E.7 Section L - Instructions, Conditions, and Notices to Offerors or Respondents.pdf

Draft RFP: 75FCMC25RJ003, Amend. 01 Exhibit 7: Section L - Instructions, Conditions, and Notices to Offerors or Respondents

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SECTION L – INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS OR

RESPONDENTS

L.2 52.212-1 INSTRUCTIONS TO OFFERORS – COMMERCIAL ITEMS (SEP 2023)

- ADDENDUM

The following changes replace and supersede FAR 52.212-1 as follows:

An Offeror may submit a proposal for any one or more RAC Regions.

(b) Submission of offers. Offerors are hereby advised that proposals shall be submitted electronically to the below identified points of contacts:

POCs: Megan Anuszewski/ Megan.Anuszewski@cms.hhs.gov

Nicole Hoey/ Nicole.Hoey@cms.hhs.gov

The maximum file size for an incoming mail message is 20MB. Offerors may choose to zip their submission. It is acceptable to submit the proposal in multiple e-mails. If you choose to submit multiple e-mails, please make it clear how many e-mails are being sent (i.e. Email 1 of 3, 2 of 3).

All files submitted must be Microsoft Office compatible. CMS must be able to open each file, and the contents must be editable, with copy and paste functionality. Further, formulas/calculations shall be viewable/verifiable and editable.

Your RFP does not commit the Government to pay any cost for the preparation and submission of a proposal. In addition, the CO is the only individual who can legally commit the Government to the expenditures of public funds in connection with the proposed procurement.

Late submissions, modifications, revisions, and withdrawals of offers will be addressed in accordance with FAR 52.212-1(f).

(c) Period for acceptance of offers. The offeror agrees to hold the prices in its offer firm for 180 calendar days from the date specified for receipt of offers, unless another time period is specified in an addendum to the solicitation.

L.3 PROCUREMENT TIMELINE:

Draft Request for Proposal (RFP) Released: November 22, 2024 Draft RFP Questions Due: December 13, 2024 by 9:00 A.M (EST) Draft RFP Amend. 01 Released: January 17, 2025 Final Questions Due: January 27, 2025 by 9:00 A.M (EST) Proposal (RFP) Released: TBD, 2025 Intent to Submit a Proposal February 3, 2025 Proposals Due: February 10, 2025 by 9:00 A.M. (EST)

L.4 SOLICITATION QUESTIONS:

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Draft RFP and Final Questions must be received no later than the dates and times specified above in Section L.3.

All questions pertaining to this RFP shall be submitted electronically to Megan.Anuszewski@cms.hhs.gov & Nicole.Hoey@cms.hhs.gov.

Questions should be submitted using Exhibit E.2, Questions/Answers template" and written in a manner that enables clear understanding of the Offeror's questions or concerns. Statements expressing opinions, sentiments, or conjunctures are not considered valid inquiries and will not receive a response. Further, Offerors are reminded that CMS will not address hypothetical questions aimed at receiving a potential "evaluation decision." Questions submitted to any other e-mail address, by telephone, or verbally will not be honored.

CMS will respond to relevant questions by amendment to this solicitation, with copies of both the questions and answers being supplied to all prospective Offerors via SAM.gov, without reference as to the originating source. Offerors will not be notified individually. All Offerors are responsible for checking the website for additional information and amendments that may be issued to the solicitation. Additionally, CMS reserves the right to determine the relevancy of questions.

L.5 INTENT TO SUBMIT A PROPOSAL:

The Offeror shall indicate their intent to submit a proposal no later than February 3, 2025 at 9:00 a.m. (EST, Baltimore, MD). This notice shall be submitted via e-mail to Megan.Anuszewski@cms.hhs.gov & Nicole.Hoey@cms.hhs.gov.

NOTE: Please be advised that intent to submit a proposal is not binding on the Offeror and is for planning/scheduling purposes only.

L.6 PROPOSAL ORGANIZATION:

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

Volume I - Written Technical Proposal Volume II - Business Proposal Volume III - Conflict of Interest & Section 508 Compliance

Each volume shall be separate and complete so that the evaluation of one may be accomplished independently of the evaluation of the other. The written technical proposal must not contain reference to cost/price (firm fixed Contingency fee).

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.

mailto:Megan.Anuszewski@cms.hhs.gov mailto:Nicole.Hoey@cms.hhs.gov mailto:Megan.Anuszewski@cms.hhs.gov mailto:Nicole.Hoey@cms.hhs.gov

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Proposal Formatting:

Page size shall be 8.5 x 11 inches.

Font shall be Times New Roman Size 12 with no less than single spacing between lines.

Page margins may be no less than 1 inch on both sides.

Charts, graphs, and tables may be no less than 10-point font Times New Roman

Volume I - Written Technical Proposal The written technical proposal (Volume I) shall not exceed 42 pages. Resumes, table of contents, and any appendices, including Staffing Plan and Organizational Chart, submitted will not count towards the 42-page limit.

The proposal should be an example of the Offeror's ability to communicate clearly and concisely the requirements set forth in the SOW. 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.

In order to facilitate review and evaluation, the Offeror shall submit a technical proposal with the following sections in the order in which they are listed:

TECHNICAL FACTORS:

Factor 1: Legislative Requirements Factor 2: Identification of Improper Payments Factor 3: Web Portal, General Website, and Communications Plan Factor 4: Quality Assurance and Accuracy Factor 5: Capability to Meet all IT Systems, Security Specifications & Data Accessibility Requirements Factor 6: Key Personnel and Staffing Plan

The Offeror is cautioned that any material submitted other than that specified within this solicitation will be removed from the proposal and will not be reviewed or evaluated.

Proposals that merely restate the SOW will be found non-responsive to the Government's evaluation criteria. Promising to carry out requested activities without providing substantive descriptions of anticipated approaches to the work as well as merely presenting extensive discussions that elaborate on general principles is not acceptable.

TECHNICAL EVALUATION FACTORS

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 the Social Security Act, Title XVIII, Section 1893 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

Pg. 4 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.

Factor 2: Identification of Improper Payments

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

knowledge and experience with the process of developing and implementing system edits for automated review determinations; AND knowledge and experience in developing and performing complex review of medical records and submitted documentation to identify improper payments; AND knowledge and experience with developing training modules and providing material to educate staff; AND knowledge and experience with requirements for communicating detailed and concise claim review findings to billing providers, in compliance with Medicare Program Integrity Manual and RAC SOW requirements; AND knowledge and experience with large data repositories for the management of claim review processes

Factor 3: Web Portal, General Website, and Communications Plan

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

approach to develop and maintain a separate and distinct Medicare FFS RAC website to communicate with the provider community that will meet the requirements as outlined in the SOW; AND approach to develop and maintain a secure web-based application to serve as a provider portal as described in the RAC SOW; AND approach to develop and maintain a customer service center that identifies how the Offeror will assure accurate and timely responses to Medicare providers and other prospective stakeholders; AND plan that describes all potential or existing outreach methods for all eligible provider types; AND communication plan for Medicare contractors, inclusive of JOAs, with all applicable Medicare contractors.

Factor 4: Quality Assurance and Accuracy

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

internal Quality Assurance Plan that includes steps toward correcting instances of the quality and/or accuracy failing to meet the expected standards, as outlined in the SOW; AND plan to establish and maintain the SOW required support and participation in the Medicare Appeals Process and/or Debt Collection Improvement Act Process; AND plan for obtaining an annual Statement of Standards for Attestation Engagements (SSAE) No. 18 review Type II Audit by an independent CPA.

Factor 5: Capability to Meet all IT Systems, Security Specifications and Data Accessibility Requirements

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

system and business processes to ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) when using or disclosing protected health information (PHI); AND

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Business and system processes to ensure security documents are uploaded timely and security controls are documented timely in the CMS FISMA Control Tracking System (CFACTS); AND process of obtaining an Authority to Operate (ATO) within 60 days of contract award; AND knowledge and ability to maintain a medical record management documentation system; AND approach for completing the security plan and accreditation requirements in clause 352.239-71, Security Requirements for Information Technology Resources.

Factor 6: Key Personnel and Staffing Plan

To be considered technically acceptable, the Offeror’s proposal shall: provide resumes for key personnel and backups that reflect all key personnel & designated backups meet minimum SOW requirements; AND the offeror's proposal shall demonstrate an acceptable staffing plan for medical review personnel and other personnel identified in SOW; AND an acceptable organizational chart that aligns with the Offeror’s technical approach

L.7 BUSINESS PROPOSAL INSTRUCTIONS

The business proposal (Volume II) page count is unlimited. The Offeror shall submit an excel spreadsheet (Exhibit E.1 – Proposed Firm Fixed Contingency Fee) for the business proposal (shall not be read-only).

Using Attachment E.1, an offeror shall propose one contingency fee for each RAC Region, depending upon which region(s) the offeror is bidding on.

In addition to Exhibit E.1, the Offeror shall address/submit the following completed information in the business proposal:

(a) Completed Offeror Representations and Certifications

(b) Completed FAR 52.229-11 Representation and Certification

(c) The following completed items from Section J:

(1) Exhibit E.3, Virus Detection Certification

(2) Exhibit E.4, Responsibility Questionnaire

(3) Exhibit E.5, Prime Proposal Checklist

(4) Exhibit D.6, Subcontractor Proposal Checklist - The Offeror shall include a definitive list of all known or proposed subcontractors and suppliers as part of their proposal.

(c) Financial Capability: The offeror’s business proposal (Volume II) must also demonstrate that the offeror has adequate financial resources to sustain operations in the region(s) and combination or regions, if applicable, it is bidding on without any payment from CMS during the initial phases of the contract (at least one year) or for any period of work stoppage. Please provide the items listed below:

(1) Statement on the Offeror’s Financial Capability: The Offeror’s proposal must indicate whether it has the necessary financial capability, working capital, and other

Pg. 6 resources to perform the contract without assistance from any outside source (If not, indicate the amount required and the anticipated source).

L.8 Volume III - Conflict of Interest & Section 508 Compliance

Volume III page count is unlimited. The Offeror shall address/submit the following completed information in proposal Volume III:

(a) Business Ethics, Conflicts of Interest and Compliance

In accordance with CMS Conflict of Interest Term & Condition of the solicitation, the offeror shall complete and submit Attachment J.2 Contractor/Offeror Conflict of Interest as Volume III, with its proposal (or a document containing similar information). A response must be provided for all sections of the form even if no conflict exists. The Prime Contractor/Offeror shall conduct an analysis of each of its subcontractors’ COI submissions (attachment J or similar information) in order to ensure that the subcontractor can perform services conflict-free. The Prime Contractor/Offeror shall not include each of its subcontractors’ analysis with its proposal. The Prime Contractor shall not submit the underlying J.2 for subcontractor disclosures to CMS, however, the Contracting Officer may request a copy of the subcontractor submission.

(b) Section 508 Compliance Proposal Instructions

Provide an Accessibility Conformance Report (ACR) for each commercially available Information and Communication Technology (ICT) item offered through this contract. Create the ACR using the current Voluntary Product Accessibility Template.

HHSAR 352.239-78 INFORMATION AND COMMUNICATION TECHNOLOGY

ACCESSIBILITY NOTICE (FEB 2024) (DEVIATION)

(a) Any offeror responding to this solicitation must comply with established HHS Information and Communication Technology (ICT) accessibility standards. Information about Section 508 is available at https://www.hhs.gov/web/section-508/index.html.

(b) The Section 508 accessibility standards applicable to this solicitation are stated in the clause at 352.239-79 Information and Communication Technology Accessibility. In order to facilitate the Government’s determination whether proposed ICT supplies, products, platforms, information, and documentation meet applicable Section 508 accessibility standards, offerors must submit an appropriate HHS Section 508 Accessibility Conformance Checklist (see https://www.hhs.gov/web/section-508/accessibility-checklists/index.html) or an Accessibility

Conformance Report (ACR) (based on the Voluntary Product Accessibility Template (VPAT) see https://www.itic.org/policy/accessibility/vpat), in accordance with the completion instructions. The purpose of the checklists and conformance reports are to assist HHS acquisition and program officials in determining whether proposed ICT supplies, products, platforms, information, and documentation conform to applicable Section 508 accessibility standards.

Checklists and ACRs evaluate—in detail—whether the ICT conforms to specific Section 508 accessibility standards and identifies remediation efforts needed to address conformance issues.

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(c) If an offeror claims its supplies or services meet applicable Section 508 accessibility standards, and it is later determined by the Government, i.e., after award of a contract or order, that supplies, products, platforms, information, documentation, or services support delivered do not conform to the described accessibility standards, remediation of the supplies, products, platforms, information, documentation, or services support to the level of conformance specified in the contract will be the responsibility of the Contractor at its expense.

(d) In order to facilitate the Government's determination whether proposed ICT supplies meet applicable Section 508 accessibility standards, offerors must submit an Accessibility Conformance Report, in accordance with its completion instructions and tailored to the requirements in the solicitation. The purpose of the Report is to assist HHS acquisition and program officials in determining whether proposed ICT supplies conform to applicable Section 508 accessibility standards. The template allows offerors or developers to self-evaluate their supplies and document, in detail, whether they conform to a specific Section 508 accessibility standard, and any underway remediation efforts addressing conformance issues. Instructions for preparing the HHS Section 508 Evaluation Template are available at https://Section508.gov/.

(e) In order to facilitate the Government's determination whether proposed ICT services meet applicable Section 508 accessibility standards, offerors must provide enough information to assist the Government in determining that the ICT services conform to Section 508 accessibility standards, including any underway remediation efforts addressing conformance issues.

(f) Respondents to this solicitation must identify any inability to conform to Section 508 requirements. If an offeror claims its supplies or services meet applicable Section 508 accessibility standards, and it is later determined by the Government, i.e., after award of a contract or order, that supplies or services delivered do not conform to the described accessibility standards, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its expense.

(g) Items delivered as electronic content must be accessible to HHS acceptance criteria.

Checklist for various formats are available at http://508.hhs.gov/. Materials, other than items incidental to contract management, that are final items for delivery should be accompanied by the appropriate checklist, except upon approval of the Contracting Officer or Contracting Officer’s Representative.

The current VPAT template can be found at: https://www.itic.org/policy/accessibility/vpat

L.9 52.212-2 EVALUATION – COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021) - ADDENDUM

(a) 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. The following factors shall be used to evaluate offers:

https://www.itic.org/policy/accessibility/vpat

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Factor 1: Legislative Requirements Factor 2: Identification of Improper Payments Factor 3: Web Portal, General Website, and Communications Plan Factor 4: Quality Assurance and Accuracy Factor 5: Capability to Meet all IT Systems, Security Specifications & Data Accessibility Requirements Factor 6: Key Personnel and Staffing Plan

(c) A written notice of award or acceptance of an offer, furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer’s specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

(End of provision)