Amendment 0003 - Attachment J.1_RMADA 3 IDIQ Statement of Work - CLEAN.pdf

Attachment J.1 – Statement of Work Amendment 0003 – 05/30/2025

SECTION C – DESCRIPTION/SPECIFICATIONS/ STATEMENT OF WORK

C.1 BACKGROUND

The Centers for Medicare & Medicaid Services (CMS) is the Federal agency responsible for the operation and oversight of the Medicare and Medicaid programs and the Federal participant in State-operated Medicaid programs and the Children’s Health Insurance Program (CHIP). CMS’ mission is to assure healthcare security for the public through managing programs that include Medicare, Medicaid, and State Children’s Health Insurance Programs and to provide leadership in the broader healthcare marketplace to improve the health of all citizens. As an effective steward of public funds, CMS is committed to strengthening and modernizing the nation’s healthcare system by putting patient needs first, creating more flexibilities at the state and local levels, and providing access to high-quality care and improved health at lower costs. To help accomplish this mission, CMS was given broad authority through legislation to test innovative care delivery and payment models to determine whether they can maintain or improve quality and reduce cost, are sustainable, and are feasible for broader-scale applications. This work includes the development, implementation, monitoring, analysis, technical assistance, and rapid cycle evaluation of such models, building collaborative learning networks to disseminate best practices, developing the necessary technology to support this activity, conducting rapid cycle analysis of the programs and participants, and rapid reporting of interim findings and summative findings as feasible.

Under this Research, Measurement, Assessment, Design, and Analysis (RMADA) Indefinite Delivery Indefinite Quantity 3 (IDIQ) umbrella contract, the Centers for Medicare & Medicaid Services (CMS) shall award task orders (TOs) for a wide range of analytical support and technical assistance activities that support models and demonstration programs created or derived under the auspices of the Patient Protection & Affordable Care Act (ACA), the Medicare Access and CHIP Reauthorization Act (MACRA), other non-ACA statutes, and future health reform legislation. The demands of new reforms created under ACA have redefined how CMS approaches and conducts research activities, Model testing, and demonstrations affecting Medicare, Medicaid, CHIP, and uninsured populations. The role of state and private sector payers is also being redefined, as many new models include multiple payers working in collaboration with CMS to reform the care delivery system. Note: CMS also refers to other Innovative State-based programs when the term model/demonstration is used throughout this work statement. The RMADA 3 IDIQ contract shall provide CMS with a robust tool to meet these needs and opportunities. The RMADA 3 Contractor shall work with CMS on matters including but not limited to:

Conducting program, data, and environmental analyses.

Monitoring model site implementations.

Designing and carrying out surveys and other primary data collection activities.

Obtaining and analyzing secondary data sources, including data regarding Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) and data from private payer sources needed to support operations, and evaluations.

Reporting on formative and summative analyses.

Providing rapid cycle evaluation feedback to CMS and model participants, Creating summative reports of annual and final program findings.

Assisting in developing program templates, tools, toolkits, and driver diagrams.

Support stakeholder engagement and training.

Provide data analysis/ integration support.

Assist in developing program-specific technical/policy resource guides and informational/ educational/ briefing materials.

Provide grant proposal reviews and summarization reports Developing and disseminating learning system analyses and products to support and accelerate data-driven learning and improvement among participants.

In addition to the list above of required tasks, the RMADA 3 Contractor may be asked to work with CMS on developing and implementing learning systems to support accelerated learning, improvement, and dissemination of promising practices.

C.2 INFORMATION TECHNOLOGY SYSTEMS

RMADA 3 is not an Information Technology (IT) contract vehicle. CMS will not use this IDIQ to develop new CMS IT systems. For this contract, an IT system is defined as a discrete set of information resources organized for collecting, processing, maintaining, sharing, disseminating, or disposing of information. [National Institute of Standards and Technology Special Publication (NIST SP) 800-53].

The RMADA 3 Contractor shall not create a formal CMS IT system through RMADA 3 task orders (unless CMS approves an exception). The RMADA 3 Contractor shall not:

Develop a system that requires completing the CMS Expedited Lifecycle (XLC).

Develop a system that requires obtaining a new Authority to Operate (ATO). All

CMS IT systems must obtain an ATO before startup and “go live;” or Host public-facing web-based systems in its corporate facilities that store CMS data.

CMS has dedicated contract vehicles for developing IT systems. The RMADA 3 Contractor shall collaborate with the third-party CMS IT Contractors to ensure that CMS has the IT capabilities to operate and evaluate models. The RMADA 3 Contractor may be required to collaborate with third-party IT Contractors and model teams to identify requirements, assist with User Acceptance Testing, and use the systems (e.g., help desk coordination and data entry). The RMADA 3 Contractor shall execute a Joint Operating Agreement (JOA) with CMS-designated Contractors when necessary. The JOA shall define the roles and responsibilities and create mutually agreed-upon and cost- effective methods to work together to support the CMS mission. A JOA clearly describes the work that needs to be accomplished and the roles and responsibilities of each signatory for the success of the task or project. It includes specifics about who shall do what, when, and for whom. The RMADA 3 Contractor may be asked to participate in monthly status calls with third-party IT support Contractors and applicable model staff.

CMS recognizes that the RMADA 3 Contractor may have innovative ideas for IT capabilities that can benefit models. The RMADA 3 Contractor may propose IT capabilities and systems to CMS in response to task order requests for proposal.

However, the RMADA 3 Contractor shall only develop the proposed system if CMS approves. IT staff in the CMMI/Business Services Group and Office of Information Technology shall review the proposed IT capabilities and strategies.

i. DATA ASSUMPTIONS

This section of the SOW describes how the RMADA 3 Contractor shall work with CMS data and technology.

There are several concepts that are foundational to this portion of the SOW.

1. RMADA 3 is not a software development or system development IDIQ. CMS will not use RMADA 3 to acquire new IT systems such as data collection websites and online participant dashboards.

2. CMS distinguishes between IT systems development and the use of data to perform analysis. The RMADA 3 Contractor will need to access data to perform analysis to meet Innovation Center requirements.

3. CMS’ Technical Reference Architecture (TRA) includes a Data Stewardship and Governance policy that all CMS data remain within CMS authorization boundaries (i.e., data should remain in CMS).

4. The TRA describes the use of preferred solutions to leverage CMS strategic investments and economies of scale (i.e., use CMS tools that are on the TRA).

The foundational concepts create several requirements.

1. The RMADA 3 Contractor shall not develop new IT systems such as data collection websites and online participant dashboards.

2. The RMADA 3 Contractor shall use CMS data in CMS environments.

3. The RMADA 3 Contractor shall not extract CMS data to an environment outside of CMS unless they have explicit approval from the COR.

4. The RMADA 3 Contractor shall submit written justification to the COR if it proposes extracting data to a non-CMS environment. The justification must include the reason for removing the data, the planned use of the data, the plan to secure the data according to the Federal Information Security Management Act (FISMA) and CMS’ Information Systems Security and Privacy Policy (IS2P2).

5. The RMADA 3 Contractor shall complete a Data Use Agreement (DUA) and comply with its terms.

6. The RMADA 3 Contractor shall primarily use the Model Space CMS IT environment for data analytics (see the “Section C.2.ii – Model Space Requirements” subsection below).

7. The RMADA 3 Contractor shall be proficient in working in both Model Space (Databricks) and the Virtual Research Data Center (VRDC) CMS IT environments.

The RMADA 3 Contractor shall adapt their expertise accordingly as they transition from using both VRDC and Model Space to exclusively Model Space by approximately December 2026 when SAS support ends.1 As part of the transition, all analytic tools using VRDC (SAS) will be migrated by CMS to Model Space (Databricks).

8. The RMADA 3 Contractor shall collaborate with a third-party data aggregation Contractor (see the “See Section C.2.vii – Data Aggregation Requirements” subsection below).

9. The RMADA 3 Contractor shall store its analytical code in a CMS source code repository such as GitHub (the CMS instance). Analytical code includes, but is not limited to, Python and SQL programs.

ii. MODEL SPACE REQUIREMENTS

The RMADA 3 Contractor shall use Model Space to complete the data analysis associated with contract requirements. Model Space is an analytical workspace managed by a CMMI third-party contractor. All RMADA 3 Contractors shall be granted access to Model Space by CMS at the task order level.

Description: Model Space is powered through DataBricks and presents a pre-defined set of data in a workspace. Once the data is available in Model Space, the RMADA 3 Contractor can write code to analyze the data.

The RMADA 3 Contractor can use Model Space to:

Access CMS data in the Integrated Data Repository Cloud (IDR-C)2.

1 The sunset timeline for VRDC is estimated and subject to change.

2 CCW will be available in the future.

Add third-party data and link it to CMS data.

Complete calculations such as attribution, quality measures, payment, etc.

See the details of the software that the Innovation Support Platform (ISP)

Contractor developed for the model, if relevant (e.g., supply visibility into how ISP computes a claims-based quality measurement).

Figure 1. Model Space

iii. DATA

CMMI’s third-party contractor has a pipeline to all data in IDR-C. The third-party contractor then makes a defined set of data available in Model Space based on requirements.

The third-party contractor will set up a schedule with the RMADA 3 Contractor for how often Model Space will refresh data from the IDR-C (e.g., weekly, monthly, quarterly, etc.).

The data in IDR-C and Model Space will be identical for the in-scope data set at the agreed-upon refresh frequency. For example, if the RMADA 3 Contractor needs a data element refreshed weekly, IDR and Model Space will have the same data content as of that weekly snapshot.

The data will be available to the RMADA 3 Contractor in Model Space as if the RMADA 3 Contractor pulled data from the IDR-C directly. Each workspace in Model Space is only visible to the RMADA 3 Contractor and model team.

Model Space can make final action or interim versions of claims available in Model Space.

iv. TECHNOLOGY

Model Space makes Python, R, Scala, and SQL available to the RMADA 3

Contractor for analysis.

Model Space is in the CMS Amazon Web Services (AWS) Cloud. Model Space makes analytical workspaces available to CMMI teams and Contractors through Databricks. Model Space uses Snowflake to access data.

Users can upload additional data sources into Model Space.

v. PROCESS

The third-party contractor will configure Model Space according to the RMADA

3 Contractor’s requirements.

It typically takes two weeks to set up a new workspace in Model Space.

The third-party Contractor can support ad-hoc data pulls of IDR data.

vi. DATA ANALYTICS REQUIREMENTS

The RMADA 3 Contractor shall:

1. Collaborate with the CMS third-party contractor that manages Model Space.

2. Describe data requirements to the third-party contractor that manages Model

Space.

3. Use Model Space to complete calculations and analysis required by the Contract.

CMS will supply direct access to CCW or IDR-C if the RMADA 3 Contractor has an exceptional need and provides a justification to the COR that Model Space is not a suitable solution.

vii. DATA AGGREGATION REQUIREMENTS

Data aggregation enables analyses that require data from multiple sources such as Medicare claims, commercial claims, State Medicaid claims, clinical data, lab data, and data from organizations such as patient registries and Community Based Organizations. Data aggregation requires collecting and linking data across diverse data sets.

Unless specified otherwise, the RMADA 3 Contractor shall collaborate with a third-party contractor when aggregated data is required to complete Contract tasks. A third-party contractor supplies data aggregation services for the Center. The third-party data aggregation contractor will primarily collect, link, and aggregate the data. However, if the third-party contractor is unable to perform these tasks CMS may request the RMADA 3 Contractor to assist. The RMADA 3 Contractor will complete the analyses using the data supplied by the third-party data aggregation contractor.

Figure 2 illustrates the relationship between the Contractors.

Figure 2. Relationship with Third-Party Data Aggregation Contractor

1. Describe the data business requirements and collaborate with the third-party data aggregation contractor. The business requirements will describe essential information such as the required data elements or variables, frequency, and level of detail, etc.

2. Work with the COR to establish access to the CMS IT environment.

3. Use CMS tools (Model Space) to perform analytics and create reports.

The third-party data aggregation contractor will:

1. Document the data aggregation business requirements and design. Share the business requirements with the RMADA 3 Contractor for review.

2. Establish the necessary agreements with external entities to obtain the data.

3. Collect and aggregate data from internal and data sources.

4. Make analytical data sets available to the RMADA 3 Contractor in Model Space.

viii. DESIGN OF MATERIALS

The RMADA 3 Contractor’s deliverable materials shall reflect principles and best practices in information design. This is the practice of making information easy to understand and remember. The RMADA 3 Contractor may use concepts from overlapping disciplines, such as plain language, human-centered design (HCD), interaction design, and usability. CMS will require the RMADA 3 Contractor to adopt elements of federal style that already reflect information design expertise, such as the font choices and icons of the US Web Design System. To assess the evidence base and promote stakeholder engagement, the RMADA 3 Contractor shall consult with and engage experts internal and external to CMS, serving as an education and outreach liaison.

a. Materials will be produced across several formats, including print, online

(including mobile-friendly), audio, and video. Materials should be consumer-friendly (simple and intuitive to understand), be informative and actionable for the target audiences, provide clarity, and reduce confusion and consumer anxiety. Based on user and stakeholder needs, the RMADA 3 Contractor shall manage these products as syndicated content that can be distributed through multiple partner channels and mediums. These products may include, but are not limited to:

Frequently Asked Questions Infographics Timelines Fact Sheets User Guides Presentations Drop-in articles Tip sheets Listserv message content Social media specifically for Twitter Podcasts Web-based learning modules Templates; and Resource Guides

ix. MODEL CHARACTERISTICS

Models authorized under the ACA and more recent legislation differ from past CMS demonstrations and evaluations and often include implementing learning systems for participants. The scope of activities of these models consists of all areas of healthcare research: costs, access, quality, service delivery models, financing, and payment approaches. These models are larger, more complex, and may be scaled without Congressional approval if programs demonstrate cost savings while maintaining or improving quality. These highly visible models draw intense interest and scrutiny from market and oversight stakeholders, the press, and policymakers. These models often are closely integrated with existing national programs and other models in testing. Such interactions must be carefully anticipated, understood, and managed to account for complex legal, operational, and policy priorities. These models also typically move from design to announcement and implementation in two years requiring adherence to deadlines and strong coordination across contractors and CMS.

Expectations for support of today’s models have also evolved. Unlike past demonstrations, greater emphasis is being placed on supporting more than one phase of a model. This requires close coordination with CMS and the ability to respond quickly to evolving situations. This work may require the expertise of multi-disciplinary staff, including economists, physicians, other health professionals, pharmacists, social scientists, actuaries, statisticians, public health & health policy analysts, improvement scientists, project managers, training specialists, public/media relations staff, and systems analysts.

RMADA 3 Contractor staff must also have a wide range of health care, and Medicare payment/health policy expertise. RMADA 3 Contractor staff should know the Innovation Center’s model life cycle framework used to facilitate model design, announcement, award, implementation, monitoring, evaluation, and close-out. RMADA 3 Contractors should also possess the analytic and management ability to accurately assess program risks, develop contingency plans, and implement them to balance risk, cost, and time to market adequately. Because CMS collaboratively engages model participants, support staff must be able to provide intensive technical assistance to 100-250 model participants in an accessible, client-oriented manner and at scale to all model participants.

Additionally, the RMADA 3 Contractor shall be able to staff multiple large-scale CMS models simultaneously adequately.

Evaluations of models are based on ongoing analyses using real-time claims and utilization data. These fluid and evolving studies create a need for the following:

Periodic reports for all models rather than just those at risk of being canceled.

Analytic designs that incorporate regression-based approaches as well as actuarial approaches.

Analytic designs that integrate qualitative and quantitative results; and The development of various reports tailored to specific audiences (e.g., social scientists, mid- and executive-level management, and political staff).

This approach provides insight into factors associated with process improvement and helps CMS understand factors that drive the success or failure of the relevant models and recommend changes accordingly. Because many CMS Model tests involve collaboration across multiple payers and entities, and analysis and evaluation approaches must also account for the need to gather, coordinate, and analyze private payers and other data sources, as appropriate.

C.3 REQUIREMENTS

Tasks required under this RMADA 3 IDIQ contract include, but are not limited to:

i. PRE-IMPLEMENTATION PHASE (3-6 months before model launch)

1. REGULARTORY POLICY ISSUES

The RMADA 3 Contractor shall identify regulatory and policy issues and requirements, including identifying necessary waivers.

a. Identify beneficiary population and target geographic locations and options.

b. Identify provider populations.

c. Identify specific intervention strategies, benefits, and financing changes.

d. Identify payment operational requirements and strategies; and

e. Identify operational data requirements and collection strategies.

2. DATA (FEDERAL, STATE, HEALTH CARE SECTOR)

The RMADA 3 Contractor shall identify Federal, State, and private healthcare sector data as needed or requested. The RMADA 3 Contractor shall be knowledgeable about available data sources. Examples include but are not limited to:

Claims (e.g., fee-for-service (FFS), Medicare Advantage (MA), and Medicaid claims) available through the Virtual Research Data Center (VRDC), Integrated Data Repository (IDR), and Model Space (Databricks).

All-payer claims databases (APCD).

Enrollment/eligibility information.

Survey data; and Data provided by states.

RMADA 3 Contractors shall provide an approach that identifies data directly from the CMS data sets and other appropriate sources.

RMADA 3 Contractors must propose appropriate, timely, cost-effective ways to access and identify the necessary data. This work could include the following:

Medicaid data directly from states or sites.

Hospital-level data from the AHA survey.

Physician practice data from Management Group Management

Association.

Data from other publicly available data sources; and Data from CMS.

Primary data collection may also be required. The RMADA 3 Contractor shall work with CMS to identify the best data source. CMS will work with the RMADA 3 Contractor to facilitate access to existing CMS data collection tools as appropriate. The RMADA 3 Contractor shall be responsible for obtaining any necessary Data Use Agreements (DUAs) and for adhering to CMS data security policies and procedures.

3. ENGAGEMENT

In coordination with CMS, the RMADA 3 Contractor shall consult with and engage experts internal and external to CMS. Experts may include public and private sector resources; federal and State officials; or other experts as required to refine policy issues and identify additional data sources or reports to be examined.

The RMADA 3 Contractor may be required to develop and carry out a detailed plan for managing expert engagement. The plan shall include but is not limited to compiling, analyzing, assessing, and incorporating input into activities and ICIP development, as appropriate. Relevant phases of a task order include:

Stakeholder outreach and readiness assessment during the design phase.

Creation and approval of education and outreach materials during the announcement, award, and implementation phases.

Analysis of Stakeholder interest and potential engagement during the implementation and analysis/evaluation phase; and Analysis of Stakeholder receptivity and dissemination opportunities during the report writing phase (for annual or summative reporting).

ii. IMPLEMENT & EVALUATE

The RMADA 3 Contractor shall help design operational processes, provide technical assistance, and conduct an appropriate monitoring approach. The approach shall identify potential unintended consequences of the program, detect whether participants are making progress and quality improvements, and assess whether programmatic requirements are being adequately followed. The monitoring activity shall serve as a primary source of information for tracking activities within the model operations. This may include general operational progress, such as improvements in services furnished by participating providers, and performance progress, such as improvements in care quality, care experience, or other measurable indications and model efficiency measures.

The RMADA 3 Contractor shall propose a plan to perform the following tasks:

1. DURING THE IMPLEMENTATION PHASE

1. Implement beneficiary and/or provider enrollment process.

a. Maintain a master enrollment list of beneficiaries and providers (comprehensive and point in time).

b. Maintain records on participation status, participant attribute data, and performance scores data.

c. Create ad hoc operational reports upon request by CMS.

d. Calculate and process various types of payments (disbursed or received) and

e. Generate and share data, as requested, with model participants/providers.

2. Support data sharing.

The RMADA 3 Contractor shall propose a viable plan for producing appropriate data files, ensuring timely transfer of data files to participants and complying with all CMS data use requirements, including administering data use agreements (DUAs) with all model participants, as needed. The RMADA 3 Contractor shall ensure accurate documentation of participation/data sharing status for beneficiaries/patients and providers.

3. Distribute data files.

The RMADA 3 Contractor shall distribute data to CMS and to all participants, as instructed, on a periodic basis. This distribution process may require extensive resources and IT capabilities from the RMADA 3 Contractor. For all data distributed by the RMADA 3 Contractor, appropriate documentation and evidence of compliance with DUAs, including the return of original datasets or documentation/evidence of their destruction or archival, shall be provided.

All documentation and data shall be provided to CMS after the model ends for Records Retention purposes.

4. Provide technical assistance to model sites.

The RMADA 3 Contractor shall, as required, provide technical assistance to the operating sites to improve project implementation and perform continuous quality improvement efforts within the context of supporting the model design. Examples of efforts may include stakeholder engagement, quality assurance, data collection, monitoring, soliciting participants, developing referrals, working with community partners, and designing processes to operate the project design.

5. Refine the model.

The RMADA 3 Contractor shall assist in any aspect of operations, as needed, to improve its success in improving health and care, and reducing costs. In most cases, the RMADA 3 Contractor shall consult with the model team to make refinements when needed.

6. Conduct routine and ad hoc program monitoring activities.

a. The RMADA 3 Contractor shall monitor participants for non-compliance with program rules, participant agreements, standard terms and conditions, and program-specific terms and conditions that apply to the model and report to CMS any findings.

b. The RMADA 3 Contractor shall provide technical assistance - Such assistance may include, but not limited to, written documents, webinars, and help desk responses as appropriate to the model and circumstance.

c. The RMADA 3 Contractor shall design and prepare reports in the frequency and format appropriate to the data type, target audience (including senior level federal executives, industry leaders and stakeholders internal and external to CMS), and evolving nature of the programs. For reports to CMS, the content shall be appropriate for addressing the needs for program oversight, evaluation, and, if applicable, learning and diffusion.

d. For reports to participants, the content should include information that would be helpful for participants to track their progress among peers and to gauge areas for improvement. Reports to participants may include varying levels of grouping (i.e., at the state, hospital system, and hospital level or other levels) as appropriate to the research questions at hand and the program or demonstration being examined.

The formats of the reports should address all of the needs of the audiences, and may include, but are not limited to, trend reports, dashboards, customizable data tables and charts, summary statistics, and summary findings. The reports must be produced in a rapid manner, and may range from immediate notification to annual reports, depending on the content and urgency of the information to be delivered. At a minimum, the RMADA 3 Contractor shall have the capacity to generate a large volume of monitoring reports on a quarterly basis.

7. Provide orientation and ongoing technical assistance to model participants.

The RMADA 3 Contractor shall develop an approach for providing support to model participants related to a variety of operational activities including, but not limited to:

the use and proper maintenance of data.

rationale for interpretation of findings.

payment.

evaluation.

data collection.

quality/performance measurement.

data sharing.

establishing an inquiry system/process and help desk to respond to inquiries; and Collaboration with other CMS contractors to provide subject matter expertise to support the various models.

The RMADA 3 Contractor shall demonstrate the capacity to proactively address participants’ information needs and use various media to provide training, including webinars, conference calls, face-to-face meetings, and written materials to educate them about protocols.

8. Provide technical assistance for self-administered design plans.

In many models, awardees are expected to evaluate their projects separately from CMS’ independent evaluation. Where applicable, the RMADA 3 Contractor shall provide technical assistance for the design of Awardees’ self-evaluations. This task aims to ensure that the design and execution of the self-evaluation plan are feasible and informative. Further, this technical assistance should, to the extent possible, correct deficiencies in self-evaluations that would significantly impact CMS’ ability to evaluate the proposed projects independently. However, this task should not impede progress on completing other tasks.

9. Develop and prepare initiative-specific standard operating procedures & programmatic protocols (e.g., payment administration, marketing, grievances and appeals, and stakeholder input).

The RMADA 3 Contractor shall assist CMS in ensuring that participating stakeholders' operational policies and procedures are cataloged, accurate, and current. This includes reviewing policies and procedures developed and distributed by CMS and the RMADA 3 Contractor to identify areas needing further clarification or revision based on inquiries or model experience and proposing language for inclusion in written policies and procedures for practices.

10. Develop operational requirements and manage data files for enrollment/attribution, including developing outreach strategy/materials, claims algorithms, etc.; and maintain primary enrollment lists of beneficiaries and providers (comprehensive and point in time).

The RMADA 3 Contractor shall work with CMS to organize and synthesize administrative and programmatic data collected and maintained by the RMADA 3 Contractor. This data may include but is not limited to, periodic attribution and payment information. The RMADA 3 Contractor shall make this data available to other CMS contractors for model or agency needs periodically as directed by CMS.

11. Providing enrollment support to CMS and model participants.

Providers and beneficiaries may enroll in Models through various methods, including active (recruitment) or passive (attribution) methodologies. The RMADA 3 Contractor shall provide support to CMS in the following:

Running attribution methodologies.

Preparing and maintaining current lists of model participants, considering potential overlaps with other programs.

Entering participants into the CMS Master Database Management system (MDM), as needed; and Conducting appropriate information exchanges with the CMS Center for

Program Integrity (CPI) and the Division of Technical Payment Policy, the Office of the Inspector General (OIG), the Department of Justice, and other enforcement bodies, as directed by CMS.

To be shared, data must have the appropriate level of encryption. CMS provides data encryption and transmission guidance as part of the data use agreement process and CMS policies for handling data. For the manual data exchange between federal agencies, privacy requirements for both agencies must be met. (See C.2 )

12. Develop a model-specific and cross-model quality strategy.

The RMADA 3 Contractor shall support several initiatives across CMS supporting quality performance assessment and improvement for Alternative Payment Models.

The RMADA 3 Contractor shall have expertise in:

Health services research.

Quality performance measurement.

Quality measure development and the re-specification of existing quality measures (for example, re-specification of a claims-based measure to an Electronic, Clinical, Quality, Measure (eCQM), or a change in measure specification inclusion criteria to a different age range).

Clinical quality and claims data analytics; and Statistical methodologies to support the development of a model’s quality strategy, including developing a quality payment incentive methodology.

The RMADA 3 Contractor shall support models in implementation phase for all models. The RMADA 3 Contractor shall develop standardized processes to identify appropriate quality measures for model(s) at various stages in the model lifecycle and ensure the identified quality measures meet the goals of the model’s payment design, participants, patient population, and regulatory needs of the model.

Obtain the measure specifications.

Obtain the necessary approvals to use the measures from the government liaisons (e.g., measure stewards).

Perform literature reviews and search quality measure databases to identify appropriate measures.

Identify the method for quality data collection.

Develop the benchmarking methodology and perform sample size calculations as needed.

Conduct technical expert panels, if needed.

Liaison with the Consensus Based Entity (CBE) regarding any measure questions/changes to an already CBE-endorsed measure and its implications for continued use.

Conduct ad hoc analyses as needed (for example, use historical data to determine if a model population has sufficient case size for the reliability of a measure); and

Assist with the design of the quality performance-based payment as needed.

Develop materials for meetings with the CMMI Quality Innovation Council (QIC), an internal workgroup at CMMI, that helps determine the proper measures for a given model.

Work with other CMS contractors to ensure data integration and reporting quality metrics from CMMI models to other CMS programs are performed as needed.

Coordinate with the relevant CMS evaluation lead(s) (and evaluation Contractor(s)) to assess the evaluability of each measure.

The RMADA 3 Contractor shall develop a limited number of new measures that fill identified gap areas in performance measurement for alternative payment models and re- specify existing standards to meet model needs.

The RMADA 3 Contractor will need to develop or re-specify measures under tight timelines to use the measures within the model’s planned years of operation. The RMADA 3 Contractor would be expected to support multiple models concurrently, if applicable. The RMADA 3 Contractor may also provide administrative support to a center-wide quality committee and develop standard operating procedures, agendas, and meeting documents.

The measures developed or re-specified shall be explicitly designed for inclusion in models that are typically different than those used in CMS quality reporting programs. Quality measure work will require specifications and testing for the use of the measure in many settings, across many types of providers, and in different model designs (e.g., in Bundled Payment models, Accountable Care Organizations). The RMADA 3 Contractor shall support the model’s other quality measure work, including testing new measures introduced (except quality data collection). The need to re-specify or develop a measure should be performed not to interrupt the model lifecycle and other operations.

The RMADA 3 Contractor shall create/maintain processes for collecting performance data; obtain appropriate claims, surveys, and clinical data for measurement; conduct necessary training for participants; and use existing IT platforms and software as appropriate. The RMADA 3 Contractor may be required to determine performance benchmarks, calculate quality scores, perform site reviews and audits where needed, and create participant performance reports. Information regarding nuances of Medicare claims data is available through Research Data Assistance Center, Resdac:

http://www.resdac.org/. Other information that cannot be obtained through retrospective claims-based analyses may need to be collected through surveys or other mechanisms that are project specific. The RMADA 3 Contractor shall propose appropriate supplemental data collection techniques.

13. Develop core measures

Other quality initiatives the RMADA 3 Contractor may perform include designing, implementing, and analyzing Center-wide core quality performance measures. Core quality performance measures would be used in every model across CMS. The RMADA 3 Contractor may be asked to develop a plan to identify appropriate steps for use across all models, implement the measures, collect participant data, and conduct data analyses within and across models.

This work may also involve designing, administering, and analyzing a survey to assess patient-reported outcome measures. The RMADA 3 Contractor shall administer this survey to a sample of patients from each model participant and promptly communicate the results to the model participants. The RMADA 3 Contractor would then re-survey the same patient cohort at a pre-determined interval. The RMADA 3 Contractor shall develop the data benchmark methods, perform meta- data analyses, and develop reports for models’ participants, CMS leadership, and the public.

14. Provide quality improvement reviews

Additional quality initiatives may include assessing individual models to improve the quality of care based on predetermined quality measures or quality improvement data from each model. The quality improvement review may be done annually for each model and include a center-wide report that compares all models against preset strategic objectives.

15. Develop operational requirements and systems for sharing data, including processes for administering data use agreements

Propose a viable strategy for implementing the transfer of data files to participants and CMS and its Contractors to ensure timely transfer of data files to participants and compliance with all CMS data use requirements, including establishing data use agreements with all model participants, as needed. The RMADA 3 Contractor shall propose a plan to ensure accurate participation/data sharing status documentation for beneficiaries/patients and providers.

16. Payment operations and administrative activities

The RMADA 3 Contractor may be asked to collaborate with a third-party contractor (the Innovation IPC (IPC)) about payment operations and administrative activities. These services available to any model on contract with the IPC may include:

Establish a Bank account for the disbursement of funds to model payees.

Disburse Electronic Funds Transfer (EFT) or paper check payments to eligible Medicare and Medicaid providers and beneficiaries.

Apply Federal Payment Levy Program (FPLP) withholding for each payee.

Issue demand letters, conduct collection activities (payment offset/ withholding and pay and chase), and report on receivables.

Manage/monitor recoupment debt repayment plans.

Process debt referrals to Treasury.

Adjust payments, including accounts payable/receivable netting, as required.

Manage model bank accounts.

Send IRS 1099s annually to all payees.

Provide proper funds control, oversight, and compliance with all applicable laws, regulations, Federal Accounting Standards, Generally Accepted Accounting Principles, Office of Financial Management (OFM) guidelines, and reporting requirements in compliance with the CMMI internal controls.

Additionally, the IPC is currently/can perform the following additional tasks at the behest of CMMI:

o Work with other CMS centers and contractors to integrate with other new and existing systems o Currently working towards integrating the Healthcare Integrated General Ledger Accounting System (HIGLAS).

o Currently housed on the fully ATO’d Small Business Health Options Plan (SHOP) Premium Aggregation Services (PAS) Center for Consumer Information and Insurance Oversight (CCIIO) infrastructure to make payments with National Government Systems (NGS) performing annual recertification of the ATO o Currently developing an interface with Provider Enrollment Chain and Ownership System (PECOS) and the Shared Systems to automate and verify provider banking data o Serve as a financial service resource providing CMMI with expertise and advice in all areas of payment servicing.

17. Provide payment audit support

CMS will provide the RMADA 3 Contractor with analytical code (SAS, Databricks, or other platforms) and supplementary materials prepared by a third-party contractor (the IPC). The RMADA 3 Contractor shall review these materials and develop original analytical work products. When requested by CMS, the RMADA 3 Contractor shall consult with the IPC.

a. Audit and validate

The RMADA 3 Contractor shall validate the payment calculation performed by the IPC throughout the duration of the contract. The RMADA 3 Contractor shall audit and validate the IPC’s calculations for each episodic period for newly submitted claims and updates to previous claims. After receipt of the IPC’s initial calculations, CMS expects for the RMADA 3 Contractor to complete calculation validations and produce audit reports on a timely basis established by CMS.

The RMADA 3 Contractor shall provide CMS with a written report of the results of the payment calculation validation, along with a summary file and summary report. Using work performed by the IPC and provided by CMS, the RMADA 3 Contractor shall refine these deliverables as directed. The summary report must document discrepancies between the summary file and IPC’s results. The RMADA 3 Contractor shall provide the data files used for each calculation as requested by CMS.

The RMADA 3 Contractor shall provide CMS with a written report on the results of the validation work, clearly documenting any discrepancies between the their results and the Payment contractor’s results. The report shall include variables such as dates falling within the model, all assumptions made in performing calculations, and outputs of the financial analyses as performed by the RMADA 3 Contractor. It is expected that this task will vary episodically.

b. Recoupment validation

The RMADA 3 Contractor shall audit and validate the IPC’s calculation of the amount that must be paid or recouped by CMS for actual expenditures that are either above or below the target price. The RMADA 3 Contractor shall generate reports and summary files of auditing and validation work as directed by CMS.

18. Develop a viable process for responding to beneficiary/provider inquiries

The RMADA 3 Contractor shall support CMS in interfacing with 1-800- Medicare, state Medicaid agencies, or other organizations and conduct different approaches for monitoring beneficiary concerns related to the administration of the model. Some of these activities shall include, but are not limited to, developing FAQs, analyzing complaints, and developing scripts.

19. Develop viable operational requirements for monitoring

The RMADA 3 Contractor shall assist CMS in providing ongoing monitoring and oversight of models, determining needs, obtaining the necessary data, and conducting all relevant analyses, as requested. Such data collection and analysis activities shall be based on data from participants, CMS, and secondary data sources, as well as on routine surveys, other primary data, and ad hoc data. The RMADA 3 Contractor’s frequency of obtaining secondary data may be as frequent as monthly or as periodic as a quarterly collection for primary data. The frequency could change with each task order issued.

20. Perform quantitative and qualitative analyses

The various data types should be obtained as defined by the deliverable established by a specific proposal, methodologically sound, robust, comprehensive, and appropriate to the respective research questions and the target audiences. Analyses may need to incorporate extensive performance and evaluation data analysis to ensure that learning is focused on those elements of models where the data demonstrates that the intervention has been effective or ineffective. Upon identifying potential issues of concern, the RMADA 3 Contractor shall notify CMS or a CMS contractor with auditing responsibilities to further investigate any suspicious patterns and trends.

21. Maintain critical systems of record

a. The RMADA 3 Contractor shall comply with all applicable records management laws and regulations, as well as National Archives and Records Administration (NARA) records policies, including but not limited to the Federal Records Act (44 USC chs. 21, 29, 31, 33), NARA regulations at 36 CFR Chapter XII Subchapter B, and those policies associated with the safeguarding of records covered by the Privacy Act of 1974 (5 USC 552a). These policies include preserving all records, regardless of form or characteristics, mode of transmission, or state of completion.

b. In accordance with 36 1222.32, all data created for Government use and delivered to, or falling under the legal control of, the Government are Federal records subject to the provisions of 44 USC chapters 21, 29, 31, and 33, the Freedom of Information Act (FOIA) (5 USC 552), as amended, and the Privacy Act of 1974 (5 USC 552a), as amended and must be managed and scheduled for disposition only as permitted by statute or regulation.

c. In accordance with 36 CFR 1222.32, the RMADA 3 Contractor shall maintain all records created for Government use or created while performing the contract and delivered to, or under the legal control of the Government and must be managed per Federal law. Electronic records and associated metadata must be accompanied by sufficient technical documentation to understand and use the documents and data.

d. The RMADA 3 Contractor shall take the annual HHS records management training.

22. Develop, implement, and manage stakeholder engagement, model recruitment, and model launch.

The RMADA 3 Contractor shall support stakeholder engagement, model recruitment, and model launch for CMS. This work includes, but is not limited to, identifying appropriate delivery platforms for engaging stakeholders and designing the strategy, structure, and continuous quality improvement processes for model recruitment and model launch efforts. Specifically, the RMADA 3 Contractor shall work to:

a. Advance CMS priorities, including but not limited to patient/beneficiary/caregiver engagement, empowerment, and experience, and multi-payer alignment.

b. Provide data-driven support for participant and stakeholder engagement activities.

c. Engage external stakeholders (e.g., patients, caregivers, primary/specialty providers, and public/private payers) most directly affected by models.

d. Increase external stakeholder awareness of new models and CMS programs, including aims, plans, and conditions for participation.

e. Support targeted model participant recruitment/engagement by increasing interest among eligible and prospective model participants and improving the quality of model applicant pools.

f. Generate insights based on stakeholder feedback highlighting the needs, perspectives, and challenges of CMS stakeholders who participate in and are impacted by models.

g. Improve the quality of model applicant pools.

h. Accelerate model team and participant preparedness for model launch through data analysis, and stakeholder engagement activities.

i. Execute and administer a process for direct communication with external stakeholders to obtain feedback. To support this effort, the RMADA 3 Contractor shall work with CMS and execute a stakeholder communication plan to convene and organize Listening Sessions, Town Halls, and National Stakeholder Calls, develop and maintain email distribution lists, and offer other direct communication methods with stakeholders.

j. Lead the development and implementation of model pre-launch activities. This includes, but is not limited to, model footprint analyses, journey, mapping, model factsheet and FAQ development support, virtual event coordination, project management support, patient/family/caregiver journey mapping, and beneficiary engagement.

k. Support driver diagram development to articulate the aim and critical drivers of success for the model and hypotheses of tactics that might work to improve the model aim.

l. Inform model learning system development through identifying and providing CMS with model and cross-model participant and contextual insights to support participant and model success during the model performance period.

23. The RMADA 3 Contractor shall work collaboratively with CMS to document and execute CMS’ education and outreach plan. The plan may integrate with other related CMS Innovation Center communication efforts and must be refined throughout the performance period. The education and outreach plan may focus on areas such as:

a. Reaching all stakeholders with appropriate user-specific information

b. Providing details about eligibility

c. Connecting stakeholders with appropriate tools and resources

d. Increasing participation and performance by clinicians

e. Monitoring and evaluation of activities

f. The RMADA 3 Contractor shall develop, update, determine how to present, and curate program education and outreach products to effectively reach internal and external stakeholders with the information needed to participate successfully and support CMS’ efforts to educate users and stakeholders. In producing all materials, the RMADA 3 Contractor shall ensure the integration of CMS branding elements and compliance with CMS communications policies and guidelines in all products and strategies. Materials should be developed to conform to plain language principles.