Ammendedment_1_-_Attachment_2_-_Amended_RFP_.pdf

Request for Proposal AHRQ-13-10001

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PART I - THE SCHEDULE Request for Proposal

SECTION A - SOLICITATION FORM No. AHRQ-13-10001

Date Issued: November 30, 2012, 12:00 PM EST

Date Questions Due: December 7, 2012, 12:00 PM EST

Date Notice of Intent Due: January 3, 2013, 12:00 PM EST

Date Proposals Due: January 15, 2013, 12:00 PM EST

You are invited to submit a proposal to the Agency for Healthcare Research and Quality

(AHRQ) for Request for Proposal (RFP) No. AHRQ-13-10001 entitled ―Medical Expenditure

Panel Survey (MEPS) Medical Provider Component (MPC)‖. Your proposal must be developed and submitted in accordance with the requirements and instructions of this RFP.

Solicitation Information: Please review the table of contents and refer to the appropriate section of this RFP for requirements, proposal instructions and evaluation information. The

Government intends to award this contract without negotiations, so it is imperative that all questions are addressed during the solicitation phase, and that all proposals submitted include the required information and accept the terms and conditions as stated. Failure to comply with proposal instructions or submit required information may result in the removal of a proposal from consideration for award. Please review Section L carefully.

Proposal Intent: If you intend to submit a proposal in response to this solicitation, please inform the Contracting Officer of your intent by completing the Proposal Intent Response Form (See section L.13 and Attachment A) and send it to the Contracting Officer no later than January 3, 2013. You may mail it to the address below, fax it to 301-427-1740, Attention: Robert Zuhlke, Contract Specialist/Contracting Officer or email it to Robert.Zuhlke@ahrq.hhs.gov .

Questions: All Questions regarding this solicitation shall be received in this office no later than the date shown above. All questions shall be submitted electronically by e-mail to Robert

Zuhlke, Contract Specialist/Contracting Officer, at the following email address:

Robert.Zuhlke@ahrq.hhs.gov . Subject line shall read: Proposal Questions RFP No. AHRQ-

13-10001. Answers to questions and all solicitation amendments will be posted to the Federal

Business Opportunities web page: www.fedbizopps.gov. It is your responsibility to monitor the web site.

mailto:Robert.Zuhlke@ahrq.hhs.gov http://www.fedbizopps.gov/

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Additional Information:

A cost plus fixed fee contract is contemplated for a period of five (5) months, with four

20-month options.

The Government anticipates awarding 1 contract from this solicitation on or about July

23, 2013.

Proposals submitted in response to this solicitation must state that they are valid for a period of at least 120 days (reference FAR clause 52.215-1 in Section L of this document.

The NAICS code for this requirement is 518210 with a size standard of $25,000,000.

Proposal Submission: The proposal shall be signed by an authorized official to bind your organization and must be received in our Contracts Office by the due date specified above.

Your proposal must be mailed to the following address:

Agency for Healthcare Research and Quality

Division of Contracts Management

540 Gaither Road

Rockville, Maryland 20850

Attn: Robert Zuhlke, (301) 427-1714

Hand carried proposals may be dropped off at the above location. However, please allow ample time as proposals cannot be accepted until they have gone through security. We will not be held responsible for any delays that may be incurred getting your proposal through security.

NOTE: The U.S. Postal Service‘s ―Express Mail‖ does not deliver to our Rockville, Maryland address. Packages delivered via this service will be held at a local post office for pick-up. The Government will not be responsible for picking up any mail at a local post office. If a proposal is not received at the place, date, and time specified herein, it will be considered a ―late proposal.‖

Central Contractor Registration: In accordance with Federal Acquisition Regulation, all contractors must be registered in the central contractor registration (CCR) database in order to conduct business with the government [See Section I - FAR clause 52.204-7 Central Contractor

Registration]. Access the CCR through the System for Award Management (SAM) at http://www.sam.gov .

Reminder: The Procurement Integrity Act prohibits the unauthorized disclosure of, inquiry about, or acceptance of procurement information. Communications with any other individual outside the AHRQ contracting office may result in rejection of an offeror‘s proposal. All requests for any information concerning this RFP should be referred to Robert Zuhlke, (301) 427-1714 or e-mail: Robert.Zuhlke@ahrq.hhs.gov. Please note e-mail requests should state subject as RFP http://www.sam.gov/

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AHRQ-13-10001.

TABLE OF CONTENTS

PART I Pages

Section A Solicitation 1 – 2

Section B Supplies or Services & Prices/Costs 4 – 6

Section C Description/Specification/Work Statement 7 – 33

Section D Packaging and Marking 34

Section E Inspection and Acceptance 34

Section F Deliveries or Performance 35 – 46

Section G Contract Administration Data 47 – 50

Section H Special Contract Requirements 51 – 65

PART II

Section I Contract Clauses 66 – 71

PART III

Section J List of Attachments 72

PART IV

Section K Representations and Certifications 73 – 81

Section L Instructions, Conditions & Notices to Offerors 82 – 108

Section M Evaluation Factors for Award 109 – 113

Attachments

Attachments listed in Section J are appended at the end of this document.

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SECTION B-SUPPLIES OR SERVICES AND PRICES/COSTS

B.1 BRIEF DESCRIPTION OF SUPPLIES OR SERVICES

―Medical Expenditure Panel Survey (MEPS) – Medical Provider Component (MPC)‖. See

Section C for a complete description.

B.2 ESTIMATED COST AND FIXED FEE:

a. The Estimated Costs (exclusive of fees) for performance of the work under the base period of this contract, including direct and indirect costs is $ To Be Determined (TBD).

b. The Fixed Fee for the base period of this contract is $TBD. The fixed fee shall be paid in installments based on the percentage of completion of work, as determined by the Contracting Officer. Payment shall be subject to the withholding provisions of the Clause ALLOWABLE COST AND PAYMENT and FIXED FEE incorporated herein.

c. The total contract value, represented by the sum of the estimated cost plus the fixed and award fees for the base period is $TBD.

Period of Performance

Estimated Cost Fixed Fee Total

Base Period $ $ $

B.3 OPTION PERIODS

If the Government exercises its option(s) pursuant to the option article in Section H of this contract, the Government‘s total contract amount represented by the sum of the estimated cost and fixed fee will be revised as follows:

Period of Performance

Estimated Cost

Fixed Fee

Total

Option Period 1

Option Period 2

Option Period 3

Option Period 4

The base period and each option are separate and distinct from one another for accumulation of costs and billing purposes.

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OPTION TASKS

SOW Task Estimated Cost Fixed Fee Total

Optional Item A $ $ $

Optional Item B $ $ $

Optional Item C $ $ $

Optional Item D $ $ $

Optional Item E $ $ $

Optional Item F $ $ $

B. 4 PROVISIONS APPLICABLE TO DIRECT COSTS

a. Items Unallowable Unless Otherwise Provided

Notwithstanding the clauses, ALLOWABLE COST AND PAYMENT, and FIXED FEE, incorporated into this contract, unless authorized in writing by the Contracting Officer, the costs of the following items or activities shall be unallowable as direct costs:

(1) Acquisition, by purchase or lease, of any interest in real property;

(2) Rearrangement or alteration of facilities;

(3) Purchase or lease of any item of general purpose-office furniture or office equipment regardless of dollar value. (General purpose equipment is defined as any items of personal property which are usable for purposes other than research, such as office equipment and furnishings, pocket calculators, etc.);

(4) Accountable Government property (defined as both real and personal property with an acquisition cost of $1,000 or more, with a life expectancy of more than two years) and "sensitive items" (defined and listed in the Contractor's Guide for Control of Government Property, 1990, regardless of acquisition value;

(5) Travel to attend general scientific meetings;

(6) Foreign Travel;

(7) Any costs incurred prior to the contract's effective date;

(8) Rental of meeting rooms not otherwise expressly paid for by the contract;

(9) Any formal subcontract arrangements not otherwise expressly provided for in the contract;

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(10) Consultant fees;

(11) Information Technology hardware or software; and

(12) Food and Beverages.

(13) No funding or expenditures are authorized under this contract/task order for travel or meeting expenses of any person that is not an employee of the contractor or approved subcontractor or approved consultant in accordance with the terms of the contract. See 31 USC 1345 for appropriations restrictions.

Note: Food and Beverages are unallowable costs. Contracting Officer Authorization for Food and Beverages will be only be made as specifically authorized by statute, which is extremely rare. The contractor shall not provide food or beverages of any type. The contractor shall not accept food or beverages, even if included in, or provided ‘free’ as part of a meeting/conference ‘package’.

b. Travel Costs

This contract is subject to the provisions of Public Law (P.L.) 99-234 which amends the

Office of Federal Procurement Policy Act to provide that contractor costs for travel, including lodging, other subsistence, and incidental expenses, shall be allowable only to the extent that they do not exceed the amount allowed for Federal employees. The Contractor, therefore, shall invoice and be reimbursed for all travel costs in accordance with Federal Acquisition Regulations (FAR) 31.205-46.

The following applies to Educational Institutions: The Contractor shall invoice and be reimbursed for all travel costs in accordance with OMB Circular A-21 - "Cost Principles for Educational Institutions."

B.5 CONTRACTING OFFICER AUTHORIZATION

Other provisions of this contract notwithstanding, approval of the following items within the limits set forth is hereby granted without further authorization from the Contracting Officer.

To Be Determined

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SECTION C - DESCRIPTION/SPECIFICATION/WORK STATEMENT

Independently and not as an agent of the Government, the Contractor shall be required to furnish all the necessary services, qualified personnel, material, equipment, and facilities, not otherwise provided by the Government, as needed to perform the Statement of Work as follows:

Statement of Work

Unless otherwise noted under a specific task, this Statement of Work applies to the base period and all options (if exercised).

Medical Expenditure Panel Survey Medical Provider Component (MEPS-MPC) Support

1.0 Introduction

The MEPS Medical Provider Component (MPC) collects data from all hospitals, emergency rooms, home health care agencies, outpatient departments, long term health care facilities and pharmacies reported by MEPS Household Component (HC) respondents as well as all physicians who provide services for patients in hospitals but bill separately from the hospital. Office based medical providers where the provider is either a doctor of medicine (MD) or Osteopathy (DO) or practices under the direct supervision of an MD or DO are included in the MPC as well. For this contract, long term health care facilities include nursing homes, assisted living facilities, rehabilitation facilities, as well as any health care facility providing medical care to those reporting such care in the HC of the MEPS. Jails, prisons, and medical facilities or pharmacies outside the United States are considered out of scope for the MPC.

The primary objective of the MPC is to collect data from medical providers (hospitals, physicians, home health agencies, pharmacies, long term health care facilities) on charges, payments and source of payments for medical services provided to MEPS sample persons. MPC data serve as an imputation source for item nonresponse to reduce the level of bias in survey estimates of medical expenditures. They also serve as the sole source of expenditure information for physicians who provide care in a hospital but are not billed by the hospital, as well as serving the primary source of expenditure information for Medicaid recipients, hospital care and prescription medicines. The sample for the MPC is chosen from medical providers identified in the HC as having provided care to the sample person during the year. Only providers for whom the respondent completed a signed permission form authorizing contact are candidates for the

MPC.

The MPC sample includes all hospitals, emergency rooms, home health care agencies, outpatient departments, pharmacies, and long term health care facilities reported by HC respondents, as well as all physicians who provide services for patients in hospitals but bill separately from the hospital (these physicians are identified by the hospitals not the HC respondents). HMOs are included. Office based medical providers where the provider is either a doctor of medicine (MD) or Osteopathy (DO) or practices under the direct supervision of an MD or DO are included in the

MPC as well.

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Home health care providers which include all home health care agencies, hospitals, social service agencies, and other places identified as providing home health care to the sample person are included in the MPC. However, self-employed and unpaid persons providing home health care services are not considered in scope for the MPC.

Providers for the MPC sample for one year are identified based on three rounds of HC data collection for two HC panels. (The MEPS HC is a separate requirement that is not covered under this solicitation.) The panel design of the survey, which features five core rounds of interviewing, covers two full calendar years. The MEPS HC collects data from a sample of families and individuals in selected communities across the United States, drawn from a nationally representative subsample of households that participated in the prior year's National

Health Interview Survey (conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention). During the household interviews, the MEPS HC collects the following detailed information for each person in the household: demographic characteristics, health conditions, health status, use of medical services, charges and source of payments, access to care, satisfaction with care, health insurance coverage, income, and employment.

There will be significant integration of work activities between the HC and MPC contractors.

The two contractors must work harmoniously and integrated work activities can not have a negative impact on work products or product deliverable schedules, or public use file release dates. It is important to note that MEPS public use file release dates are on a continual accelerated schedule and the contractors must work together to adhere to these accelerations.

2.0 Scope

2.1 Types of Services

The contractor shall perform the following types of services under this contract:

* Survey/project management

* Continuity of MEPS MPC

* Preparation of MEPS MPC documentation

* Liaison and cooperation with MEPS principals

* Cooperation and liaison with the HC contractor assuring timely, accurate and complete file transfers so the HC contractor can complete editing/imputation work (for all files but prescribed medicines) and public use file development for all MEPS event files on schedule

* Cooperation with AHRQ to obtain clearances

* Meeting arrangements

* Project closeout/transfer of operations

* Reporting, work planning, management meetings

* Data Collection http://www.cdc.gov/nchs/nhis.htm http://www.cdc.gov/nchs/nhis.htm

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* Receiving and receipting permission forms that establishes the sample for the MPC

* Implementing and documenting sample

* Maintaining MPC provider directory including SBDs and pharmacies

* Unduplicating the sample

* Identifying hospital physicians

* Producing data collection forms, advance letters, and other respondent and supporting materials

* Recruiting, training, and managing data collection specialists and abstractors

* Collecting data from medical and billing offices of providers

* Abstracting data from billing and medical records

* Coding of ICD-9-CM (and ICD-10 when ICD-10 coding scheme becomes the standard), verbatim medical conditions, CPT-4, verbatim medical procedures and supplies, prescribed medicines, and providers including hospital physicians that bill separately

* Identify duplicate events and remove from data file

* Data Processing

* Providing data security

* Forms control and receipt

* Data entry

* Recruiting and conducting training program for coders, verifiers and supervisors

* Recruiting and conducting training program for data collection specialists, verifiers and supervisors

* Recruiting and conducting training program for abstractors, verifiers and supervisors

* Data matching for all MPC provider types except prescribed medicines

* Producing matched files for use in the production of edited/imputed analytic files

* Producing input files for direct feed into the expenditure editing and imputation programs

* Benchmarking to outside data sources and previous years MEPS estimates several times throughout data collection

* Run edit checks throughout the field period and correct data as needed

* Developing MPC internal files (include matched and unmatched data) including a prescribed medicines file

* Quality control including interim checks on data quality throughout the field period

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2.2 Resources

The contractor shall furnish all the necessary qualified personnel, materials, supplies, equipment, services and facilities necessary to perform the work described below unless otherwise stated.

2.2.1 Storage

The contractor shall store all necessary materials for a period of time determined by the

Government and will investigate available technology and use the most efficient means to store all the necessary materials and documents and sensitive data.

The contractor shall also set up and maintain a secure encrypted data transmission line or FTP site so that confidential data and documents can be transmitted from the contractor to AHRQ.

The Government will provide hardware to the contractor for the encrypted line if an encrypted line is necessary.

3.0 Statement of Work

3.1 Project Management/EVM

3.1a The Contractor shall use an Earned Value Management System (EVMS) in the management of this contract that is consistent with ANSI/EIA-STD-748 guidelines.

3.1b. The Contractor shall report earned value monthly based on actual data from (or reconciliable with) its accounting systems. The Government and the Contractor shall negotiate the level of the Work Breakdown Structure (WBS) at which earned value shall be reported. If subcontractors are used, the Contractor shall develop and implement a system to ensure that its subcontractors comply with this requirement, and each monthly progress report must address performance at the prime and subcontractor level.

3.1c. The Contractor shall deliver with the Project Work Plan a contract-level Integrated

Master Schedule (IMS) that rolls up all time-phased WBSs for the individual tasks. This

IMS shall include the dependencies that exist between tasks.

3.1d. The Contractor shall deliver with the Project Work Plan a Critical Path at the contract-level.

3.1e. The Contractor shall report Earned Value Management (EVM) data for the entire project and specific deliverables/milestones in the monthly report in the form of a Contract

Performance Report (CPR). This report should contain all of the elements of the typical

CPR to include: Budget at Completion (BAC) – total planned cost of the total project or specified deliverable/ milestone at completion; Budgeted Cost of Work Scheduled

(BCWS) – cumulative expected planned cost for activities planned to be completed by the end of the reporting month; Actual Cost of Work Performed (ACWP) – cumulative amount actually spent on activities performed as of the end of the reporting month;

Budgeted Cost of Work Performed (BCWP) – cumulative planned costs of the activities

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– in the form of a %.

3.1f. The Contractor shall provide a corrective action plan with the monthly earned value report in cases where cost or schedule, as measured by Cost Performance Index (CPI) and

Schedule Performance Index (SPI), exceeds performance thresholds. The Government and the Contractor shall negotiate the performance thresholds. The corrective action plan shall address the following items: Brief description of the issue (identify the nature of the issue as cost, schedule, performance or resources and explain why the issue came to be);

Impact on project completion; Brief description of the corrective action plan strategy; and

Corrective tasks/actions that are required to eliminate or mitigate the issue, including task/action number, point of contact, start and end dates and comments

3.1g. If the corrective action plan requires rebaselining (the performance baseline), the corrective action plan also shall address the following items: The proposed new baseline;

The reason(s) why rebaselining is required; and Documentation of the reasonableness of the proposed new baselines and the accuracy of any new cost estimates

3.1h. The Performance Baseline, WBS, BCWS, Integrated Master Schedule, and monthly earned value report shall clearly breakout the deliverables and activities related to the development and maintenance of systems, software, databases, and websites. It shall also clearly separate development, modernization and enhancement (DME) deliverables and activities from operations and maintenance deliverables and activities.

3.1i. For all plans and specifications a draft will be submitted to the COTR for review and approval at least 6 weeks prior to the time the final plan or specification deliverable is due.

3.2. Continuity of the MEPS MPC

The contractor shall begin operation of the 2014 Medical Provider Component (MPC) in 2014 to collect data on 2013 expenditures for the 2013 Household Component estimates. The transition period between contracts is critical to the MEPS. Measures at various stages of the MPC data collection and abstraction efforts will be compared to ensure the transition of work will not negatively affect the work progress or the data itself. It is critical that continuity be maintained and that any changes between the old and new contracts be transparent to respondents (as much as possible) and data users.

During the Base Period, the contractor shall prepare a survey operations and methodological report. This report shall contain detailed specifications for data collection and data processing for large medical provider surveys of national scope similar to the MPC. The contractor shall

MEPS - MPC Page 12 of 112 review the existing data collection and data processing methodology used by the MEPS MPC, a large medical care establishment survey, and compare the design to other data collection and data processing methodologies and operations used by other government agencies and private entities conducting large scale medical provider surveys. These reports will have applicability to the MPC but will be broad enough to be useful for other large scale projects collecting data from medical providers. The report shall identify the specific challenges of these collections and discuss the pros and cons of different solutions. Topics covered shall include training, staffing, mode of data collection and data processing, strategies to improve upon response rates and minimize burden to respondents including leveraging EMRs will be discussed. Options considered, and specific recommendations for survey design and operational tasks and their rationale, shall all be described. Within 30 days after the effective date of the contract, the

Contractor shall provide to the COR an outline of the Methodology Report which will include topics and subtopics with brief descriptions that will be included in the report. This outline will need approval by the COR prior to the Contractor moving forward with final version of the

Methodology Report. The final Methodology Report shall be provided to the COR no later than the end of the base period.

The MPC sample will be provided to the MPC contractor by the Government.

The AHRQ will maintain strong monitoring over the expenditures, management and operations of this contract. The contractor shall maintain communication and reporting mechanisms to facilitate such monitoring. The contractor shall anticipate and plan for periodic in-person observation of data collection and processing activities by AHRQ staff at the Contract Officers discretion.

3.2.1 MEPS MPC Documentation

Options considered and decisions reached regarding survey methodological issues shall be documented in written memoranda or reports to the COR. This documentation shall be delivered within 30 days of reaching decisions. The contractor shall maintain and update a Project Plan.

The Project Plan shall detail major milestones in data collection, data processing and data delivery. The Project Plan shall also include staffing, field timing and quality milestones. The

Project Plan shall include a person loading chart which presents the number of person-days allocated to each task and subtask for each category of staff for each year of the contract and for the total contract. The chart(s) should also delineate critical milestones and the deliverables for each. The Project Plan should also include an organizational chart(s) which presents the placement of the project within the offeror’s organization and the organization of the staff proposed for this project. The chart(s) shall show clear lines of authority and function. The

Project Plan should include a schedule for completion of the work and delivery of items specified in the statement of work. Particular attention should be paid to the most important milestones in the medical provider data collection. The Project Plan should detail major and intermediate milestones. The Project Plan should also specify how the work to construct the matched internal files for all provider types except prescribed medicines will be completed and managed - what tasks will be assigned to which group of persons. Key dates for the production of each file should be specified along with the proposed method(s) of quality control and

MEPS - MPC Page 13 of 112 benchmarking the estimates. Performance or delivery schedules shall be indicated for phases or segments or tasks, as applicable, as well as for the overall program. The Project Plan shall affirm the delivery dates for deliverables and data files as specified in the delivery schedule.

The proposed completion tasks for the milestones shall remain fixed, but on a bi-annual basis the

Plan shall be updated with actual dates. At each update to the Project Plan, expected deviation from the contractually specified dates should be noted, along with any reason for deviation.

Should the deviation be such that a later date is anticipated, potential corrective actions and their implications should be noted. Schedules should be shown in terms of calendar months from the effective date of the contract or, where applicable, from the date of a stated event, as for example, receipt of a required approval by the Contracting Officer.

Upon approval by AHRQ, the contractor shall make necessary revisions to survey instruments and procedures which will be clearly documented. This documentation shall be delivered within

5 days of reaching decisions.

An annual report documenting survey progress on each major task within the Medical Provider

Component including Survey Management, Data Collection, Data Editing and Data Processing, Matching, Data Delivery, Quality Control and archival copies of decision memos shall be delivered to the COTR by June 30 of each year, referring to the previous calendar year’s activities.

3.2.2 Liaison with MEPS principals

The contractor shall make every effort to make the overlap between the current MEPS contract and this award as smooth as possible in the interest of maintaining respondent participation and data comparability. The contractor should establish cooperative staff-to-staff relationships in pursuit of this objective.

3.2.3 Integration of HC and MPC Contractor Tasks

There must be timely and accurate data and documentation deliverables between the MPC and

HC contractors (which will go through AHRQ). These deliverables will include MEPS HC data and matching variables and documentation necessary to link the HC and MPC files, as well matched HC and MPC files and documentation for use in the production of edited/imputed analytic files. Data delivered to the HC contractor for input into the expenditure editing and imputation process will be in the appropriate format and will contain the appropriate variables and variable specifications to be input directly into the editing and imputation data processing programs. All raw MPC files which will include matched and unmatched data and detailed documentation will be delivered to AHRQ. There will also need to be several discussions between the two contractors (with AHRQ oversight) that ensures all changes made in one component of the MEPS processes that has an effect on the other component’s processes are known well in advance and are well documented. There must also be ongoing discussions, as needed, between the contractors on any issues and/or questions regarding file deliveries.

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3.2.4 Cooperate with AHRQ in obtaining required OMB clearances

The contractor shall prepare materials required for any and all clearance actions during the course of the contract. This shall include preparing burden estimates, written descriptions of the survey and sample design, the design and description of any special experiments, and hard copy reproductions of survey questionnaires and respondent materials.

3.2.5 Project closeout/transfer of operations

The contractor shall turn over all files, computer programs, tabulations, documentation and other items within ninety (90) days of request made by the COTR in such form (electronic and paper) that the project may be continued by a successor.

3.2.6 Monthly progress reports

Beginning on the tenth calendar day of the second month of contract performance and on the tenth calendar day of every month of contract performance thereafter, the Contractor shall submit to the AHRQ Contracts Office, the COTR and other designated Center for Financing, Access and

Cost Trends (CFACT) staff, a monthly progress report in electronic format, via e-mail as attachments or secure final transfer protocol (ftp) or extranet site with e-mail notification that reports are available for download. When the tenth calendar day falls on a weekend, the EVM report shall be provided to the COTR and AHRQ EVM Specialist on the preceding Friday or closet weekday. The rest of the monthly report may be provided after the weekend.

At a minimum, the monthly progress report shall:

summarize the progress of work performed during the reporting period, note milestones, describe past problems (including a concise statement of success or lack thereof in solving the problems encountered) describe anticipated problems and proposed solutions describe work planned for the next reporting period, compare progress and resource expenditures to the original schedule and budget and provide explanations for any variances assess whether the current total estimated contract cost is sufficient to complete the contract describe significant changes in the Contractor's operational personnel summarize all additions, modifications, and configuration changes to all project software and database designs, specifications, testing, quality assurance efforts, maintenance and operational solutions and associated work efforts accomplished during the month provide the earned value information requested in 4.1 also provide disclosure of any new work products, computer databases or programs, or any other inventions that may be subject to intellectual property protection provide a description of how the Contractor intends to manage intellectual property rights

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During the project the Contractor shall hold, at a minimum, a bi-monthly management meeting at its office, at AHRQ, or through conference call during which the project will be discussed. The contractor shall submit an agenda, and any materials to be used for discussion, 5 working days in advance of the meetings. The participants in the management meetings will include the COR (in person or via telephone) and other Agency staff as appropriate, the Project Director, and relevant

Contractor project staff as approved by the COR prior to the meeting. Progress will be reviewed, milestones discussed, response rates presented, problems examined, solutions explored, and short-range and long-range plans made. Action items resulting from this meeting shall be prepared by the Contractor and submitted to the COR within three days after completion of the meeting. If corrections are necessary, revised replacement minutes shall be submitted to the

COR within two (2) days after receipt of the COR’s comments.

The contractor shall prepare and distribute minutes of all management meetings, and any other decision making meetings with AHRQ. The minutes shall include the contract number, project director, a list of attendees, a description of the issues discussed, action items, assignments and due dates.

All deliverables to AHRQ should be sent as separate PDF files and a naming convention for all files agreed upon by AHRQ and the contractor will be used.

3.3 Medical Provider Component

3.3.1 Implementing and documenting the sample

The contractor will be required to maintain the sample including documentation of any splits, merges and determinations of ―out of scope‖ (outside the U.S., prisons, jails) providers.

The sample for the 2014 MEPS MPC will be drawn from medical providers reported by HC respondents in the 2013 MEPS HC, and for providers that HC respondents signed authorization forms allowing contacting of their medical providers. To be eligible for the MPC, authorization forms are necessary for each provider for each respondent. The 2014 MPC collects 2013 data for the 2013 HC estimates.

3.3.2 Unduplicating the sample

Although the provider - the office, clinic, physician, hospital, pharmacy, home health care provider, long term health care facility - is the ―case‖ for the purpose of data collection operations, each MPC case may represent one or more household respondents mentioning the same provider.

To prepare for the fielding of the MPC, the Contractor shall consolidate all duplications in the medical provider lists generated by household respondents. Using the most efficient means, the contractor shall review the provider sample generated by the household survey and assign unique provider identification numbers to each provider or group of providers that represent a single

MPC respondent. These unique identifiers shall be constructed in a way that allows the MPC

MEPS - MPC Page 16 of 112 provider to be linked to the person-events recorded in the household survey that generated the provider. This unduplication shall occur within and across households, primary sampling units

(PSUs) (e.g., counties) and rounds. (The panel design of the survey, which features five core rounds of interviewing, covers two full calendar years. Each year, providers for the MPC sample are identified based on three rounds of HC data collection (the HC data collection is covered under a separate procurement). The resulting unique list of medical providers shall constitute the field sample for the MPC. The schedule for data collection requires that unduplication be conducted in an ongoing manner. The final MPC file deliveries will contain a consolidated and unduplicated ID variable that can be used to identify all MPC and HC records for each person/provider pair. This variable is critical to evaluation work at AHRQ and determining measurement error.

Processes will be developed to remove duplicate events prior to data collection.

3.3.3 Provider Directory

The contractor shall develop a mechanism that results in the provider directory remaining current in order to maintain functionality for data collection purposes. Currently, when found for a provider, the National Provider Identifier (NPI) is assigned. However, all providers in the MPC do not have an NPI assigned. All separately billing doctors (SBDs) and pharmacies must be included in this directory as well as other provider types eligible for the MPC data collection.

From year to year, the contractor will maintain contact information at the provider level as well as for the respondent within the provider organization who provided the data. This will include not only name, title and division, but telephone, fax, and email address information for the individual and the provider. The contractor shall review existing provider directory methodology and may propose alternative methodologies which would support analytic goals and improve data quality.

3.3.4 Identifying hospital physicians that provide care to a patient in a hospital setting but who bill separately from the hospital (SBD)

For each hospital event (outpatient, inpatient, emergency room), the MPC abstractor, using MPC data collection methods, shall elicit from the hospital records the names of physicians providing care to the patient during the event and who received payments not included in the accounting of charges and payment for the main hospital bill or summary of payments. These newly identified patient provider pairs become part of the MPC sample either as new cases or as additional pairs to existing cases in an ongoing manner throughout the fielding of the hospital cases. Separately billing doctors are elicited from the MPC provider or the MPC provider’s medical records.

Separately billing doctors are not household reported. Methods will be established to clearly distinguish separately billing doctors from other MPC provider types.

3.3.5 Provide data collection forms, advance letters, other respondent materials

Materials for MPC data collection, including data collection forms, brochures and other respondent materials have been prepared for previous MEPS MPC data collection. Copies of

MEPS - MPC Page 17 of 112 those materials will be provided on award. The contractor shall be responsible for maintaining, revising and adapting all questionnaires, computer programs, specifications, manuals, respondent materials and other MPC documents intrinsic to the conduct of the MPC. The contractor may rely on already developed MEPS MPC products for these materials, but shall modify them as necessary. The Government is open to new formats/alternative for these materials. All documents delivered to AHRQ shall be in electronic form readable by AHRQ, and in hard copy form, when requested. All final deliveries of instrument documentation including contact guides, training materials, MPC materials available on the MEPS web site, and reports shall be delivered in 508 compliant PDF format.

On occasion, the COR may request modifications to survey instruments and/or materials.

3.3.6 Recruiting, training and managing data collection specialists

The contractor shall develop procedures and materials to efficiently train all data collection staff necessary to obtain required response rates and required levels of data quality. Some training shall occur before each year of data collection. Training programs shall be designed so that all data collection staff performing the same function have the same training in content and in method. The initial training session for all new data collection specialists shall be face to face.

Training manuals and materials may be adapted from those used in the current MEPS contract.

Trainers are required to have expertise and experience on the tasks in which they train.

Following training, data collection specialists must be able, at a minimum to: a) identify and reach appropriate respondents in physician offices and other medical facilities; b) explain the nature and purpose of the survey and answer questions commonly asked by medical and billing staff in deciding whether or not to cooperate with data collection; c) arrange with medical and billing staff any of a variety of methods for obtaining the required data; d) collect the data, if appropriate, and know procedures for probing for data; e) be able to elicit the appropriate expenditure data with over the phone or through the abstraction of financial records; f) know how to handle difficult respondents and potential refusals; g) know when and how to correctly use manuals, references and guides; h) know how to completely, accurately and in a timely manner process all administrative forms.

In addition to the capabilities described above, supervisory personnel shall be able to perform the following functions: a) observe data collection specialists, recording instances of appropriate and inappropriate behavior and conveying these observations to the data collections specialist in a constructive fashion; b) counsel data collection specialists on appropriate handling of unusual situations; c) monitor data collection specialist production, and other performance measures at appropriate levels; d) conduct data collection specialist training sessions so that all data collection specialists shall receive, in substance and quality, the same training; e) convert difficult refusals; f) identify errors of data collection staff they supervise and convey to them the results of this review in a constructive manner; g) ensure the DCSs are collecting the appropriate data and can distinguish between charges, payments, and billing adjustments.

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The contractor shall define and implement methods for selecting data collection staff, both supervisory and non-supervisory, which will reliably predict quality performance of all data collection activities. The criteria must include previous work experience, work samples, and education.

The contractor shall also propose a staffing plan that will account for cyclical retention and work flow issues while obtaining required response rates.

The contractor shall develop and implement detailed data collection instructions, rules and verification procedures with adjudication procedures specified. The contractor will develop and maintain procedural manuals.

3.3.7 Recruiting, training and managing abstraction staff

The contractor shall develop procedures and materials to efficiently train all abstraction staff necessary to obtain required response rates and required levels of accuracy. Some training shall occur before each year of abstraction. Training programs shall be designed so that all abstraction staff performing the same function will have the same training in content and in method. The initial training session for all new data abstractors shall be face to face. Training manuals and materials may be adapted from those used in the current MEPS contract, if deemed appropriate.

Trainers are required to have expertise and experience on the tasks in which they train.

Following training, abstractors must be able, at a minimum to: a) accurately abstract data items of interest to MEPS from medical and billing records at an acceptable error rate as determined by the Government, b) identify and reach appropriate respondents in hospitals and physician offices and other medical facilities; c) explain the nature and purpose of the MEPS MPC and answer questions commonly asked by medical and billing staff in terms of follow up phone calls and in deciding whether or not to participate; d) if necessary, be able to arrange with medical and billing staff any of a variety of methods for obtaining the data sought; e) collect the data, if appropriate and know procedures for probing for data; f) know how to handle difficult respondents and potential refusals; g) know when and how to correctly use manuals, references and guides; h) know how to completely, accurately and in a timely manner process all administrative forms.

In addition to the capabilities described above, supervisory personnel shall be able to perform the following functions: a) observe abstractors, recording instances of appropriate and inappropriate abstraction and/or general behavior and conveying these observations to the abstractors in a constructive fashion; b) counsel abstractors on appropriate handling of unusual situations; c) monitor abstraction production, accuracy, time and expense and keep these and other performance measures at appropriate levels; d) conduct abstraction training sessions so that all abstractors shall receive, in substance and quality, the same training; e) identify errors of abstraction staff they supervise and convey to them the results of this review in a constructive manner, f) know in general the abstraction rules that apply in abstracting the data elements of interest to MEPS (charges, payments, and sources of payment) and be able to explain them to abstractors they supervise.

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The contractor shall define and implement methods for selecting abstraction staff, both supervisory and non-supervisory, which will reliably predict quality performance of all abstraction activities. The criteria must include previous work experience, work samples, and education.

The contractor shall also propose a staffing plan that will account for cyclical retention and work flow issues while obtaining required response rates.

The contractor shall develop and implement detailed abstraction instructions, rules and verification procedures with adjudication procedures specified. The contractor will develop and maintain procedural manuals. In concert with AHRQ, a decision log will be maintained and followed as issues arise and decisions are made in how to handle different data collection situations. The decision log will be made available to all data abstractors and all data abstractors will know how to use the decision log. This will ensure consistent data collection procedures.

On a regular basis as determined by the contractor in consultation with AHRQ, the decision log will be incorporated into the procedural manual.

3.3.8 Collecting data from medical providers including billing staff

The MEPS MPC sample is designed to provide data on events for which household respondents are less likely to be fully aware of the financial transactions regarding the medical care received, to enrich the sample of events available as donors for imputation, and to provide a basis for methodological analysis of household reported payments for different types of events. The MPC sample consists of providers specifically identified in the MEPS HC as having provided medical care to MEPS sampled persons. The MPC sample can be split into the following groups for data collection operations:

(1) Hospitals. All hospitals, including psychiatric hospitals, reported as the site of care for inpatient stays, outpatient department visits and emergency room encounters shall be included in the MPC sample. HMOs are included in this effort.

(2) Hospital physicians (i.e., separately billing doctors or SBD). Physicians identified by hospitals as providing care to sampled persons during the course of a hospital event

(inpatient stay, outpatient visit, emergency room visit) who render bills apart from the hospital facility shall be included in the MPC sample.

(3) Office based sample. A sample of office based physicians providing care to targeted HC sampled persons shall be included in the MPC. HMOs are included in this data collection effort.

(4) Home health care providers. All agency home health care providers providing care to

MEPS HC sampled persons shall be included in the MPC sample.

(5) Pharmacies. All pharmacies that have dispensed prescribed medicines to sampled persons shall be included in the MPC sample. HMOs are included in this effort.

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(6) Long term health care facilities - all long term health care facilities (nursing home, assisted living facilities, rehabilitation facilities, etc.) providing care to MEPS HC sampled persons living in the community for part of the year shall be included in the

MPC sample.

All hospitals, home health care agencies, pharmacies and long term health care health facilities

(including nursing homes, assisted living facilities, etc.) are ―in scope‖ for the MPC. Other providers and sites of care are in-scope for MPC (office based sample) if the provider is a doctor of medicine or osteopathy, or if the provider works under the direction and/or supervision of a

MD or DO. For example, physician assistants and nurse practitioners working in clinics are medical providers considered in scope for the MPC. Chiropractors and dentists are out of scope

(unless practicing in a hospital). Medical care received in prisons and jails and medical care received outside the United States is considered out of scope for the MPC.

HMOs are included in the hospital, office based and pharmacy provider types.

Based on historical sample projections, AHRQ anticipates the eligible 2014 MPC sample, which collects 2013 CY data for the 2013 MEPS HC estimates, to be no larger than the estimates in

Table 3.3.8(A). This data collection would occur in Option Period 1. The MPC sample to provide data for 2013 estimates is composed of two parts - - providers associated with 2013 events for persons enrolled in MEPS beginning in 2012 and providers associated with 2013 events for persons enrolled in MEPS beginning in 2013.