JH RFP Questions and Responses (JH RFP 75FCMC26R0001) Final 008082025.xlsx
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- Medicare Administrative Contractor (MAC) Jurisdiction H (JH) - Synopsis/Draft RFP / Presolicitation
- Solicitation number
- 75FCMC26R0001
About this file
This document is a Questions and Answers (Q&A) file for a Medicare Administrative Contractor (MAC) Jurisdiction H solicitation (RFP 75FCMC26R0001). The solicitation covers Medicare fee-for-service claims processing and health insurance benefit administration services for Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas. Key details include a contract with one base year and six option years, a NAICS code of 524114, and a small business size of $47 million.
The Q&A document addresses multiple technical, operational, and administrative aspects of the proposal, including clarifications on small business utilization (5% of total contract value), proposal submission requirements, technical evaluation factors, and specific workload details. Notable requirements include submission of proposals in PDF and Excel formats, use of specific fonts, page numbering guidelines, and detailed instructions for various proposal volumes covering staffing plans, operations, past performance, and small business utilization. The solicitation involves processing Medicare claims, complex beneficiary inquiries, and specialized projects like Veterans Affairs Medicare Equivalent Remittance Advice and Indian Health Services claims processing.
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| File | Type | Posted |
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| Solicitation - 75FCMC26R0001 Final.pdf | ||
| JH Final Attachments.zip | ZIP file | |
| JH RFP Final Backpages Question Updates 08082025.docx | DOCX document | |
| Solicitation - 75FCMC26R0001 Final.pdf |
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Text version
A. Section B-K
| Question ID | Document | Section | Page # | Question | CMS Answer/Action |
| A.1 | JH+Draft+RFP+Backpages.docx | K.3 | 126 | The NAICs code information and small business size is not populated. Please clarify if this information will be provided. | CMS confirms the RFP is updated to reflect the NAICS code of 524114 and small business size to be $47M. |
| A.2 | JH Draft RFP Backpages | F.2 Period of Performance | 25 | Instead of 1 base year + 6 options years, for a potential total of a 7 year contract, would CMS consider taking advantage of legislation that gives CMS the discretion to award the contract for 10 years? Or elaborate on why that is not an option? | CMS confirms the JH award will be for 1 base year and 6 option years as described in the RFP. |
| A.3 | JH Draft RFP Backpages | F.2 Period of Performance | 26 | CLIN 0024 appears to have an incorrect Description. Please confirm that it should be stated as: BASE (VA RECLAIM), instead of BASE Medical Review for Therapy Claims KX Modifier (KX MODIFIER). | CMS confirms the RFP is updated, the description for CLIN 0024 is corrected to Veterans Affairs Medicare Equivalent Remittance Advice Project (VA RECLAIM). |
| A.4 | JH Draft RFP Backpages | B.6 SCHEDULE OF SUPPLIES/SERVICES | 20-21 | VA RECLAIM Option Year CLINS are all labeled CLIN 0024 for Base Year and CLIN 0025 for all Option Years. Should this be updated to reflect CLIN 0024-0030? | CMS confirms the RFP is updated, all VA RECLAIM CLINs are accurately numbered from CLIN 0024-0030. |
B. Section L-M
| Question ID | Document | Section | Page # | Question | CMS Answer/Action |
| B.1 | RFP | L.12.6 Tab F, Small Business Subcontracting Plan, M.3 - Small Business Utilization | 152, 172 | Section L.12.6 states "Overall, 23% of total contract value should go to Small Businesses "; However, Section M.3 - Small Business Utilization states "The offeror will also be evaluated on meeting or exceeding a Small Business usage of 5% of the total contract value"; Can CMS please clarify what the small business total contract value goal is for Jurisdiction H? | CMS confirms section L.12.6 provides Agency information and guidance on the small business subcontracting goal of 23%. Section M.3 Technical Evaluation Factors provides the evaluation criterion the Agency will use in evaluating proposals on the Small Business Utilization criterion, which is 5% of total contract value. |
B.2 JH+Draft+RFP+Backpages.docx L.11.a 146 The instructions state, "The Offeror shall submit a second copy of its proposal as directed below, presented in Microsoft Word and Excel formats, based on the content of each section." Volumes II, III, and IV are addressed. Volumes I, V, and VI are not expressly addressed but CMS states that "Electronic copies of all other documents including signed annual reports and corporate policies shall be submitted in Adobe Acrobat PDF format. Organizational charts shall be submitted in Adobe Acrobat PDF format."
| Can CMS please confirm that for the second copy of the proposal, Volumes I,V, and VI are required to be submitted in Adobe Acrobat PDF format? | CMS confirms that all Volumes (Volumes I-VI), in their entirety, are to be submitted in Adobe Acrobat PDF format. Further, Offerors are directed to comply with additional instructions for submission of Word and Excel versions of Volumes II, III, and IV as stated in section L.11.a. | ||||
| B.3 | JH+Draft+RFP+Backpages.docx | L.11.h, L.13.2 and L.14.3.2.2 | 150, 156 and 167 | L.11.h, bullet #8 states "Each of the volumes shall be separate and complete so that the evaluations are independent of each other. The technical proposal must not contain reference to price/cost." |
L.13.2, second bullet on page 156 states, "If the Offeror wants to propose a technical approach that could reduce or eliminate a Government-provided RFP Workload/Proposal Workload for a workload other than the three specified above, the Offeror shall describe the proposed technical approach in its Technical Proposal and include detailed information clearly showing the impact to staffing and costs related to the proposed technical approach."
L.14.3.2.2 on page 167 states, "If applicable, the Offeror shall describe its proposed innovative methods, emerging technologies or operational enhancements that are worthy of note and that exceed the SOW requirements for this solicitation for the mission essential functions listed above or for any other SOW area. Describe how each proposed innovative method, emerging technology or operational enhancement affects the mission essential function(s) and/or other SOW area and why it represents added value to the Government. Include all costs (in Volume IV) for development and operations of the proposed innovative methods, emerging technologies or operational enhancements that will be incurred during the contract."
Section L.11.h states that the technical must not contain cost references, however L.13.2 and L.14.3.2.2 state that costs are to be included in the Technical. Can CMS please confirm that for these sections, CMS wants to see costs in the technical narrative as well as the business volume? The RFP is updated as the bullet in section L.11.h had a format error. CMS confirms the direction in L.11.h that each of the proposal volumes shall be separate and complete so that the evaluations are independent of each other and further, the technical proposal must not contain any reference to price/cost, "resource information such as data concerning labor hours and categories, subcontracts, etc., may be contained in the technical proposal so that Offeror’s understanding of the scope of the work may be evaluated."
B.4 JH+Draft+RFP+Backpages.docx L.12.5 (a) 151 This section states "A separate organization structure chart shall be provided for each proposed significant subcontractor (as defined in Section L.14.4)." Section L.14.4 does not appear to define the term "significant subcontractor", but a definition is located in section L.14.2." Can CMS please clarify if L.14.2 is the correct reference? CMS confirms the L.12.5(a) statement is corrected to refer Offerors to section L.14.2.
B.5 JH+Draft+RFP+Backpages.docx L.12.6 and M.3 152 and 172 The Small Business Utilization Proposed Approach Evaluation Criteria (page 172) indicates that "The offeror will also be evaluated on meeting or exceeding a Small Business usage of 5% of the total contract value." Section L.12.6, Tab F, P Subcontracting Plan (Page 152) indicates that "Overall, 23% of total contract value should go to Small Businesses."
Can CMS please confirm that offerors should comply with the 5% of Total Contract Value Small Business usage goal overall as indicated in M.3 and of that 5%, allocations should be made to the Small Business Components as indicated in the L.12.6 table (i.e., SDB 5%, WOSB 5%, HubZone 3%, SDVOSB 5%, VOSB 5%) on page 152. CMS confirms section L.12.6 provides Agency information and guidance on the small business subcontracting goal of 23%. Section M.3 Technical Evaluation Factors provides the evaluation criterion the Agency will use in evaluating proposals on the Small Business Utilization criterion, which is 5% of total contract value.
B.6 JH+Draft+RFP+Backpages.docx L.14 159 and 171 The table on page 159 shows N/A for page limit for Small Business Utilization. However, L.14.4 on page 171 has a note stating, "This section does have a page limit." Can CMS elaborate on which direction to follow? CMS confirms section L.14.4 is updated to state that the section does not have a page limit.
B.7 JH+Draft+RFP+Backpages.docx L.14.3.1 (4 & 8) 164 & 165-166 4. Staffing Level Responsiveness and 8. OY1 Management of Staff (item a) both ask offerors to address their ability to quickly adjust staffing levels to accommodate workload fluctuation. To remove the redundancy, would CMS consider requiring that in either Staffing Level Responsiveness or OY1 Management of Staff, instead of both? CMS confirms the sections are similar but not redundent.
B.8 JH+Draft+RFP+Backpages.docx L.14.3.2 (6a) and J.23.B 167 6. L.14.3.2 (6A) states, "The Offeror shall describe its proposed approach to performing the Provider Customer Service Program (PCSP). In its response, the Offeror shall address the requirements:
a. The Offeror shall complete and include the tables in Attachment J.23.B, CSR- Handled Telephone Inquiries Table in Volume III, Tab E - Operations. Further, the Offeror must provide conforming data in the BOE, in keeping with the BOE instructions. Finally, Offerors must align their staffing plans under Volume III, Tab C – Staffing Plan to their proposed workloads for CSR-handled provider telephone inquiries."
For MACs that utilize outbound call programs to better serve large providers and/or providers with significant call volumes, the impact on the CSR-Handled Telephone Inquiries volumes can be material. Neither Attachment J.23.B nor the BOE have a place to report on this workload nor the historical labor hours/productivities. Will CMS please specify how MACs should identify and incorporate the historical and proposed workloads and costs associated with outbound call programs on the BOE and within the historical and proposed CSR-Handled Telephone inquiries Table J.23.B? CMS confirms the direction in the J.23.B and BOE to provide a clear staffing plan proposal for the volume of incoming calls provided in both documents. Further, the Offerors shall describe and provide clear details on all features and tools proposed for use in JH, including features/tools that supplement activities required in the SOW, i.e., outbound call programs. All details may be provided in the Technical Proposal. CMS will review any variances between the Offeror’s historic baseline/proposed technical approach and the Offeror’s proposed workload estimates for reasonability.
B.9 JH+Draft+RFP+Backpages.docx L.14.3.2.2 and L.15 167 and 173 L.14.3.2.2 states, "If applicable, the Offeror shall describe its proposed innovative methods, emerging technologies or operational enhancements that are worthy of note and that exceed the SOW requirements for this solicitation for the mission essential functions listed above or for any other SOW area. Describe how each proposed innovative method, emerging technology or operational enhancement affects the mission essential function(s) and/or other SOW area and why it represents added value to the Government. Include all costs (in Volume IV) for development and operations of the proposed innovative methods, emerging technologies or operational enhancements that will be incurred during the contract."
L.15 states, "The business proposal narrative shall include only business proposal-related content and shall not include any technical proposal-related content. Any contents of the business proposal narrative not related to the business proposal will not be considered for evaluation."
Can the government please clarify if we are to include all costs (in Volume IV) for development and operations of the proposed innovative methods, emerging technologies or operational enhancements that will be incurred during the contract in Volume IV? CMS confirms the direction in L.14.3.2.2 and L.15 relative to Offerors including all cost related information in the Business Proposal, Volume IV. Likewise, cost information must not be in the Technical Proposal, Volume III. However, resource information such as data concerning labor hours and categories, subcontracts, etc., may be contained in the technical proposal, Volume III, so that Offeror’s understanding of the scope of the work may be evaluated.
B.10 JH+Draft+RFP+Backpages.docx L.14.3.3 170 Section M.3, Targeted and demonstrated experience factor evaluation criteria states, "The Government reserves the right to limit its review of targeted and demonstrated experience information to what he/she has determined to be relevant. The Government also may give higher confidence to more relevant and/or more recent targeted and demonstrated experience."
Can CMS please provide additional detail or specificity as to what qualifies as relevant in terms of contract type, recency, or other factors to ensure responders are able to provide examples that meet the requirement to be considered for a higher confidence rating? Relevant is information which is similar in size, scope and complexity to this contract.
B.11 JH+Draft+RFP+Backpages.docx M.3 184 M.3 states, "CMS’s technical evaluation will consider six (6) non-cost technical evaluation factors, listed below in descending order of importance, with Small Business Utilization and AbilityOne being of equal importance to each other. The Offeror shall include in its proposal sufficient information for the Government to determine the Offeror’s ability to perform the requirements of the RFP.
1. Staffing Plan: Offerors are referred to Section L.14.3.1 for evaluation criteria applicable to this evaluation factor.
2. Operations: Offerors are referred to Section L.14.3.2 for evaluation criteria applicable to this evaluation factor.
3. Targeted and Demonstrated Experience: Offerors are referred to Section L.14.3.3 for evaluation criteria applicable to this evaluation factor.
4. Past Performance: Offerors are referred to Section L.14.2 for evaluation criteria applicable to the Past Performance evaluation factor. Small Business Utilization will be included in the past performance evaluation.
5. Small Business Utilization: Offerors are referred to Section L.14. 4 for evaluation criteria applicable to this evaluation factor.
6. AbilityOne: Offerors are referred to Section L.14. 5 for evaluation criteria applicable to this evaluation factor.
| For Past performance evaluation, is CMS stating that the historical usage of subcontractors or the current proposed usage? | CMS confirms the information in section M.3. Offerors shall note, the the Past Performance evalution includes consideration of previous evaluations of the Offeror relative to its small business utilization found in annual Contractor Performance Assessment Records (CPARs). The Small Business Utilization evaluation criterion differs as the Offeror will be evaluated on its proposed use of small business subcontracts for JH. | ||||
| B.12 | JH+Draft+RFP+Backpages.docx | M.3 | 184 | Section M.3 on page 184 states, "CMS’s technical evaluation will consider six (6) non-cost technical evaluation factors, listed below in descending order of importance, with Small Business Utilization and AbilityOne being of equal importance to each other. The Offeror shall include in its proposal sufficient information for the Government to determine the Offeror’s ability to perform the requirements of the RFP." |
Can CMS please provide additional specificity as to the relative weighting of each of these factors? CMS confirms that the six non-cost technical factors are in descending order of importance to the technical evaluation and there is no additional weighting or specificity to share.
| B.13 | JH Draft RFP Backpages | L.12.6, Small Business Subcontracting Plan | 152 | Section L.12.6 indicates that Offerors are required to submit a small business subcontracting plan in accordance with FAR 52.219-9. According to FAR 52.219-9, and current small business subcontracting plan templates, separate goals should be expressed in terms of total dollars planned to be subcontracted, and as a percentage of total planned subcontracting dollars. However, Section L.12.6 cites a Small Business Goal of 23% of total contract value, which will require offerors to subcontract a considerable portion of the work to subcontractors, and will result in additional risk, inefficiency, and instability to the Program due to a significant disruption in current offeror solutions for performing the work as well as an increase in the need for management and oversight and overall cost. Please confirm that the Small Business Goal is to be based on planned subcontracting dollars. | CMS confirms the RFP language that states, "The offeror will also be evaluated on meeting or exceeding a Small Business usage of 5% of the total contract value." |
| B.14 | JH Draft RFP Backpages | L.14.3.2 VOLUME III, Tab D, Operations, Proposal Instructions | 166 | Section 14.3.2 addresses a requirement for offerors to describe its approach to accomplishing and integrating certain jurisdiction specific requirements, including SOW C.6.2.5.1 Memorandum of Understanding Regarding Part A Legacy Records. Section C.6.2.5.1 indicates that CMS will be transferring the FI responsibility to the Jurisdiction 5 A/B MAC. Please clarify the requirements regarding the MOU for Part A Legacy Records upon award. Does CMS intend that if an offeror does not have an MOU in place with the J5 MAC for the J4 records that the offeror should outline its plan for accomplishing this requirement as part of its proposal? | CMS confirms the expectation that Offeror will acknowledge the requirement and address their plan to accmplish getting an MOU in place with J5 MAC. |
| B.15 | JH Draft RFP Backpages | L.14.4 VOLUME III, Tab F, Small Business Utilization Proposed Approach, Proposal Instructions | 171 | Section L.14.4 indicates that an offeror is to submit their respective subcontracting plan with the proposal (Attachment J.03) and electronically using the U.S. Department of Health and Human Services (HHS) Small Business Customer Experience (SBCX) system at https://osdbu.hhs.gov. However other sections of the draft RFP (Section G.5. L.11, and L.12.6) refer to the SBCX website for submission of the subcontracting plan, and Attachment J.03 is marked as reserved. Please confirm if a copy of the subcontracting plan is required to be submitted with offeror proposals in Volume I. | CMS confirms the RFP language is updated to remove referrence to Attachment J.03. |
| B.16 | JH Draft RFP Backpages | L.14.4 VOLUME III, Tab F, Small Business Utilization Proposed Approach, Proposal Instructions | 172 | Although Section L.12.6 cites a Small Business Goal of 23%, Section M.3 states that the offeror will also be evaluated on meeting or exceeding a Small Business usage of 5% of the total contract value. Please confirm that offerors will be evaluated based on meeting or exceeding a small business usage of 5% of planned subcontracting dollars in accordance with FAR 52.219-9. | CMS confirms section M.3 Small Business Utilization Proposed Approach criteria language that states, "The offeror will also be evaluated on meeting or exceeding a Small Business usage of 5% of the total contract value." Section L.12.6 provides Agency information and guidance on the small business subcontracting goal of 23%. |
| B.17 | JH Draft RFP Backpages | L.14.5 VOLUME III, Tab G, AbilityOne Proposal Instructions | 172 | Section L.14.5 indicates that the contractor shall meet or exceed an AbilityOne usage of 1% of the total contract value. Please confirm that this requirement is intended to be 1% of our annual JH total dollars subcontracted, not of total contract value. | CMS confirms section M.3 AbilityOne criteria language that states, "The offeror will also be evaluated on meeting or exceeding an AbilityOne usage of 1% of the total contract value." |
| B.18 | JH Draft RFP Backpages | L.15.3 VOLUME IV, Tab C, Written Narrative and Other than Certified Cost or Pricing Data | 176 | Per L.15.3, Direct Labor, offerors are to “provide invoices that were approved in the past three years”. This request will result in hundreds of invoices and thousands of pages. Given the volume of pages, please confirm that CMS wants offerors to include these invoices which were previously submitted to CMS. | CMS confirms the RFP language is updated. |
| B.19 | JH Draft RFP Backpages | L.16, Volumn V, Conflicts of Interest Proposal Submission Instructions (OCT 2020) | 181 | Section H.1 references date (AUG 2024). Please confirm the date referenced in Section L.16 (OCT 2020) is correct. | CMS confirms the RFP language is updated to remove date from L.16. |
| B.20 | JH Draft RFP Backpages | M.5 Conflict of Interest Evaluation (OCT 2020) | 185 | Section H.1 references date (AUG 2024). Please confirm the date referenced in Section M.5 (OCT 2020) is correct. | CMS confirms the RFP language is updated to remove date from M.5. |
| B.21 | JH+DRAFT+RFP+Backpages | L.11 SUBMISSION, DELIVERY, ORGANIZATION AND GENERAL INSTRUCTIONS | 146 | L.11 requires Offerors to submit each volume of its proposal in separate emails. Will the Government consider setting up a secure submission portal instead? | No, CMS confirms Offerors are to submit proposals in accordance with the instructions of the RFP. |
| B.22 | JH+DRAFT+RFP+Backpages | L.11 SUBMISSION, DELIVERY, ORGANIZATION AND GENERAL INSTRUCTIONS | 149 | For table text and proposal graphics, will the Government allow Offerors to use all font in the Arial family? | No, CMS confirms Offerors are directed to to section L.11.f for clear direction on font, font size, etc. Specifically, Offerors shall use only Times New Roman and Arial font as directed. |
| B.23 | JH+DRAFT+RFP+Backpages | L.14 VOLUME III, TECHNICAL PROPOSAL INSTRUCTIONS TECHNICAL PROPOSAL EVALUATION FACTORS OVERVIEW | 159 | Volume III, Tab B for Past Performance states the page limit is "2 Pages for Utilization of Small Business." Does the 2-page limit apply to Tab F, Small Business Utilization? Please confirm the page limits for Tabs B and F. | CMS confirms the section L.14 table and subsequent direction in sections L.14.2.c and L.14.4, the Tab B Past Performance Evaluation Criterion page limit is two pages. The Tab F Small Business Utilization Evaluation Criterion does not have a page limit. |
| B.24 | JH+DRAFT+RFP+Backpages | L.14 VOLUME III, TECHNICAL PROPOSAL INSTRUCTIONS TECHNICAL PROPOSAL EVALUATION FACTORS OVERVIEW | 160 | In Volume III, Tab B for Past Performance, may Offerors reformat the table that will provide a summary of past performance information? | CMS confirms that Offerors shall use the table in the form provided and shall not reformat the table. |
| B.25 | JH+DRAFT+RFP+Backpages | L.14 VOLUME III, TECHNICAL PROPOSAL INSTRUCTIONS TECHNICAL PROPOSAL EVALUATION FACTORS OVERVIEW | 161 | In Volume III, Tab F for Small Business Utilization, may Offerors provide eSRS reports in an appendix and in their original format? | CMS confirms direction in section L.14.2.c "eSRS reports will not count against the page limit but shall be submitted as part of this section." Further, Offerors may include the eSRS within Tab F or as an appendix to Volume III. |
| B.26 | JH Draft RFP | L.15.3 Volume IV, Tab C, written narrative and other than cost and pricing data - Direct Labor | 176 | We recommend the RFP language, “Provide incurred cost proposal approved in the past three years” be changed to, “Provide the three most recently submitted incurred cost proposals.” Without the change, the RFP is ambiguous since it is not clear if one or three ICPs from within the past three years is required. The verbiage “approved” is also ambiguous because ICPs do not get approved. If CMS changed “approved” to “audited” on the basis that ICPs do get audited, the resultant language would be anti-competitive (excluding otherwise competitive offerors without a reasonable basis) because when the government audits ICPs is outside the control of an Offeror. | CMS confirms the RFP language is updated. |
| B.27 | JH Draft RFP | L.15.3 Volume IV, Tab C, written narrative and other than cost and pricing data - Direct Labor | 176 | Under Direct Labor, a bullet states, "Provide Invoices that were approved in the past three years." This could yield hundreds of documents for an existing MAC, as each SLIN is a separate invoice, and if there are/were 6 SLIN invoices per month over the last 36 months, that would yield 216 invoices. Additionally, there is no context to say what the invoices should support, same or similar work, etc. Would CMS consider changing the language to “Provide a sampling of invoice that were approved, four per year for the past three years”? | CMS confirms the RFP language is updated. |
| B.28 | JH Draft RFP Backpages | L.12.6, Tab F Small Business Subcontracting Plan; Section M.3 Small Business Utilization Proposed Approach Factor Evaluation Criteria | 152, 172 | Is the 23% percent of total contract value small business goal correct (p. 152)? It is contradicted by the 5% of total contract value on page 172, Section M.3 Small Business Utilization Proposed Approach Factor Evaluation Criteria. | CMS confirms section L.12.6 provides Agency information and guidance on the small business subcontracting goal of 23%. Section M.3 Technical Evaluation Factors provides the evaluation criterion the Agency will use in evaluating proposals on the Small Business Utilization criterion, which is 5% of total contract value. |
| B.29 | JH Draft RFP Backpages | L.14.4 Volume III, Tab F, Small Business Utilization Proposed Approach, Proposal Instructions | 171 | Please confirm that "(Note: This section does have a page limit.)" should read "(Note: This section does not have a page limit.)" | CMS confirms section L.14.4 is updated to state that the section does not have a page limit. |
| B.30 | JH Draft RFP Backpages | L.14.4 Volume III, Tab F, Small Business Utilization Proposed Approach, Proposal Instructions | 171 | Please provide Attachment J.03. | CMS confirms that Attachment J.03 is reserved and no attachment is provided. | |
| B.31 | JH Draft RFP Backpages | L.11.a Delivery Instructions | 146 | In the following requirement for submission, please confirm that the required Cost Proposal Templates should include Attachments J.33-J.63 instead of J.33-J.56 as written: | ||
| • The Offeror shall submit the Proposal Self-Check Tool (Attachment J.21), Basis of Estimate (Attachment J.22), Historic & Proposed FTE, Hours & Gross Cost Worksheet (Attachment J.22.B) and Cost Proposal Templates (Attachments J.33-J.56) in Microsoft Excel. | CMS confirms the RFP has been updated to correct references to the final cost template (one reference to J.56 and several references to J.62). The full set of cost templates are attachments J.33-J.63. |
| B.32 | JH Draft RFP Backpages | L.11.a Delivery Instructions | 146 | Due to the 25 MB file size limit, is it acceptable to break up the "one copy" PDF file into separate PDF files to meet the requirement? | CMS confirms language in section L.11.a, Offerors may create separate PDF files to comply with the 25 MB file size limit. |
| B.33 | JH Draft RFP Backpages | L.11.a. Delivery Instructions; L.11.f. Page Size, Typing, Spacing, and Page Numbering | 147, 149 | Please clarify whether "all pages shall be numbered" (L.11.a) conflicts with "So as to allow for more clarity in the numbering of pages; the pages of each separate volume shall be numbered sequentially - from page 1 through the end of the volume. The Offeror shall not restart numbering the pages in each separate Tab of the particular volume" (L.11.f). | CMS cofirms direction section L.11.a and L.11.f, Offerors shall number the pages of every volume sequentially - from page 1 through the end of the volume. Do not restart numbering within a volume with each new tab. |
| B.34 | JH Draft RFP Backpages | L.11.a. Delivery Instructions; L.11.f. Page Size, Typing, Spacing, and Page Numbering; L.15.3 Volume IV, Tab C, Written Narrative and Other than Certified Cost or Pricing Data | 147, 150, 176 | In cases of digitially signed documents, including financial exhibits such as Incurred Cost Proposals required in L.15.3 Volume IV, Tab C (p. 176), is it acceptable for offerors to exclude these from page numbering and include them as separate files with submission as to not compromise the integrity of the digital signatures? | CMS confirms digitally signed documents, financial exhibits or any separate document shall be provided in the appropriate volume, within the volume or at the end of volume as an appendix. |
| B.35 | JH Draft RFP Backpages | L.14 Volume III Technical Proposal Instructions Technical Proposal Evaluation Factors Overview; L.14.3.2 Volume III, Tab D, Operations, Proposal Instructions | 159, 166 | Please confirm that "The Offeror shall complete and include the Attachment J.24, Security Attestation, in Volume III, Tab E - Operations" should read Tab D - Operations, and if so, that offerors' Volume III technical proposal organization should align with the Volume III Table of Contents on p. 159. | CMS confirms the RFP is updated and section L.14.3.2.1 references to Tab E are replaced with Tab D. Section L.14.3.3.1 are replaced with Tab E. |
B.36 JH Draft RFP Backpages L.14.3.1 Volume III, Tab C Staffing Plan Proposal Instructions 163, 164 In the RFP staffing section (3.e) narrative requirements page 163, 164, it is not referencing the CLINs for VA Reclaim Base year and OY1 like the other CLINS listed. Does CMS intend for the offeror to include the VA Reclaim Base and Option year CLINs in those staffing requirements? CMS confirms the RFP is updated and section L.14.3.1.3 items d. and e. include the VA Reclaim staffing requirements for Base Year and Option Year 1.
&D &14Jurisdiction F
&12&A &9&P
C. Section J.1 SOW
| Question ID | Document | Section | Page # | Question | CMS Answer/Action |
| C.1 | J.01 Statement of Work | C.7.5 Veterans Affairs Medicare Equivalent Remittance Advice Project (JH) | 179 | For the C.7.5, does the offeror need to plan for performing maintenance or validation for the Medicare Supplemental insurance entries? | CMS confirms that Offerors shall perform maintenance for Medicare supplemental insurance entities as performed for Medicare claims processing. For proposal puroses assume that any additional additional maintenance/validation will be determined during Implemenation Period. |
| C.2 | J.01 Statement of Work | C.7.5 Veterans Affairs Medicare Equivalent Remittance Advice Project (JH) | 179 | For C.7.5 can CMS confirm the calls noted in the GPPA call volume are only Provider (VA Facilities)inquiries? If theses calls are from other organizations, can CMS proivde which organizations would be included in these calls? | CMS confirms the calls provided in the GPPA are only from VA facilities. |
| C.3 | J.01 Statement of Work | C.7.5 Veterans Affairs Medicare Equivalent Remittance Advice Project (JH) | 179 | For C.7.5, can CMS confirm if all VA member calls would be routed through normal NGD complex inquiries process or do the VA members have an option to call the JH MAC directly? | CMS confirms this project does not involve calls from VA members or beneficiares and callers are not directed to the JH MAC. |
| C.4 | J.01 Statement of Work | C.7.5 Veterans Affairs Medicare Equivalent Remittance Advice Project (JH) | 179 | Can CMS provide the number of VA facilities for the C.7.5 Workload? | CMS confirms this activity is with a "singular" overaching institution representing a volume for 129 medical centers. |
&D &14Jurisdiction F
&12&A &9&P
D. Sections J.1-J.11
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&D &14Jurisdiction F
&12&A &9&P
E. Section J.22 BOE
| Question ID | Document | Section | Page # | Question | CMS Answer/Action |
| E.1 | JH Attachments | J.22 Basis of Estimate | BOE #244 Excel Row 253 | With the issuance of TDL-240500 effective July 3, 2024, contractors have been directed to only review/process credit balance reports that providers utilize to self-report overpayments – all other activities associated with the quarterly credit balance process have been eliminated. Is the volume identified the total number of credit balance reports received/processed, or the number of self-reported overpayments? | CMS confirms the BOE is updated. Workload for Credit Balance Reports has been decreased. |
| E.2 | JH Attachments | J.22 Basis of Estimate | BOE #277 Excel Row 286 | Can CMS confirm what the workload for ‘OPA PA Requests – Number of Claims Reviewed for Exempt Providers’ represents? Is the workload represented what it states in the MSRE data dictionary, or is it truly the volume of claims reviewed annually for exempt providers? | ||
| The MSRE Data Dictionary definition is “The number of paid claims submitted from exempt providers for the month prior to the reporting period.” | CMS confirms the workload 2,986 for OPA PA Requests – Number of Claims Reviewed for Exempt Providers is the number of paid claims submitted from exempt providers. | |||||
| E.3 | JH Attachments | J.22 Basis of Estimate | BOE #25/ Excel Row 34 | Since agile calls have not been fully implemented, can CMS provide the expectations for the length of the calls and number of attendees expected as well as provide information on how the workload volume was derived? | CMS directs Offerors to CR FFS 12547 – MAC Participation in Change Request (CR) Development. For proposal purposes: all MACs shall attend the final demo call for all system CRs, MACs must attend all demos for the CRs where they are the sponsor MAC, estimate approximately 275 system change CRs per year and MACs will need to attend the final demo for each of these CRs. MACs are selected as the sponsor MAC for approximately 10% of these CRs (27-30 CRs per year). When the sponsor MAC, expect to attend all demo calls and there will be 3-5 demo calls for each CR. CMS does not dictate how many people should attend each call, it is a MAC decision. MACs can estimate 30 minutes for each demo call. |
| E.4 | Attachment J.22 | N/A | N/A | In the BOE 5.12.2.22 (RSNAT) is listed under SLIN name Medicare Integrity Program (MIP) and SLIN code AB. Can this be updated by CMS to state Prior Authorization for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) in the SLIN name column and RS under the SLIN code column. | CMS confirms the Offeror shall complete the the BOE lines for RSNAT in the form provided relative to SLIN Name and SLIN Code columns. |
| E.5 | Attachment J.22 | N/A | N/A | In the BOE 5.12.2.23 (KX) is listed under SLIN name Medicare Integrity Program (MIP) and SLIN code AB. Can this be updated by CMS to state Medical Review for Therapy Claims KX Modifier (KX Modifier) in the SLIN name column and KX under the SLIN code column. | CMS confirms the Offeror shall complete the the BOE lines for KX Modifier in the form provided relative to SLIN Name and SLIN Code columns. |
| E.6 | J.22 Basis of Estimate | All Period of Performance tabs, SOW C.5.4.5.3, Complex Beneficiary Inquiries RFP Workload values | NA | Specifically the workload values for the Complex Beneficiary Inquiry Responses compared to the Complex 2nd Level Screenings, we would have expected the complex 2nd Level Screening to be a lower number than the Complex Beneficiary Inquiry Responses. The Complex Beneficiary Inquiry Responses is typically the total number of beneficiary inquiries and the 2nd level screenings is a subset of the total number of inquiries. Can CMS confirm the Complex Beneficiary Inquiry Responses and the Complex 2nd Level Screenings workload numbers in the BOE file? | CMS confirms the BOE is updated and both the Complex Beneficiary Inquiry Responses and Complex 2nd Level Screening workload numbers have updated. |
&D &14Jurisdiction F
&12&A &9&P
F. Section J.23 GPPA
| Question ID | Document | Section | Page # | Question | CMS Answer/Action |
| F.1 | Attachment J.22/ J.23 Government Provided Proposal Assumptions (GPPA) | Item 32. Veterans Affairs Medicare Equivalent Remittance Advice Project (C.7.5) | 14, 15 | In the BOE C.7.5 (VA Reclaim) is not listed separately although the proposal instructions provide workload volumes. Will the BOE be updated to reflect the volumes under item 32 of the J.23 Government Provided Proposal Assumptions (GPPA). Can this be updated by CMS to state Veterans Affairs Remittance Advice Project (JH Only) (VA Reclaim) in the SLIN name column and VA under the SLIN code column. | CMS will not be updating the BOE to include the VA Reclaim workloads. Offerors shall not update the BOE to include the VA Reclaim workloads. Offerors shall include any narrative they wish to share in the technical proposal where appropriate and detailed cost related information in the cost templates. |
| F.2 | J.23 Government Provided Proposal Assumptions (GPPA) | Item 32. Veterans Affairs Medicare Equivalent Remittance Advice Project (C.7.5) | 14, 15 | For the "Monthly Incoming Calls" volume noted in Table 35 under item 32 of the J.23 Government Provided Proposal Assumptions (GPPA), is that a monthly call volume, or is it an annual volume as noted in the Table title of Annual Workloads. | CMS confirms the GPPA is updated and the word “monthly” is removed from that category. The number in the chart, 9,747, is the annual total. |
F.3 J.23 Government Provided Proposal Assumptions (GPPA) Item 32. Veterans Affairs Medicare Equivalent Remittance Advice Project (C.7.5) 14, 15 For the Table 35 under item 32 of the J.23 Government Provided Proposal Assumptions (GPPA), what is Monthly Carryover workload? Is the Monthly Arryover workload in addition to the Total Claim Receipts and Total Claims Processed, or a subset of those volumes? CMS confirms monthly carryovers are the total number of claims (related to the VA workload) from the prior month that are still pending. However, the line has been removed from the chart as it was totaling a monthly status reporting as a cumulative annual total.
| F.4 | J.23 Government Provided Proposal Assumptions (GPPA) | Item 32. Veterans Affairs Medicare Equivalent Remittance Advice Project (C.7.5) | 14, 15 | For the Table 35 under item 32 of the J.23 Government Provided Proposal Assumptions (GPPA), can CMS confirm that all claims for the C.7.5 are received electronically? If all claims are not received electronically, can CMS provide the breakdown by claim submission methods? | CMS confirms all claims are received electronically. |
| F.5 | J.23 Government Provided Proposal Assumptions (GPPA) | Item 32. Veterans Affairs Medicare Equivalent Remittance Advice Project (C.7.5) | 14, 15 | Can CMS provide the number of VA facilities for the C.7.5 workload? | CMS confirms this activity is with the a “singular” overarching VA institution. |
| F.6 | J.23 Government Provided Proposal Assumptions (GPPA) | Item 30. Centralized Billing for Mass Immunizers (C.7.1) | 14 | For the Centralized Billing for Mass Immunizers (C.7.1) workload, understanding this workload experiences an annual spike, can CMS provide a monthly average for this workload? | CMS confirms the annual spike occurs between October-February, highest months are October 1.4M and November 3.2M. December is 1M and January-February are each half a million. March, April and August are the lowest months and average 50,000. May-July averages under 200,000. |
| F.7 | J.23 Government Provided Proposal Assumptions (GPPA) | Item 2. Implementation Cutover and Item 32, Veterans Affairs Medicare Equivalent Remittance Advice Project (C.7.5) | 1, 2, 14, 15 | For the C.7.5 VA claims, can CMS confirm which CICS regions the VA Claims will be processed? | CMS confirms JH process Veterans Affairs Demo in all existing CICS Regions - Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas, including Indian Health Service (IHS)/Tribal/Urban Indian providers and Veterans Affairs providers. |
| F.8 | J.23 Government Provided Proposal Assumptions (GPPA) | Item 2. Implementation Cutover, and Item 31. Indian Health Services (C.7.2) | 1, 2, 14 | For the C.7.2 Indian Health Services claims, can CMS confirm which CICS regions the IHS claims will be processed? | CMS confirms JH process Indian Health Services claims in all existing CICS Regions - Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas, including Indian Health Service (IHS)/Tribal/Urban Indian providers and Veterans Affairs providers |
| F.9 | J.23 Government Provided Proposal Assumptions (GPPA), and J.22 Basis of Estimate | Item 31. Indian Health Services (C.7.2), BOE Claims Processing | 14, and SOW C.5.8.2 and C.7.2 | For the J.22 BOE, will CMS be providing the C.7.2 IHS claim volumes in C.7.2 claim lines, or are those volumes included in the C.5.8.2 claim workloads noted in the BOE? If the IHS claim volumes are included in the C.5.8.2 claim volume totals in the BOE, is the offeror to account for the staff needed for IHS processing under the C.5.8 SOW or under a C.7.2 SOW line. | CMS confirms claims volumes includes Indian Health Services (HIS)claims. Additional details and any flexibility in process can be determined during implementation. |
| F.10 | J.23 Government Provided Proposal Assumptions (GPPA), and J.22 Basis of Estimate | Item 32. Veterans Affairs Medicare Equivalent Remittance Advice Project (C.7.5), BOE Claims Processing | 14, 15, and SOW C.5.8.2 and C.7.5 | For the J.22 BOE, will CMS be providing the C.7.5 VA claim volumes in C.7.5 claim lines, or are those volumes included in the C.5.8.2 claim workloads noted in the BOE? If the VA claim volumes are included in the C.5.8.2 claim volume totals in the BOE, is the offeror to account for the staff needed for VA processing under the C.5.8 SOW or under a C.7.5 SOW line. | CMS confirms claims volumes includes VA claims. Additional details and any flexibility in process can be determined during implementation. |
| F.11 | J.23 Government Provided Proposal Assumptions (GPPA), and J.22 Basis of Estimate | Item 32. Veterans Affairs Medicare Equivalent Remittance Advice Project (C.7.5), BOE Telephone Inquiries | 14, 15, and SOW C.5.7 and C.7.5 | For the J.22 BOE, will CMS be providing the C.7.5 VA claim incoming call volumes in C.7.5 telephone inquiries lines, or are those volumes included in the C.5.7 telephone inquiries workloads noted in the BOE? If the VA claim telephone call volumes are included in the C.5.7 telephone inquiries volume totals in the BOE, is the offeror to account for the staff needed for VA telephone inquiries under the C.5.7 SOW or under a C.7.5 SOW line. | CMS confirms call volumes includes VA calls. Additional details and any flexibility in process can be determined during implementation. |
&D &14Jurisdiction F
&12&A &9&P
G. Section J.23.A-J.32
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&D &14Jurisdiction F
&12&A &9&P
H. Section J.33-J.49
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&D &14Jurisdiction F
&12&A &9&P
I. Cost Realism
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&D &14Jurisdiction F
&12&A &9&P
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