Cost Report Contract Requirement (ORAP - PWS).pdf

SSN 75H70424R00001-BM Medicare Cost Reporting Services

SECTION C – DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C. TITLE

Medicare Cost Reporting Services

C.1. BACKGROUND

The Indian Health Service (IHS) provides comprehensive primary health care and disease prevention services to approximately 2.1 million American Indians and Alaska Natives through a network of over 632 hospitals, clinics, and health stations on or near Indian reservations.

Facilities are predominantly located in rural primary care settings and are managed by IHS, Tribal, and Urban Indian health programs. The IHS provides a wide range of clinical, public health and community services primarily to members of 576 federally recognized Tribes. Under special legislative authority, Social Security Act (SSA), Title 18 and Title 19, the IHS is eligible for Medicare and Medicaid payment for services provided to these beneficiaries. The IHS is required to submit Medicare cost reports (Method A) to establish inpatient and outpatient Medicare and Medicaid rates used as the basis to set Medicare and Medicaid rates for reimbursement. Over $1 billion annually in collections from Medicare and Medicaid is used to maintain its current level of health care.

Contract support services are required to complete tasks associated with the annual submission of cost reports to the Centers for Medicare and Medicaid Services (CMS). Federal and tribal facilities operating within the Indian Healthcare Delivery System (IHDS) and participating in Medicare are obligated to file annual cost reports with CMS. Additionally, the Indian Health Service (IHS) is responsible for calculating and publishing 8 All-Inclusive Rates (AIR) in the Federal Register, which are used for Medicare and Medicaid reimbursement purposes. Moreover, facility-specific rates must be determined for hospitals designated as Critical Access Hospitals. As part of this contract, the completion of Home Office Cost Reports is also required to be completed and submitted to CMS. In addition to these requirements, the contractor shall be expected to undertake additional tasks, such as completing an ancillary study, performing cost analysis, and fulfilling other duties associated with the completion of cost reports and calculating rates.

C.2. Tasks

C.2.1. Task 1: Kick-Off Meeting C.2.1.1 Contractor shall schedule a kick-off meeting within 10 business days of the execution date of the contract (EDOC) C.2.1.2 Compile an agenda for the kick-off meeting and send to the COR within 48 hours of the Kick-Off meeting C.2.1.3 Present work plan. The work plan should be provided to the COR no later than 48 hours prior to the kick-off meeting C.2.1.4 Incorporate feedback into the work plan within 7 days of the kick-off meeting

C.2.2. Task 2: Monthly Progress Reports

C2.2.1 The Contractor shall submit a monthly technical progress report to the Contracting Officer’s Representative (COR) within 10 calendar days after the end of each month. The report shall include a review of the activities by task undertaken to date; problems and barriers to implementation/completion that have arisen and agreed-upon solutions; and activities planned for the next month addressing scope of work deliverables.

C.2.3. Task 3: Cost Report Preparation

The contractor shall be responsible for performing all necessary tasks required to prepare and submit up to 53 cost reports to the Centers for Medicare and Medicaid Services (CMS) on an annual basis. The contractor shall ensure the completion of the cost reports in accordance with all Medicare regulations and meet all deadlines outlined by Medicare to submit the reports to CMS on time. In the event that the cost reports are deemed unacceptable by CMS or a facility, the contractor shall work collaboratively with CMS, the facility, and other relevant staff to correct the report and resubmit it until it is deemed acceptable. Furthermore, in the event of an audit, the contractor shall actively cooperate with CMS, the facility, and all other relevant parties to address and resolve any audit concerns. The contractor may utilize cost reporting software of their choice, provided it complies with Medicare regulations.

The Indian Health Service (IHS) will provide the contractor with financial obligation and payroll data, as well as facility workload data, to assist in preparing the cost reports. If additional data is required to complete the cost report, the contractor shall provide specific guidance on the necessary data and propose a solution for gathering that data. The contractor shall also provide a uniform collection tool (that is in compliance with federal government policy) to gather the additional data needed to complete the cost report or calculate the All-Inclusive Rates from each facility.

C.2.4.1 Critical Access Hospital Cost (CAH) Reports: The contractor shall be responsible for gathering and compiling the necessary data and information required to create and submit cost reports for CAHs, in accordance with Medicare regulations. The cost reports will be submitted to the appropriate regulatory bodies in compliance with the reporting requirements by February 28 of each calendar year.

C.2.4.1.1 The contractor shall calculate and submit the specific CAH facility rates for the CAHs in accordance with Medicare regulations. The submission of these CAH facility rates shall be completed by February 28 of each calendar year. The IHS staff at the hospital will certify the draft cost reports.

C.2.4.2 Inpatient Prospective Payment System (IPPS) Cost Reports:

The contractor shall be responsible for gathering and compiling the necessary data and information required to submit cost reports for IPPS facilities, in accordance with Medicare regulations. The Contractor shall ensure conformity for of the cost reports per the Method-A model and provide uniform materials for collecting data. The IHS staff at the hospital will certify the draft cost reports. The cost reports will be submitted to the appropriate regulatory bodies by

June 30 of each calendar year.

C.2.4.3 Home Office Cost Report Preparation The contractor shall be responsible for gathering and compiling the necessary data and information required to create comprehensive cost reports for tribal and federal home office cost reports in accordance with Medicare regulations. The contractor shall ensure conformity of the cost reports with the Method-A model and provide uniform materials for data collection. The staff at the appropriate home office will be responsible for certifying the draft cost report. Home office cost reports associated with CAH cost reporting are due February 28, the remaining are due March 31 each calendar year.

C.2.4.4 Rural Emergency Health (REH) Cost report The contractor shall be responsible for gathering and compiling the necessary data and information required to create and submit cost reports for REHs, in accordance with Medicare regulations. The cost reports will be submitted to the appropriate regulatory bodies in compliance with the reporting requirements by February 28 of each calendar year

C.2.4.5 The Contractor shall conduct site visits, as appropriate, to gather the required data for the preparation of the cost reports. Additionally, the contractor shall conduct an introductory meeting at the beginning of the site visit, followed by an exit Conference to debrief all parties involved on the findings and any follow-up items. The Contractor shall schedule pre-meetings virtually with the sites to ensure they are aware of the purpose of the site visit. Moreover, the contractor will schedule virtual post-meeting calls if additional information is needed. It is important to note that site reviews may not be necessary for all facilities on an annual basis. The decision on which facilities to visit and at what time is at the discretion of the contractor. Draft copies of the cost report and any discussion items will be made available prior to the site visit.

C.2.4.6 The contractor shall provide responses to CMS audit staff upon their review of the cost reports. The contractor shall respond within the timeframe given by CMS and IHS staff on follow up questions

C.2.4.7 In addition to preparation of the cost reports, the Contractor shall compare fully allocated costs from IHS data on Worksheet B, Part 1, to the prior year cost report. Where significant variances are noted, further review of inquiry must be made and documented, including written responses to CMS and IHS upon request. This analysis must be done prior to September 30 each year.

C.2.4.8 The contractor shall conduct a Low Payment Volume Analysis. This analysis should identify payment trends, evaluate operational costs against these low volumes, review specific diagnosis-related groups contributing to lower payments, assess any associated risks, and offer recommendations for optimization. Upon completion, a detailed report summarizing your findings and actionable insights will be invaluable. Our primary aim is to enhance our processes for better reimbursement and adherence to regulatory guidelines.

C.2.4.8 The contractor will provide documentation to the COR at the end of each cost reporting cycle. The documentation will include, but may not be limited to, the 51 completed cost reports, summary documents and/or cover page explaining the methodology used to complete the cost reports, and other pertinent documentation deemed necessary by the COR and/or the program office. Their main point of contact for each cost report location will be listed on the summary page for each cost report record.

A full list of cost report locations and due dates can be found on attachment A.

C.2.4. Task 4: Develop All Inclusive Rate (AIR)

On an annual basis, IHS calculates and publishes, in the Federal Register, 8 specific calendar year reimbursement rates. These rates are often referred to as the All-Inclusive Rates (AIR), Office of Management and Budget (OMB) rates, or encounter rates.

Due to the higher cost of living in Alaska, separate rates are calculated for Alaska and the Lower 48 States. The 8 specific rates are as follows:

• Inpatient Hospital Per Diem Rate

1. Lower 48 States

2. Alaska

• Outpatient Per Visit Rate (Excluding Medicare)

3. Lower 48 States

4. Alaska

• Outpatient Per Visit Rate (Medicare)

5. Lower 48 States

6. Alaska

• Medicare Part B Inpatient Ancillary Per Diem Rate

7. Lower 48 States

8. Alaska

Before September 30 of each calendar year the contractor shall:

C.2.4.1 Gather all required data necessary to calculate the 8 specific All-Inclusive Rates (AIR), perform the calculations, and provide the rates to the COR in a format consistent with historical practices.

C.2.4.2 Provide documentation that explains the methodology, identifies mathematical elements utilized in the calculations, and identifies the data sources employed for determining the rates. Provide variance analysis for the rates which includes reasons why rates are going up or down. The contractor may be required to explain these documents to various IHS and Tribal staff members.

C.2.4.3 Collaborate and provide IHS with document to assist with the development with briefing documents that substantiate the proposed rates and adhere to IHS current best practices. The contractor may be required to be present at these briefings

C.2.4.4 Provide documents that can be used to update the AIR webpage.

C.2.4.5 Participate in a rate preview and data verification process to support the development of the AIRs. This task entails providing estimated rates and working in collaboration with IHS and tribal staff to ensure the accuracy of the data utilized in the AIRs calculations. Although we anticipate the AIR preview to take place on October 15th annually, it could potentially occur as early as June or July.

C.2.5. Task 5: Various Management Reports and tasks

The Contractor shall submit management reports on an ongoing basis. The contractor shall extract information for the reports from the Medicare cost reports, national inpatient and outpatient workload data, Medicare and other legislation affecting or potentially affecting IHS revenue, ancillary costs reviews and studies and historical knowledge regarding IHS unit cost and Medicare and Medicaid method(s) of payment to IHS facilities.

As the Medicare cost reports are being completed, the Contractor shall gather information on workload from several National IHS data sources and compile information from each of the hospitals to identify Medicare and Medicaid billable workload. After the cost reports have been completed, the Contractor shall summarize applicable cost report data elements and integrate IHS workload data to form a basis to evaluate and analyze cost of delivering health care in IHS facilities. This analysis is the basis for determining the per diem payments for Medicare and Medicaid inpatient and outpatient services.

The Contractor shall provide special expertise and assistance to help the IHS in its review and interpretation of the Medicare hospital cost reports planned for completion during the contracting period. The Contractor shall provide data analysis and integration of the Medicare and Medicaid workload with the Medicare hospital cost reports to assist in the development of individual hospital estimates of the costs for a wide range of inpatient and outpatient services. Based on this analysis, the Contractor shall assist IHS in evaluating alternatives for use in evaluating cost and to consider in the development of rates.

C.2.5.1 Management reports include:

1. Summary of payments made by the Medicare Fiscal Intermediary (FI) (from Program Summary and

Reimbursement [PS&R]), data with a view toward identifying areas where additional revenue may be possible

2. Comparison of hospital cost, workload and unit cost for each hospital, Fiscal Years (FY) 2025-2029, where Medicare hospital cost reports were completed

3. A report evaluating interim Calendar Year (CY) inpatient and outpatient rates and revenue impacts for CAH facilities and recommending rate changes as appropriate

4. An evaluation of financial impact potential for the conversion of selected hospitals to CAH status or

REH status or back to IPPS

5. Developing outpatient visit workload and finalizing inpatient workload consistent with FY cost reports for the Lower 48 state facilities and Alaska

6. Questionnaires provided to facilities and templates used to prepare and complete cost reports provided electronically

7. Ancillary cost review and ratio development (only available for the Option Period 1 and Option Period 4, See Section C.3.7 Task 7).

C.2.6. Task 6: Disproportionate Share Hospital (DSH) Reimbursement Calculation

Disproportionate Share Hospital Reimbursement is an add-on to DRG payments for hospitals that serve a large number of low-income patients for which virtually all IHS non-CAH hospitals qualify.

C.2.6.1: Prior to June 30 each year. The contractor shall complete the following analysis to determine the DSH reimbursement rate as part of the cost report development as follows:

1. Obtain raw data for analysis from federal and tribal facilities

2. Perform various data validation exercises to normalize the total patient data

3. Verify patient Medicaid eligibility through third party vendor

4. Analyze and test the validity of the Medicaid eligibility information obtained or received from third party vendors.

5. Ensure patients identified as Medicaid by the Hospital have proper

Medicaid eligibility information.

6. Perform out-of-state eligibility analysis

7. Perform separate analysis to match newborns with mother’s eligibility.

8. Review and test proposed final eligibility results.

9. Respond to any related audit questions by CMS Fiscal Intermediary by working with the hospitals to fulfill documentation requests and responding to questions.

C.2.7. Task 7: Conversion analysis report

C.2.7.1 The contractor shall prepare an annual report for the Indian Health Service (IHS) that outlines any recommended facilities that may benefit from converting to Critical Access Hospital (CAH) or Rural Emergency Hospital (REH) status by September 30 of each calendar year.

This process involves conducting reports and analyses of financial and workload data, specifically evaluating the applicability of conversion to CAH or REH status. The contractor shall project revenue and workload data for current CAHs and other hospitals that meet the requirement of having 25 or fewer beds. In cases where CAH audits by the Medicare Fiscal Intermediary (FI) identify areas for improvement, follow-up work shall be conducted. For potential conversion sites, the contractor shall provide technical assistance to support the transition to CAH or REH status. Additionally, the contractor shall develop a report summarizing selected information from the cost reports and data from the Medicare FI Payment System. This report will assist IHS sites in evaluating the potential for converting to CAH or REH status and assessing the impact of prior-year conversions.

Regular analyses may be conducted to assist the IHS in determining if certain facilities would benefit from a cost perspective by converting to CAH or REH status.

C.2.8. Task 8: Work plan

C.2.8.1 The contractor shall create a work plan to be included with their proposal and evaluated by the Technical Evaluation Panel. The work plan document should clearly outline your plan of action to execute the tasks outlined in this PWS. The plan should clearly delineates roles and responsibilities between the contractor, federal staff and our tribal partners, includes a timeline with major milestones deadlines. They plan should also identify sources of data required to complete the cost reports and calculate the rates and if it’s the contractor’s or federal staff’s responsible to collect/furnish that data. The work plan can be completed in the software program of the contractor’s choice. The work plan will be created for the base year, then updated for each option period.

C.2.8.2 Present the work plan at the kick-off meeting

C.2.9. Task 9 Revenue Cycle Analysis (optional task)

A revenue cycle analysis in a healthcare setting, such as a hospital or clinic, involves a comprehensive review of processes and practices associated with revenue cycle management.

This analysis traverses the entire patient care journey, from initial appointment scheduling and patient registration to the final payment collection. It aims to identify inefficiencies, errors, and potential areas for improvement in key components of the revenue cycle. Third-party revenue is a critical aspect of operations in our IHS facilities. Efficient revenue cycle operations allow these facilities to enhance their financial health, streamline operational efficiency, and provide superior patient care.

C.2.9.1 The contractor shall conduct a comprehensive revenue cycle analysis. The contractor will interview relevant staff and gather all data necessary to perform this extensive review. The review can be conducted in-person or virtually, as decided by the contractor and the COR.

C.2.9.2 The contractor will provide a detailed report of their findings. This report will include an executive summary, a summary of findings, process flows, visual aids, recommendations, suggested improvements, and next steps.

C.2.9.3 Present report of findings to relevant IHS facility staff and other stakeholders as determined by the contractor and the COR.

C.2.10. Task 10: Ancillary Ratio Development (Optional Task)

C.2.10.1 Perform the ancillary study and develop the ancillary ratio

The objective of the ancillary cost study is to develop an ancillary ratio that is representative of the population, is statistically valid, auditable, and supportable with patient charts. Rather than utilizing 82 separate universes and 82 different sample selections (41 inpatient and 41 outpatients), the population should be a combination of all facilities into only four separate universes (Critical Access Hospitals and Non-Critical Access Hospitals). Samples will be selected from the following four subsets.

- Critical Access Hospital Inpatients

- Critical Access Hospital Outpatients

- Other Hospital Inpatients

- Other Hospital Outpatients

A total of the 2,220 patient charts shall be reviewed to document the cost relationship between an inpatient day and an outpatient visit. The total chart samples should include 1,067 inpatient charts and 1,153 outpatient charts should be reviewed for the nine CAH’s. Two sample frames for the CAH inpatient chart review be drawn and a second frame be utilized if the first review results in an outpatient to inpatient ratio above 60% or below 20%. Should the second sample frame review be necessary, the second frame ancillary outpatient ratio result should be utilized for the CAH’s.

For the non- CAH hospitals to be reviewed, a total of 749 inpatient charts and a total of 769 outpatient charts should be reviewed. It is believed that a 769 outpatient chart review or 95% confidence level is necessary because of the large variation in the size of each of the remaining hospitals.

Specific optional task requirements include:

A. Coding and pricing of ancillary services for all charts including inpatient charts (admissions) and outpatient charts (visits) provided by each facility in accordance with Medicare reimbursement rules to be provided by IHS. A certified coder is required to code all the charts. Chart documentation must be maintained on coded charts with the summary file submitted.

B. A summary by Service Unit of each inpatient and outpatient cost by revenue code utilizing the guideline provided by IHS in excel format.

C. The Contractor shall provide an electronic record (copies) of the charts provided by the hospitals listing of charts by patient and specific medical coding and pricing by patient and revenue code to the Service Unit to enable CMS and/or the FI to review and audit if necessary.

D. The Contractor shall provide a summary of all facilities on excel spreadsheet. The Contractor shall also provide summary statistics for all facilities in excel format of evaluation and maintenance codes and revenue codes. The ancillary costs analysis shall include two face to face meetings with the COR for Option Period 1 and Option Period 4.

C.2.11. Task 11 – Urban Indian Organization AIR Development (Optional) The IHS enters into limited, competing contracts and grants with non-profit organizations as defined in 501(c)(3) of the Internal Revenue Code to provide health care and referral services for Urban Indians throughout the United States. Urban Indian Organizations (UIO) are defined under the Indian Health Care Improvement Act (IHCIA). Urban Indian Organizations are non-profit corporate bodies situated in an urban center, governed by an Urban Indian-controlled board of directors. The 41 Urban Indian Organizations provide unique access to culturally appropriate and quality health care for Urban Indians.

This task will require the contractor to gather and analyze information from 15 of 29 UIO ambulatory health centers.

As part of this contract, there is an option to develop an Urban Indian Organization All-Inclusive Rate (UIO AIR) or multiple UIO AIRs that will be used for reimbursing Urban Indian Organizations for Medicaid outpatient encounters. These rates will be published annually before December 31, following the existing IHS AIR methodology. Below, we outline the tasks required to fulfill this optional requirement.

C.2.11.1 Methodology Development: The contractor, in collaboration with the Contracting Officer's Representative (COR) and the UIO point of contact (POC), shall develop the methodology required to establish a single UIO AIR or up to six distinct UIO AIRs. This methodology must include a comprehensive guide outlining the new approach. Additionally, the contractor will be responsible for creating all necessary forms to collect the information required for calculating the UIO Rate(s). The contractor should also ensure compliance with any state or CMS audit requirements if an audit of the rate is required.

C.2.11.2 Information and Data Gathering: The contractor shall interface with UIOs either virtually or in person, as deemed necessary by the contractor, the COR and the UIO POC, to collect and analyze the required information for implementing the methodology established in

C.2.11.3. A uniform collection methodology will be developed by the contractor to gather the data and information needed to implement the methodology established in C.2.11.1. The contractor will provide training as necessary to gather and transmit the required information from the UIOs. The contractor is required to gather information and data from at least 15 out of the 29 UIOs. The methodology developed must meet IHS privacy standards and is subject to review and approval by the IHS privacy officer.

C.2.11.4 Meetings and Briefings: The contractor shall actively participate in meetings and briefings as needed to explain and describe the UIO AIR methodology. Collaboratively with the COR and the UIO POC, the contractor shall develop briefing materials necessary for publishing the UIO AIR(s) annually in the Federal Register. Additionally, the contractor will be expected to undertake various tasks, including cost and/or payment analysis and other duties associated with completing the UIO AIR methodology.

C.2.11.5 The contractor shall provide documentation to the COR at the end of each cost reporting cycle. The documentation will include, but may not be limited to, the 15 completed cost reports, summary documents and/or cover page explaining the methodology used to complete the cost reports, and other pertinent documentation deemed necessary by the COR and/or the program office. Their main point of contact for each cost report location will be listed on the summary page for each cost report record.

C.2.11.6 The contractor shall provide draft Urban Indian Organization AIRs by August 15 each calendar year with the goal of publishing final rates before December 31 each calendar year.

A full list of potential cost report locations can be found on attachment B

C.2.12. Youth Regional Treatment Centers (YRTC) AIR Development

As part of this contract, there is an option to develop a Youth Regional Treatment Centers (YRTC) All- Inclusive Rate (AIR) or multiple YRTC AIRs that will be used for reimbursing Youth Regional Treatment Centers for Medicaid outpatient and inpatient encounters. These rates will be published annually before December 31, following the existing IHS AIR methodology. Below, we outline the tasks required to fulfill this optional requirement.

C.2.12.1 Methodology Development: The contractor, in collaboration with the Contracting Officer's Representative (COR) and the YRTC point of contact (POC), shall develop the methodology required to establish a single YRTC AIR or up to six distinct YRTC AIRs. This methodology must include a comprehensive guide outlining the new approach. Additionally, the contractor will be responsible for creating all necessary forms to collect the information required for calculating the YRTC Rate(s). The contractor should also ensure compliance with any state or CMS audit requirements if an audit of the rate is required.

C.2.12.2 Information and Data Gathering: The contractor shall interface with YRTCs either virtually or in person, as deemed necessary by the contractor, the COR, and the YRTC POC, to collect and analyze the required information for implementing the methodology established in

C.2.12.3. A uniform collection methodology will be established by the contractor to gather the data and information needed to implement the methodology established in C.2.12.1. The contractor will provide training as necessary to gather and transmit the required information from the YRTCs. The contractor is required to gather information and data from at up to 7 YRTCs. The exact number will be decided by the COR and the YRTC POC. The methodology developed must meet IHS privacy standards and is subject to review and approval by the IHS privacy officer.

C.2.12.4 Meetings and Briefings: The contractor shall actively participate in meetings and briefings as needed to explain and describe the YRTC AIR methodology. Collaboratively with the COR and the YRTC POC, the contractor shall develop briefing materials necessary for publishing the YRTC AIR(s) annually in the Federal Register. Additionally, the contractor will be expected to undertake various tasks, including cost and/or payment analysis and other duties associated with completing the YRTC AIR methodology.

C.2.12.5 The contractor shall provide documentation to the COR at the end of each cost reporting cycle.

The documentation will include, but may not be limited to, the 7 or more completed cost reports, summary documents and/or cover page explaining the methodology used to complete the cost reports, and other pertinent documentation deemed necessary by the COR and/or the program office. Their main point of contact for each cost report location will be listed on the summary page for each cost report record.

C.2.12.6 The contractor shall provide draft Youth Regional Treatment Centers (YRTC) AIRs by August 15 each calendar year with the goal of publishing final rates before December 31 each calendar year.

A full list of cost report locations can by found on attachment C

C.2.13. Deliverables Table

Task Deliverable:

Delivery method Due Date:

C.2.1 Task 1: Kick-Off Meeting

C.2.1 Schedule Kick-Off Meeting

Electronic meeting Zoom or teams or equivalent

Within 5 working days of The execution date of the contract

C.2.1.2 Create Agenda Electronic via email within 24 hours of the Kick- Off meeting

C.2.1.3 Present comprehensive event plan Electronic via email

No later than 48 hours prior to the kick-off meeting

C.2.1.4 Incorporate feedback Electronic via email within 7 days of the kick-off meeting

C.2.2 Task 2: Monthly Progress Report

C.2.2.1 Monthly Status Report Electronic via email

Within 10 calendar days after each month end

C.2.3 Task 3: Cost Report Preparation

C.2.4.1 Critical Access Hospital Cost (CAH) Reports

Electronica lly to CMS by February 28 each calendar year

C.2.4.1.1 Calculate CAH Rates Electronica lly to CMS by February 28 each calendar year

C.2.4.2 Inpatient Prospective Payment System (IPPS) Cost Reports

Electronica lly to CMS

By June 30 each calendar year

C.2.4.3 Home Office Cost Report Preparation Electronica lly to CMS

Home office cost reports associated with CAH cost reporting are due February 28, the remaining are due March 31 each calendar year.

C.2.4.4 Rural Emergency Hospital Cost Report Preparation

Electronica lly to CMS by February 28 each calendar year

C.2.4.5 Conduct site visits as appropriate various As needed

C.2.4.6 Participate and provide responses to CMS auditors

Electronic meeting Zoom or teams or equivalent As needed

C.2.4.7 Compare worksheet B, Part 1 to prior years cost reports

Electronica lly via email by September 30 each year

C.2.4.8 The contractor shall conduct a Low Payment Volume Analysis

Electronica lly via email by September 30 each year

C.2.4 Task 4: Develop All-Inclusive-Rates

C.2.4.1 Provide the 8 rates to the COR Electronica lly by September 30 each calendar year

C.2.4.2 Provide documentation that explains the methodology

Electronica lly by September 30 each calendar year

C.2.4.3 Assist to develop briefing documents Electronica lly by September 30 each calendar year

C.2.4.4 Assist to update AIR webpage Electronica lly by September 30 each calendar year

C.2.4.5 Participate in a rate preview and data verification process

Electronica lly by September 30 each calendar year

C.2.5 Task 5: Various Management Reports and Tasks

C.2.5.1 Complete the various management reports as outlined the PWS

Electronica lly As needed

Task 6:

Disproportionate Share Calculations

C.2.6.1 Complete tasks and calculate DSH calculations

Electronica lly

By June 30 each calendar year

Task 7: Conversion Analysis

C.2.7.1 Complete and submit the conversion analysis

Electronica lly by September 30 each calendar year

Task 8: Work plan

C.2.8.1 Create a work plan to be included with their proposal

Electronica lly at the beginning of the base year and the beginning of each option period

C.2.8.2 Present the work plan at the kick-off meeting Virtually

Optional Tasks

C.2.9 Ad-Hoc Analysis C.2.9.1 Conduct Revenue Cycle Analysis Virtual or in-person C.2.9.2 Report of findings Electronic C.2.9.3 Present report of findings Virtual C.2.10 Ancillary Ratio Development

C.2.10.1 Perform the ancillary study and develop the ancillary ratio electronica lly As needed

C.2.11 Urban Indian Organization AIR Development

C.2.11.1

Provide documentation on the methodology and provide the UIO rate(s) to the COR

Electronica lly Aug 15 each Calendar Year

C.2.11.2 Collect and analyze data for implementing methodology

Electronica lly Aug 15 each Calendar Year

C2.11.3 Gather information and data from UIOs Electronica lly Aug 15 each Calendar Year

C2.11.4 Assist in developing briefing documents Electronica lly Aug 15 each Calendar Year

C.2.11.5 provide documentation to the COR at the end of each cost reporting cycle

Electronica lly Sept 30 each Calendar Year

C.2.11.6 provide draft Urban Indian Organization AIRs

Electronica

C.2.12 YRTC AIR Development

C.2.12.1

Provide documentation on the methodology and provide the YRTC rate(s) to the COR

Electronica lly Aug 15 each Calendar Year

C.2.12.2 Collect and analyze data for implementing methodology

Electronica lly Aug 15 each Calendar Year

C2.12.3 Gather information and data from YRTC Electronica lly Aug 15 each Calendar Year

C2.12.4 Assist in developing briefing documents Electronica lly Aug 15 each Calendar Year

C2.12.5 provide documentation to the COR at the end of each cost reporting cycle

Electronica lly Sept 30 each Calendar Year

C2.12.6 provide draft Urban Indian Organization AIRs

Electronica