., RFP, SOW): SOW Title and Number (including subparagraph designations): I Scope C. General Assumptions and Constraints Page Number: p. 3 3rd bullet Question: Does this refer to the incumbent MRAC IT systems?

CMS Response: CMS is not acquiring the facilities or IT systems (hardware or software) used to support performance of the work from the current MRAC (incumbent) or the incoming MRAC.

35. (Question #) Section (I.e., RFP, SOW): SOW Title and Number (including subparagraph designations): B. Specific Requirements Task 4 Accuracy Medical Review Process for the Standard and PI Workload General Requirements Page Number: p. 12 Question: The SOW States: Services reviewed by other licensed health care professionals shall be within their scope of practice and the project-specific medical review strategy shall support the need for their specialized expertise in the review of a particular claim type. Please clarify what is meant by "project-specific medical review strategy shall support the need" Are there specific claim types, procedures or other scenarios that require the use of "other licensed health care professionals" or is it at the discretion of the MRAC?

CMS Response: There are claims that will need to be reviewed by licensed health care professionals in specialized fields.

36. (Question #) Section (I.e., RFP, SOW): SOW Title and Number (including subparagraph designations): B. Specific Requirements Task 4 Accuracy Medical Review Process for the Standard and PI Workload General Requirements Page Number: p. 12 Question: Will this be "End User Testing" or will the MRAC need to engage trained Testing Resources for this activity?

CMS Response: This will be “End User Testing”.

37. (Question #) Section, if applicable: Task 4- Accuracy Medical Review Process for the Standard and PI Workload Document, Section & Page Number as applicable: 12 Question:

1. …..coding determinations shall be performed by certified professional coders or clinicians with approved coding credentials- does the software provided have access to coding groupers?

1. Is coding performed based on clinical validation or coding guideline since these are two very distinct types of review.

CMS Response: No software is provided by CMS. If a medical review of a Medicare claim requires coding review, it is expected that the MRAC will perform the same review that the MRC did to ensure that the coding was done appropriately and within the guidelines.

38. (Question #) Section (I.e., RFP, SOW): SOW Title and Number (including subparagraph designations): Task 4 – Accuracy Medical Review Process for the Standard and PI Workload, Task 4.2 – PI Medical Accuracy Reviews for UPICs, SMRC PI and SMRC HFPP Page Number: p. 13 Question: Regarding the gathering of materials by MRC for upload to UCM or SFTP Server: Will the MRC be given ample time in which they can upload data before the close window? Are there any limitations on file sizes or UCM compatible content? How are credentials provided to the MRC prior to upload?

CMS Response: The MRCs currently upload all the medical records/information required for review into the MRAC’s SFTP server, on the same timeline as the SOW provided in the Solicitation. The timelines are outlined in SOW Tasks 4.1 and 4.2. File size limitations and credentials are included in each JOA.

39. (Question #) Section (I.e., RFP, SOW): SOW Title and Number (including subparagraph designations): Task 5 – Accuracy Review Worksheet(s), Task 5.2 The Accuracy Review Agreement Worksheets Page Number: p. 16 Question: Regarding the MAC award fee versus Prior Authorization Requests (PARs), what is the distinction between worksheets provided for these subtasks and how is the MRAC notified of any PAR?

CMS Response: The specifications are in each JOA, but in general, each MRC identifies the type of workload (i.e., award fee, PAR) on an excel spreadsheet either as a part of a header or on a separate Excel spreadsheet tab included with the monthly universe submission.

40. (Question #) Section (I.e., RFP, SOW): SOW Title and Number (including subparagraph designations): Task 7—Annual Performance Evaluation, Task 7.1. Standard – Performance Metrics Page Number: p. 18 Question: How are representative samples chosen and does the MRAC contribute to the sample choice? Can the scoring methodology be shared prior to performance reviews?

CMS Response: In accordance with SOW Tasks 7.1 and 7.2, CMS will review a representative sample of disagreements, the MRAC does not contribute to the selection of the sample. CMS does not share the scoring methodology prior to the review.

41. (Question #) Section (I.e., RFP, SOW): SOW Title and Number (including subparagraph designations): APPENDIX B – SECURITY REQUIREMENTS, h. Internet Protocol Version 6 (IPv6) Page Number: p. 25 Question: This section contains details around adherence to IPv6. How is this possible if most transport is still IPv4?

CMS Response: The Federal Mandate is to be 100% IPV6.

MISCELLANEOUS QUESTIONS

42. (Question #) Section, if applicable: RFP, E.10 PROPOSAL ORGANIZATION, Electronic Proposals, p. 79 Document, Section & Page Number as applicable: E.4 Prime Proposal Checklist, p. 2 Question: The table in E.4 provided for subcontractor information violates the 1” margin standards noted in the RFP. Will the government make an exception to the margin standards for this document, or should each contractor reformat E.4 (e.g., make the document landscape, change the fonts and cell dimensions in the table) to ensure that the required margins are maintained?

CMS Response: Please, see the revised Exhibit E.4.

43. (Question #) Section, if applicable: RFP Document, Section & Page Number as applicable: RFP, E.8 SOLICITATION QUESTIONS AND NOTICE OF INTENT, p. 78 Question: Since the answers to some of our company’s questions directly affect the content of our Technical Approach, will CMS commit to releasing the Q&A at least 48 hours prior to the due date for Phase 1, even if it requires moving the Phase 1 due date out further?

CMS Response: The due dates are as stated in the Amendment 0001 to the solicitation.