E.2 Q&A- Responses to Draft RFP.pdf

Draft RFP No. 75FCMC25RJ003 Questions Answers

Section Subsection Page number Contractors Question CMS Response

RFP N/A N/A Draft RFP states "under development" - to ensure clarity for all requirements and appropriate proposal response, in the final RFP, will CMS provide additional information for this section?

All sections that state "under development" will have additional information in the final

RFP.

B.3 Schedule of Supplies/ Services 5 of 57

For section B.3 Continuation of Blocks 19-24, at the bottom of page 5, CMS states "The firm fixed contingency fee percentage that will be applied to each all categories of claim review is (TBD)%." Is CMS planning on issuing guidance to offerors that would necessitate varied contingency rates based on the type of claim review?

If yes, please provide this guidance so offerors may apply this guidance to the Business Proposal.

The sentence, "For section B.3 Continuation of Blocks 19-24, at the bottom of page 5, CMS states "The firm fixed contingency fee percentage that will be applied to each all categories of claim review is (TBD)%." has been removed from Section B.3. There will be one contingency fee applicable to all categories of claims.

B.3 Schedule of Supplies/ Services 5 of 57

CMS states: "The chart below provides the applicable firm fixed contingency fee proposed per category of recovery for Region (TBD)." The referenced chart is not included in the draft RFP. CMS also states: "The firm fixed contingency fee percentage that will be applied to each all categories of claim review is (TBD)%."

Can CMS clarify/confirm that the Offeror will propose a separate firm fixed price contingency fee for each category (in the chart yet to be provided) of recovery for each Region?

The sentence, "For section B.3 Continuation of Blocks 19-24, at the bottom of page 5, CMS states "The firm fixed contingency fee percentage that will be applied to each all categories of claim review is (TBD)%." has been removed from Section B.3. There will be one contingency fee applicable to all categories of claims.

B.3 Schedule of Supplies/ Services 5 of 57

CMS states: "In order to be complaint with CMS systems, funding has been included during this time of award. The amount of funding that is obligated to this contract is not guaranteed to the contractor. The RAC payments process is identified in Section B.2. The obligated amount for this contract is $TBD."

It is the contractor's responsibility to notify the Contracting Officer (CO) and Contracting Officer Representative (COR) when the contractor expects the balance of obligated funds to be at or less than $3,000,000. Delay in this notice will delay payments until a modification is completed."

Will CMS consider deleting this requirement, since the source of funding for payments to the contract is recovered amounts attributable to the Medicare Trust Funds as opposed to fiscal year appropriations?

No, this requirement cannot be changed.

B.3 Schedule of Supplies/ Services 6 of 57

CMS states in the table under Item 001: "Severability: No" and under Item 002: "Severability: Yes".

Can CMS clarify the applicability of severability to the contract, which normally relates to the obligation and use of appropriated funds?

The inclusion of this information, CLIN severability/non-severability, is the result of a new contract writing system recently deployed by the agency. This particular information is relevant for internal agency purposes only. The RACs are funded by no year money therefore severability is not applicable.

H H.X 19 of 57

In section H.X HHSAR 352.204-71 Information and Information Systems Security (Feb 2024) (Deviation), subsection (f) at top of page 19, first paragraph, first sentence, CMS states the contractor "shall provide written notification to the COR immediately, and not later than four (4) hours [emphasis added], when an employee working . . . ".

The requirement for notification within 4-hours may not always be possible based on operational workflows, will CMS consider modifying this requirement to "not later than 24-hours"?

The requirement has been updated to allow notification within 24-hours.

H H.X 19 of 57

In section H.X HHSAR 352.204-71 Information and Information Systems Security (Feb 2024) (Deviation), subsection (g) near the top of page 19, CMS states the contractor and subcontractors "shall submit completed non-disclosure agreements . . .".

The requirement for the completion of NDAs appears to be a new requirement within the RAC contracts or seemingly other contracts we're aware of. As such, will CMS provide an example NDA that can be used/modeled to ensure compliance with this requirement?

An Non-Disclosure Agreement (NDA) template has been added to the end of Appendix C: CMS Security and Privacy Language for Information and Information Technology of the Statement of Work.

L.1 Procurement Timeline 47 of 57

CMS states: "Proposals Due: January 6, 2025 by 9:00 A.M (EST)"

Based on the Draft RFP having a number of sections of the Draft RFP identified as under development or are not included, would CMS consider an extension of at least 14 days from the current Proposal Due date, following CMS returning responses to the Final Questions and any associated amendment(s)?

Proposal Due date has been amended to February 10, 2025 by 9:00 A.M (EST).

Draft RFP No. 75FCMC25RJ003 Questions & Answers

L.3 Intent to Submit a Proposal 50 of 57 If an offeror does not share with CMS its intent to submit a proposal under Section L.3, and then subsequently submits a timely proposal, will that proposal be disqualified from consideration by CMS? No. Intent to Submit notifications are for planning/scheduling purposes only.

L L.4 48 of 57 Regarding Factor 6-Key Personnel, Staffing Plan, and Organizational Chart: Is it acceptable to place the Staffing Plan and Organizational chart in an appendix that does not count towards the 42-page limit?

This is acceptable; the RFP has been updated to reflect a Staffing Plan and Organizational chart can be included as an appendix that will not count towards the page limit.

L L.5 50 of 57 Subsection (b)(2) identifies the completion and submission of a Responsibility Questionnaire. Please clarify how the Responsibility Questionnaire will be evaluated and scored as part of an offeror's overall response.

Offerors will be evaluated in accordance with the techncial factors identified in Section L.6. The Responsibility Questionnare will be used to determine if a prospective awardee meets the general standards in FAR 9.104-1.

L L.5 51 of 57

Subsection (c) Financial Capability - CMS states: The offeror’s business proposal (Volume II) must also demonstrate that the offeror has adequate financial resources to sustain operations without any payment from CMS during the initial phases of the contract (at least one year) or for any period of work stoppage.

Given the contingency fee nature of the RAC program and history of work interruptions (Covid restrictions, concept review holds, natural disaster TDLs, etc.) over the last 15 years, how will the Government evaluate offeror’s financial resources and ability to sustain operations for at least one year, or for any period of work stoppage?

Will the government evaluate an offeror’s financial resources as a either a strength (or weakness) in its best value determination, where an offeror is either able (or unable) to adequately maintain staff during periods of work interruption to support the RAC program or invest adequately in the program to meet CMS’ expected review volumes?

Offerors will be evaluated in accordance with the techncial factors identified in Section L.6. Financial Capability will be used to determine if a prospective awardee meets the Responsibility standard in FAR 9.104-1.

L L.6 51 of 57 Subsection (b) advised offers they are to "provide an Accessibility Conformance Report (ACR). An example of the ACR is not provided in the draft RFP or draft SOW, is CMS able to provide a copy of the ACR so offers may review and thereby ensure compliance with CMS expectations?

The last line at the end of Subsection (b) provides a link where prospective offerors can find the current VPAT template. A Voluntary Product Accessibility Template (VPAT) , once completed, is refered to as an Accessibility Conformance Report (ACR).

L L.5 50 of 57 The Business Proposal Instructions references "Exhibit E.1 - Proposed Firm Fixed Contingency Fee", which was not included with the draft RFP. When will this exhibit be available for review and will CMS allow offerors an opportunity to ask questions once it is made available?

All attachments and exhibits will be provided in the final RFP. Offerors will be provided an opportunity to submit 'new' questions to any 'new' information provided for in the release of the final RFP.

L L.1 PROCURMENT

TIMELINE 46 of 57 Is there an anticipated release date for the full proposal (RFP)? Mid/late January 2025

L.4

Proposal Organization, Volume I - Written Technical Proposal

For Volume I - Written Technical Proposal, CMS states "The written technical proposal (Volume I) shall not exceed 42 pages. Resumes, table of contents, and any appendices submitted will not count towards the 42-page limit."

Will CMS allow for a Cover Letter to be submitted with the RFP response that does not count towards the 42-page limit?

A 1-page cover letter is acceptable and will not count towards the page limit.

L.4 - Proposal Organization

Volume I - Written Technical Proposal 48 Will CMS accept an Offeror's proposed Staffing Plan as an appendix, i.e., excluded from the page limit/count?

This is acceptable; the RFP has been updated to reflect a Staffing Plan and Organizational chart can be included as an appendix that will not count towards the page limit.

L.4 Proposal Organization 48 of 57

CMS states: "The Offeror's proposal shall be submitted in three separate PDFs, unless otherwise stated, as identified below:"

Can CMS clarify the instructions that a PDF (not editable) is expected for each volume and whether the entire volume (with appendices, exhibits, or attachments) is expected to be a single PDF or whether a volume may contain several PDF files, such as the business volume which contains multiple exhibits?

A PDF is expected for each volume unless otherwise stated. To the extent feasible, it is prefered, but not required, Volume I and III be a single PDF inclusive of appendices, exhibits, and/or attachments as applicable. It is antcipated that Volume II will consist of more than one seperate file.

L.4 Volume I - Written Technical Proposal 48 of 57

CMS states: "Each volume shall be signed by both an official authorized to bind your organization as well as the author(s) of the proposal. Specifically, the name, title, and signature of the person authorized, shall be included on the first page of each volume. Additionally, the author(s) of the proposal shall be identified by name, title, and position as well as include a signature."

According to the FAR, a proposal requires the name, title, and signature of the person authorized to sign the proposal. The instruction to include the name, title, and signature of the author(s) is not consistent with this requirement. Would CMS remove the instruction to include the author(s) name, title, and position on each volume?

The FAR does not prohibit the instruction to include the name, title, and signature of the author(s). This instruction will not be removed.

L.4, M.1

Volume I - Written Technical Proposal

48 of 57, Section L.4 of the draft RFP states: “the Offeror's proposal shall be submitted in three separate PDFs” identified as “Volume I - Written Technical Proposal”, “Volume II - Business Proposal” and "Volume III - Conflict of Interest & Section 508 Compliance”. Section L.4 of the draft RFP states: " The offeror shall submit one technical proposal – that proposal shall speak to any regional nuances, depending upon which region(s) the offeror is bidding on."

Section M.1 of the draft RFP states: "Three firm fixed Contingency-Fee type contracts will be awarded in accordance with this solicitation that includes awards of Regions 3 and 4 that cover specific regions to review Part A/B Claims and Region 5 that covers Durable Medical Equipment and Home Health & Hospice claims for the entire country."

Above are the only instructions regarding how Offerors should organize proposals to speak to any regional nuances for each region on which the Offeror is bidding. Can CMS provide further clarification on how responses to the solicitation should be organized to separately address any regional nuances for the region(s) for which the Offeror is bidding?

For each task where there are regional nuances, those nuances should be discussed.

Offerors are encouraged to identify and disucss any regional nuances they, in their professional experitise and knowledge, feel are important to their approach.

L.4, M.4

Factor 1: Legislative Requirements

49 of 57, CMS States: "Factor 1: Legislative Requirements

To be considered technically acceptable, the offeror's proposal shall demonstrate:

appropriate clinical knowledge of, and experience with, the payment rules and regulations under this title or the contractor has, or will contract with, another entity that has such knowledgeable and experienced staff;

AND the Offeror is not a fiscal intermediary under section 1816, a carrier under section 1842, or a Medicare administrative contractor under section 1874A;

AND the offeror has more than 3 years direct management experience and a proficiency for cost control or recovery audits with private insurers, health care providers, health plans, under the Medicaid program under title XIX, or under Social Security Act, Section 1893."

The third line above refers to "regulations under this title" although does not specify which title (either Title XVIII or the Social Security Act, Section 1893). Can CMS clarify that the reference (in the third line above) to "this title" and that the applicable sections include Section 1893(h)(6)(A), Section 1893(h)(6)(B), and Section 1893(h)(6)(C); respectively to the three requirements listed above (for section L.1 and section M.1)?

The referenced title is the Social Security Act, Title XVIII, Section 1893. The RFP has been updated to refelect this information.

L.5 Business Proposal Instructions 50 of 57

CMS States: "The Offeror shall submit an excel spreadsheet (Exhibit E.1 – Proposed Firm Fixed Contingency Fee) for the business proposal (shall not be read-only)."

Can CMS clarify or confirm whether the Offeror shall submit a separate Exhibit E.1 for each RAC Region depending upon which region(s) the Offeror is bidding on?

Exhibite E.1 has a separate tab for each RAC Region therefore a separate Exhbit E.1 is not required for each region an offeror is bidding on.

L.5 (c) Financial Capability 51 of 57

CMS States: "Statement on the Offeror’s Financial Capability: The Offeror’s proposal must indicate whether it has the necessary financial capability, working capital, and other resources to perform the contract without assistance from any outside source (If not, indicate the amount required and the anticipated source)."

Can CMS clarify whether the Offeror must indicate which regions it is bidding on and whether it has the necessary financial capability for the combination of region(s), depending upon which region(s) the offer is bidding on?

The offeror’s business proposal (Volume II) must demonstrate that the offeror has adequate financial resources to sustain operations in the region(s) and combination of regions, if applicable, it is bidding on.

L.4, M.4

Factor 4: Quality Assurance and

Accuracy

50 of 57, In the RFP, Factor 4 under both L.4 and M.4, CMS states: "plan for obtaining an annual Statement of Standards for Attestation Engagements (SSAE) No. 16 Type II". The SOW under section III. Requirements, under B.

Statement on Standards for Attestation Engagements (on page 3), states: "Each RAC shall be required to complete an annual Statement on Standards for Attestation Engagements Number 18 (SSAE 18 Type II Audit)."

Can CMS confirm the standard that CMS will use is SSAE No. 18 instead of SSAE No. 16?

CMS will use is SSAE No. 18; the RFP has been updated to reflect such.

L.6

(b) Section 508

Compliance Proposal Instructions

CMS States: A Voluntary Product Accessibility Template (VPAT) is an accessibility conformance report that should be used to outline to what degree information and communication technology (ICT) products, electronic documents, software and web-based solutions meet or will meet the Revised 508 Standards and/or the Web Content Accessibility Guidelines (WCAG) 2.0 Level AA criteria. CMS also states: "There are four editions of the VPAT, but only the 508 and the WCAG editions are used at CMS."

Based upon the current link also provided in this subsection, can CMS confirm that the current applicable VPAT version is: VPAT 2.5 WCAG (November 2023) (November 1, 2023)?

The contractor will need to submit the applicable VPAT 2.5 WCAG that is in effect at the time of proposal submission. CMS can not confirm that the Nov 2023 VPAT 2.5 WCAG will be in effect at that time.

M.1 - FAR

52.212-2 –

Evaluation – Commercial items (Nov 2021) n/a 53 Is there a CMS restriction on the maximum number of RAC region contracts a single contractor may receive/retain?

There are no restrictions as to the number of RAC Regions a single contractor may hold concurrently.

M M.1 FAR 52.212-2 53 of 57 CMS has specified that the evaluation of the Technical Approach response, Factors 1 - 6 will be determined on a "Pass/Fail" basis. Will CMS favorably consider and positively evaluate bidders who have demonstrated experience as a CMS Recovery Audit Contractor?

Offerors will be evaluated in accordance with the techncial factors identified in Section L.6.

M M.1 FAR 52.212-2 53 of 57 The draft RFP does not appear to identify evaluation criteria and scoring for bidders' utilization of Small Businesses, AbilityOne contractors, Disadvantaged Vendors (e.g., Minority Owned, Veteran Owned, Woman Owned, etc.). How will CMS evaluate proposals that address any of these entities?

CMS will evaluate offerors based upon the evaluation criteria established in the RFP.

M M.1 FAR 52.212-2 53 of 57

In section M.1 FAR 52.212.-2 - Evaluation, CMS states: "The Government will award three contracts resulting from this solicitation to the responsible offeror(s) on the basis of the lowest evaluated price of proposals . . . ".

As part of CMS' evaluation, will CMS perform a Price Realism analysis to ensure that an offer's proposed contingency rate is reasonable and realistic for the performance of the proposed work? A Price Realism analysis will ensure that an offeror has not submitted a "lowball " business proposal to secure a contract award that potentially creates a risk for the performance of CMS' requirements and expectations. How will CMS guard against this "lowball" pricing approach?

A fair and reasonable price determination will be made through the comparison of proposed contingency fees among those offerors who are techncially acceptable and comparison of proposed contengency fees with the independent Government estimate.

M M.1 FAR 52.212-2 53 of 57

For the Evaluation criteria and contract award determination, CMS states: "The Centers for Medicare & Medicaid Services (CMS) will conduct a comprehensive evaluation of all proposals and select the offer based upon an assessment of the proposals that, in the Government’s estimation, provides a technically acceptable approach to performing the Statement of Work while providing the lowest firm fixed contingency fee percentage to the Government.

If CMS determines that multiple offerors achieve a "pass" evaluation/rating on all Factors (factors 1 thru 6), achieve an acceptable Volume III for COI and Section 508 Compliance, and have the same exact proposed contingency fee percentage, how will CMS determine the successful offeror for contract award?

Offerors will be evlauted in accordacne with the procudures identified in Section M of the solicitation.

M M.1 FAR 52.212-2 53 of 57

For the Evaluation criteria and contract award determination, CMS states: "The Centers for Medicare & Medicaid Services (CMS) will conduct a comprehensive evaluation of all proposals and select the offer based upon an assessment of the proposals that, in the Government’s estimation, provides a technically acceptable approach to performing the Statement of Work while providing the lowest firm fixed contingency fee percentage to the Government.

If CMS determines that multiple offerors achieve a "pass" evaluation/rating on all Factors (factors 1 thru 6), achieve an acceptable Volume III for COI and Section 508 Compliance, will CMS simply award the contract to the offer with the lowest contingency fee price? Or will the relative strengths of the other Factors still be taken into consideration for best value?

CMS will make award to the lowest price technically acceptable offeror(s). Best value is expected from selecting the technically acceptable proposal with the lowest price.

M M.1 FAR 52.212-2 53 of 57

For the Evaluation criteria and contract award determination, CMS states: "The Centers for Medicare & Medicaid Services (CMS) will conduct a comprehensive evaluation of all proposals and select the offer based upon an assessment of the proposals that, in the Government’s estimation, provides a technically acceptable approach to performing the Statement of Work while providing the lowest firm fixed contingency fee percentage to the Government.

If CMS determines that multiple offerors achieve a "pass" evaluation/rating on all Factors (factors 1 thru 6), achieve an acceptable Volume III for COI and Section 508 Compliance, and have the same evaluated price per region, how would CMS determine the awardee(s)?

Offerors will be evlauted in accordacne with the procudures identified in Section M of the solicitation.

M M.1 FAR 52.212-2 53 of 57

For the Evaluation criteria and contract award determination, CMS states: "The Government will award three contracts resulting from this solicitation to the responsible offeror(s) on the basis of the lowest evaluated price of proposals meeting or exceeding the acceptability standards for non-cost factors."

Will CMS place any restriction on the award of a contract for RAC Regions 3, 4 and 5 based on an offeror already possessing an existing RAC contract for Regions 1 thru 5? Is there any restriction on the number of RAC contracts one entity may be awarded? If such a limit does exist, could CMS please provide a clarification on that limit to help potential bidders assess the prudence of submitting proposal and/or pricing for multiple regions/contracts?

There are no restrictions as to the number of RAC Regions a single contractor may be awarded.

M M.1 FAR 52.212-2 53 of 57

For the Evaluation criteria and contract award determination, CMS states: "The Government will award three contracts resulting from this solicitation to the responsible offeror(s) on the basis of the lowest evaluated price of proposals meeting or exceeding the acceptability standards for non-cost factors."

Is there any restriction on the number of RAC contracts one entity may be awarded?

There are no restrictions as to the number of RAC Regions a single contractor may be awarded.

M M.1 FAR 52.212-2 53 of 57

For the Evaluation criteria and contract award determination, CMS states: "The Government will award three contracts resulting from this solicitation to the responsible offeror(s) on the basis of the lowest evaluated price of proposals meeting or exceeding the acceptability standards for non-cost factors."

If a bidder submits a proposal that meets or exceeds the acceptability standards for non-cost factors and has the lowest evaluated price for each region, could CMS award all three contracts to that bidder?

Yes; this scenario is possible.

M.1

FAR 52.212-2 -

Evaluation -

Commercial Items (Nov 2021)

CMS states: “The Centers for Medicare & Medicaid Services (CMS) will conduct a comprehensive evaluation of all proposals and select the offer based upon an assessment of the proposals that, in the Government’s estimation, provides a technically acceptable approach to performing the Statement of Work while providing the lowest firm fixed contingency fee percentage to the Government. Award will be made after the following steps for each region:”

Question: Because the draft solicitation requires CMS to make award to the technically acceptable offeror with the lowest contingency fee percentage per region, it is possible that a single RAC could end up being awarded all three regions and subsequently performing in all five regions. CMS may have considered the need to maintain a contractor industrial base and mitigate the risk associated with a single RAC contractor for all five regions. Would CMS be open to considering a limit on the number of regions that a single offeror may hold overall?

There are no restrictions as to the number of RAC Regions a single contractor may hold concurrently.

M.1 Step 1: Determine

Technical Acceptability

CMS states: "The evaluation factors that establish the requirements of acceptability are set forth in the solicitation in Section L.4 above. If the offeror fails to demonstrate the necessary qualifications in all technical factors, it will be eliminated from the competition and its proposal will not be reviewed further."

Given that CMS will award three contracts resulting from the solicitation, can CMS confirm or clarify that the determination of technical acceptability will be determined individually (including consideration of the "nuances") for each region on which the Offeror is bidding?

Technical acceptability will be determined individually per each Region.

M.1 Step 2: Determine

Lowest Price/ Contingency Fee:

CMS states: "The Government will review the offeror’s business proposal to determine which offeror has the lowest firm fixed price contingency fee for each RAC Region."

Can CMS confirm that Exhibit E.1- Proposal Firm Fixed Fee Contingency Fees, is the only part of the business proposal (Volume II) that will be evaluated in Step 2: Determine Lowest Price/Contingency Fee?

Correct; confirmed.

M.1

Step 3:

Responsibility Determination, Determine Conflict of Interest and 508

Compliance

CMS states: "After completion of Step 2 – Determine Lowest Price/Contingency Fee, for the apparent successful offeror(s) the Government will determine whether or not the offeror is responsible, in accordance with FAR 9.104., if the offeror demonstrate compliance with H.X Conflict of Interest and FAR 9.504(e) requirements, and the 508 accessibility standards."

Can CMS provide further clarification whether the responsibility determination (the Government will determine whether or not the if the offeror is responsible) will include the Statement on the Offeror's Financial Capability, as well as E.4 Responsibility Questionnaire?

Responsibility determinations under FAR 9.104-1 will include, but are not limited to, Financial Capability submissions as well as Responsibility Questionnaire submissions.

Section H.X Conflict of

Interest Subsection c.2.i 42 Will CMS please clarify if it considers MAC, UPIC, or QIC conflicts jurisdictional/regional, similar to the proposed restraint on future contractor activities tied to a BFCC-QIO, QIN-QIO, or ESRD?

A RAC may not become a MAC, UPIC, QIC, AdQIC, or RVC, regardless of jurisdictional/regions.

Section Subsection Page number Contractors Question CMS Response

III. Requirements C. System

Requirements and Data Accessability

CMS states: "The CMS may make system changes that could result in additional (not previously present) administrative tasks being placed on the RAC. These administrative tasks shall be within the scope of this contract and shall be applicable to the identification and recovery of improper payments. The CMS will provide minimal administrative support for system changes and cannot guarantee implementation timeframes."

Question: Can CMS clarify the definition of administrative tasks to be those tasks which do not increase the cost of contract performance or otherwise that any change in the scope of this contract may result in a negotiation to the contingency fee(s)?

CMS does not adopt this definition of administrative tasks.

SOW Questions

III. Requirements C. System

Requirements and Data Accessability

CMS states: "The CMS may make system changes that could result in additional (not previously present) administrative tasks being placed on the RAC. These administrative tasks shall be within the scope of this contract and shall be applicable to the identification and recovery of improper payments. The CMS will provide minimal administrative support for system changes and cannot guarantee implementation timeframes."

Question: Can CMS clarify the reference (in the third sentence above) as to what is meant by "provide minimal administrative support for system changes and cannot guarantee implementation timeframes" or otherwise remove this statement?

The RAC is responsible for posessing the personnel to implement timely system changes to meet CMS requirements.

IV. Personnel Requirements

A. Key Personnel, 3.

Medical Review (MR) Manager

CMS states: "For this SOW, “fully dedicated” means that the individual identified for any key personnel position shall be a full time equivalent (FTE) employee. The PM, MR Manager, and CMD may serve as a designated back up, or in an ancillary capacity, on another RAC contract with CMS COR approval; they may not fulfill the role of a primary key personnel on another contract. The primary CIO and SSO may serve in the primary key personnel role, or backup key personnel role, on more than one RAC contract, with CMS COR approval. Key personnel may not perform duties on any Medicare/non-Medicare contract or commercial line of business, other than a RAC contract, without approval by the CO and CMS RAC COR."

CMS also states: "Each RAC is required to employ a Medical Review (MR) Manager. The MR Manager is responsible for the overall medical review and quality assurance of the RAC review staff and associated processes. The MR Manager shall have broad knowledge of the Medicare program and working knowledge of the CMS FFS Recovery Audit Program requirements and activities. The MR Manager shall be responsible for keeping abreast of regulatory, policy, and coding changes as well as clinical practice and technology changes that may result in improper payments."

Question: The SOW indicates that the PM and CMD are fully dedicated. Consistent with the statement for the CIO and SSO, can CMS clarify that the MR Manager may serve in the primary key personnel role, or backup key personnel role, on more than one RAC contract, with CMS COR approval?

Yes, the MR Manager may serve in the primary key personnel role, or backup key personnel role, on more than one RAC contract, with CMS COR approval. The SOW has been updated to reflect this clarification.

V. Statement of Work Tasks, Task

3:

A. Improper payments included in this SOW

CMS states: "Any proposed uses of advanced technology, such as artificial intelligence (AI) applied under this SOW shall be reviewed, vetted, and subject to approval by the CMS RAC COR."

Question: The terms "advanced technology" and "artificial intelligence" are not defined in the SOW. Can CMS clarify which types of artificial intelligence and/or uses of artificial intelligence can be applied under this SOW, or which can not be applied under this SOW, or otherwise remove this statement?

CMS can not clarify.

V. Statement of Work Tasks, Task

3:

A. Improper payments included in this SOW

CMS States: "Unless prohibited by Section B below, the RAC may review claims and identify improper payments (overpayments or underpayments) that result from any of the following:...Claims from the following provider types:..."

Question: Can CMS clarify the inclusion of claims from provider types for: DMEPOS suppliers, Home Health Agencies, Hospice providers, which are not currently listed?

The SOW has been updated to reflect DMEPOS, HH/H providers.

V. Statement of Work Tasks, Task

3:

Task 5: Claim Review Process 23 of 84

CMS States: "Upon completion of an automated review, the RAC shall inform the provider/supplier of the improper payment no later than 7 business days following the discovery, unless otherwise directed by their

CMS RAC COR."

Question: Based upon provider limits, review topic limits, and other CMS constraints, the RAC may not be able to inform the provider/supplier within 7 business days. Can CMS clarify the statement (considering such constraints) or otherwise remove the 7 business day statement?

No.

V. Statement of Work Tasks, Task

10:

A. RACDW

Required Upload

Fields

CMS States: "The following fields, referred to as the date codes, are required by CMS for entry into the

RACDW...

Question: Date field 06 and 07 are no longer supported. Can CMS clarify the inclusion of 06 and 07 or otherwise remove these statements?

These date codes are supported and will not be removed.

V. Statement of Work Tasks, Task

10:

K. Review Timing Incentive

40 of 84, CMS States (on page 43): " The CMS encourages the RACs to review the newest claims to be the most impactful on provider behavior. Therefore, the review timing incentive will be calculated by the RACDW as follows for automated reviews:...The review timing incentive will be calculated by the RACDW as follows for complex reviews:

• Claims with an Initial Claim Paid Date less than 6 months (183 days) from the date of the ADR (Date 02), will receive a 1.5% contingency fee increase.

For example, a RAC with a contingency fee of 13%, would receive 14.5% contingency fee for claims reviewed with an Initial Claim Paid Date that is less than 6 months from the date of the ADR (Date 02).

• Claims with an Initial Claim Paid Date less than 1 year (365 days) but greater than 6 months (183 days) from the date of the ADR (Date 02), will receive a 1% contingency fee increase..."

CMS also states (on page 40): "The RAC shall delay sending ADRs until at least 60 calendar days after the claim paid date. This delay is necessary to minimize the likelihood of reviewing a claim that had a prepayment review done by a MAC."

Question: In order to align to the 6 month and 1 year timeframes, and given that the RAC may not send an ADR until 60 calendar days after the Initial Paid Claim Date, can CMS adjust the review timing incentive to be less than 8 calendar months from the date of the ADR (instead of 6 months) or less than 14 calendar months from the date of the ADR (instead of 1 year), respectively, for the above review timing incentive?

No.

V. Statement of Work Tasks, Task

10:

F. RACDW

Reporting of

Identified Improper Payments

CMS States: "The RAC receives the improper payment amount and receivable/payable information from the MAC, or data center. The MAC is responsible for updating the RACDW with payment information by uploading the finalized adjustment date and amount. Unless otherwise directed by CMS, the RAC updates the RACDW with the date of MAC demand letter or no findings letter, as well as the demanded amount (negative values for underpayments)."

Question: These statements appear to have overlapping responsibilities with the RAC updating the RACDW with MAC source information. Can CMS clarify the respective RAC and MAC responsibilities to have the MAC responsible in this case for reporting of the payment information?

Please see updated SOW.

V. Statement of Work Tasks, Task

11:

D. Contractor Performance

Evaluations (CPE)

CMS States: "The CMS performs quarterly contractor performance evaluations at its discretion. Advance notice may or may not be provided. The CMS will select a focus area for the quarterly evaluations. Any finding from the review will require a corrective action plan."

Question: A finding may not necessarily require a corrective action plan. Can CMS revise the last sentence to indicate that "Any finding from the review may require..."?

Please see updated SOW.

V. Statement of Work Tasks, Task

13:

A. Customer Service 49 of 84

CMS Stated: "3. The staff answering the customer service lines shall be knowledgeable of the CMS Recovery Audit Program. The staff shall have access to all identified improper payments and shall be knowledgeable of all possible recovery methods and the appeal rights of the provider. The staff person that identified the improper payment shall return the call within one business day."

Question: Customer service staff would return calls (instead of the auditor that identified the improper payment). Can CMS clarify that a knowledgeable customer service staff person shall return the call within one business day?

Please see updated SOW.

V. Statement of Work Tasks, Task

14:

RAC Validation Contractor (RVC) calls

CMS States: "The RAC shall make available the PM, CMD, and MR Manager for all RVC calls. If a specific claim is scheduled to be discussed, the RAC shall make the actual Medical Reviewer available for discussion."

Question: Given participation by the PM, CMD, and MR Manager, would CMS consider modifying this requirement to state that the actual Medical Reviewer must be made available only if necessary or requested?

No.

IV A. Key Personnel 7 and 8

On page 7, Section A. Key Personnel, the Statement of Work lists the required Key Personnel, which includes a Medical Review (MR) Manager, which was not a required Key Personnel position in previous RAC procurements. Please confirm that a Medical Review Manager IS now a required Key Person on this procurement.

Yes, the Medical Review Manager is a required Key Person.

IV A. Key Personnel 8

On page 7, Section A. Key Personnel, the Statement of Work lists the required Key Personnel, which includes:

Project Manager, Contractor Medical Director, Medical Review Manager, Chief Information Officer, and Systems Security Officer.

On page 8, Section A. Backup Key Personnel, the Statement of Work states "The RAC shall submit a CMS approved contingency plan and designate fully qualified (meets the experience and education requirements for the respective key personnel position) backups for each key personnel role. Please confirm that a "backup" is required for ALL listed Key Personnel positions.

Yes, a backup is required for all listed Key Persons.

V Task 4.C. Paying for Medical Records 21 and 22 Would CMS consider reducing or eliminating MR reimbursement of providers who upload records directly to a secure portal? No.

V Task 4.C. Paying for Medical Records 21 and 22 Would CMS consider reducing or eliminating MR reimbursement of providers who willingly agree for the

RAC vendor to pull records directly from their EMR, without any work effort on the part of the provider? No.

V Task 4.A. Obtaining medical records 20

CMS states "Should the RAC receive medical records and/or correspondence in a language other than English, the RAC shall possess the necessary software required to translate the documentation or be required to close the review."

Will CMS restrict the translation of records from Spanish to English versus how this requirement is currently stated which implies the RACs are responsible for the translation of ALL/ANY language to English?

No.

V Task 13.A.4 49

CMS states "The RAC shall provide an interpreter for all non-English speaking providers or stakeholders."

Will CMS restrict the translation of Spanish to English versus how this requirement is currently stated which implies the RACs are responsible for the translation of ALL/ANY language to English?

No.

V Task 13.A.4 49

CMS states "The RAC shall have available resources available for those using American Sign Language (ASL and teletypewriter (TTY).

Telephone calls placed to the RAC Customer Service telephone are audio only. Is CMS able to speak to its expectations for the use of ASL with TTY technology?

Please see updated SOW.

V Task 5.C 24 CMS states "The RAC may use extrapolation for some claim types when all requirements are met." Please provide the list of requirements that must be met for extrapolation to be utilized. CMS will not provide a list of requirements.

V Task 5.C 24

CMS states "The RAC may use extrapolation for some claim types when all requirements are met." In a review of the publicly available annual reports posted to CMS' Recovery Audit Contractor webpage there does not appear to be a discussion of instances where extrapolation has been utilized within the RAC program. To ensure expectations for extrapolation are fully understood and planned for, please provide a deidentified (no PHI/PII) example where extrapolation was utilized within the RAC program.

CMS will not provide examples.

V Task 10: Utilizations of the RACDW 39

In subsection A. RACDW Required Upload Fields CMS identifies 21 data fields required for uploads to the RACDW. Is this list of 21 data fields complete, exhaustive of ALL required data fields? If no, what additional fields are required?

No, this list is not exhaustive. Additional fields may be required as the program evolves.

V Task 10:

Section D 21

In subsection H. RAC Invoicing CMS states: "If a provider files an appeal disputing the overpayment determination and the appeal is adjudicated in the provider’s favor at ANY level, the RAC shall repay Medicare any contingency fee payment that it received for that recovery."

Please confirm the intent is for the RAC to repay only the overturned portion of the fee when an overpayment finding is partially overturned on appeal.

The RACDW will generate, monthly, pre-filled invoices based on required claims information from the RAC and appeal reversal transactions from the MAC.

V Task 3 Section A 17 Subsection A. Improper payments included in this SOW, sub bullet 5 lists the provider types that are included within the scope of RAC Regions 3, 4 and 5. This sub bullet #5 does not include DMEPOS, Home and Hospice services. Should this list be updated to include DMEPOS, Home and Hospice?

Please see updated SOW.

All All All

In this procurement CMS has made the decision to create a combined "State of Work (SOW) for the Part A/B Medicare Fee-for-Service (FFS) Recovery Audit Contractor (RAC) and the National DME/HH+H RAC– Regions 3, 4, and 5". For offers wishing to submit a proposal for RAC Region 5, are there are unique SOW sections and requirements that offers should be aware of when submitting a response that is specific to RAC Region 5? If yes, what are these unique SOW sections and requirements specific to RAC Region 5?

For each task where there are regional nuances, those nuances should be discussed.

Offerors are encouraged to identify and disucss any regional nuances they, in their professional experitise and knowledge, feel are important to their approach.

Appendix C

6. Homeland

Security Presidential Directive (HSPD)-12

"The Contractor (and/or any subcontractor) and its employees must comply with Homeland Security Presidential Directive (HSPD)-12, Policy for a Common Identification Standard for Federal Employees and Contractors; OMB M-05-24; OMB M-19-17; FIPS 201, Personal Identity Verification (PIV) of Federal Employees and Contractors; HHS HSPD-12 policy; and Executive Order 13467, Part 1 §1.2."

As CMS does not provide “Government Furnished Equipment” (GFE) to Recovery Audit Contractors, are offerors’ systems (networks, desktops, laptops and servers) required to leverage CMS PIV cards and have PIV card readers when there will not be any native connectivity to CMS authentication systems or use of CMS hardware?

Yes, contractors must comply with this requirement.

D

Contracts Involving Cloud Services HHS FedRAMP Privacy and Security Requirements

Page 21, section 2(b) appears to have one or more typos which would indicate CMS ownership of proprietary contractor systems. Bidder has suggested clarification below in red to more clearly delineate CMS ownership of federal data and derivative works:

HHS/CMS will retain unrestricted rights to federal data handled under this contract. Specifically, HHS/CMS retains ownership of any resulting user Contractor created/loaded data and in Contractor’s applications and that is collected, maintained, used, or operated on behalf of HHS/CMS and hosted on contractor's infrastructure, as well as maintains the right to request full copies of these data at any time. If requested, data must be available to HHS/CMS within one (1) business day from request date or within the timeframe specified otherwise. In addition, the data must be provided at no additional cost to HHS/CMS.”

Please see updated SOW.

Section Subsection Page number Contractors Question CMS Response

Section Subsection Page number Contractors Question CMS Response

MISC Questions

Attachments Questions

N/A; No Questions Received

N/A N/A N/A

Can CMS provide the following metrics for each Region (3, 4, and 5) for FY2023 and FY2024:

• Overpayment Amount for each: Regions 3 & 4: DRG, Outpatient, SNF, Inpatient Psych, IR, Automated // Region 5: DME, Home Health, Hospice, and Automated

• Underpayment Amount for each: Regions 3 & 4: DRG, Outpatient, SNF, Inpatient Psych, IR, Automated // Region 5: DME, Home Health, Hospice, and Automated

• Overpayment Amount Recovered: Regions 3 & 4: DRG, Outpatient, SNF, Inpatient Psych, IR, Automated // Region 5: DME, Home Health, Hospice, and Automated

• Overpayment Amount Appealed: Regions 3 & 4: DRG, Outpatient, SNF, Inpatient Psych, IR, Automated // Region 5: DME, Home Health, Hospice, and Automated

• Overpayment Amount Upheld: Regions 3 & 4: DRG, Outpatient, SNF, Inpatient Psych, IR, Automated // Region 5: DME, Home Health, Hospice, and Automated

CMS cannot provide the requested metrics.

Questions