Attachment J.1 - HPSA Zip Code Crosswalk Statement of Work (SOW).pdf

Attachment J-1 Statement of Work

Statement of Work

I. Purpose:

The Purpose of this contract is to develop and provide The Centers for Medicare and Medicaid Services (CMS) a crosswalk of geographic Health Professional Shortage Area (HPSA) designations as determined by the Health Resources and Services Administration (HRSA) to United State Postal Service (USPS) ZIP Codes to be used to determine the payment of the Medicare HPSA bonus per section 413 (a) of the Medicare Prescription Drug and Modernization Act (MMA) of 2003.

II. Background:

Section 1833 (m) of the Social Security Act provides incentive payments for physicians who furnish services in areas designated as HPSAs under section 332 (a)

(1) (A) of the Public Health Service (PHS) Act, which pertains to geographical-based HPSAs. Section 1833 (m) of the Act also provided the authority to recognize all three types of geographical based HPSAs (primary medical care, dental, and mental health).

Physicians, including psychiatrists furnishing services in a primary medical care HPSA, are eligible to receive bonus payments. However, for the original HPSA bonus payment program, Medicare does not pay bonuses for services provided in dental HPSAs. Medicare HPSA bonus payments apply to all physicians who perform covered services within a primary medical care HPSA. All eligible physicians receive bonus payments regardless of specialty. In addition, psychiatrists furnishing services in mental health HPSAs are eligible to receive incentive payments. CMS now uses dental HPSAs to determine Electronic Health Record (EHR) incentive payments, per the American Recovery & Reinvestment Act of 2009 (ARRA).

III. Scope of Work and Responsibilities:

1. Background

HPSA Bonuses:

Originally, Medicare contractors paid the HPSA bonus based on the inclusion of a modifier with the service when it was billed. Section 413 (a) of the Medicare Prescription Drug and Modernization Act (MMA) of 2003 revised that process to no longer require the modifier for services rendered in ZIP Code areas that fully fell within a designated HPSA area or were classified as dominant according to the USPS.

Services provided in areas that were eligible for the bonus, but did not fully fall within a HPSA bonus area are still required to be submitted with a modifier.

Per the ARRA of 2009, CMS now uses dental HPSAs to determine EHR incentive

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2. Project Objective

In order to pay the physician bonus for the HPSA bonus payment program more accurately, CMS must provide to the Medicare contractors lists of the ZIP Codes for which the bonuses may be automatically paid. CMS must provide to the Medicare contractors lists of the ZIP Codes that fully fall within a HRSA designated primary care, mental health, and dental HPSA area. For the original HPSA bonus payment program, CMS must update the website for physician use that will provide the list of ZIP Codes for which the HPSA bonuses are automatically payable.

3. Scope of Work

Contractor Requirements:

Under this contract, the contractor shall adhere to the following requirements:

• Produce all updates to the HPSA files, by automating the part of the Geographic

Information System (GIS) data extraction and matching process that is currently manual. This automated action will improve efficiency, accuracy, reduce cycle times quickly, implement change, and reduce costs.

• Analyze the requirements provided by CMS to determine the resources that must be utilized to develop the product.

• Be able to locate necessary resources for information not supplied by CMS.

• Adhere to a schedule of regular updates and attend (by conference call) regular meetings with CMS staff.

• Be responsive (by close of business of the next business day) to CMS inquiries.

• Provide a finished product that can easily and with minimal revision be utilized by the Medicare contractors and be added to the CMS website.

• Provide support and make necessary corrections to the work product should errors be detected.

• Be able to access and manipulate the HPSA database from HRSA using SAS statistical software for use in cross-walking HPSAs to ZIP Codes.

• Have the computing capacity and archive system for large geographic and statistical operations.

• Be able to access historical data on ZIP Code boundaries and/or characteristics dating from the current quarter back to 2004.

• Be able to adjudicate questions, requests, and disputes from various sources.

• Be able to use GIS skills to crosswalk geographic areas to ZIP Codes.

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• Be able to create composite HPSA boundary files from integrating geographic component boundary files and the HPSA database and to combine them with ZIP Code boundary information.

• Be familiar with the structure of the USPS ZIP Code file and familiarity with working with ZIP Codes for Puerto Rico and U.S. outlying areas (American Samoa, Guam, Virgin Islands).

• Be able to interpret geographic data with precision and accuracy.

• Provide to CMS documentation of the process behind the development of the

HPSA designation to ZIP Code crosswalk.

• The contractor shall not perform the duties pertaining to this contract at any property location of CMS.

4. Detailed Technical Requirements

The contractor shall use the HRSA website at www.hrsa.gov, Data and Statistics, Primary Healthcare, HPSA (or the contractor may receive this data as a download from HRSA) at http://datawarehouse.hrsa.gov/data/datadownload/hpsadownload.aspx to identify the metropolitan and non-metropolitan, primary medical care, mental health, and dental areas that are designated as HPSAs for the United States, Puerto Rico, and the U.S. Virgin Islands.

CMS will provide the contractor with the County Dominance ZIP Code file to be cross-walked to the metropolitan and non-metropolitan, primary medical care and mental health, and dental areas that are designated as HPSAs for the United States, Puerto Rico, and the U.S. Virgin Islands. CMS will use its discretion to publish a second ZIP Code file and the detailed technical requirements listed in Section 4 shall be repeated using updated information from (HRSA).

The contractor shall:

• Provide a Microsoft Excel list of 5-digit ZIP Codes displayed as a major to minor sort by ZIP Code and state that fall fully within a HRSA designated primary medical care HPSA.

• Provide a Microsoft Excel list of 5-digit ZIP Codes displayed as a major to minor sort by ZIP Code and state that fall fully within a HRSA designated mental health HPSA.

• Provide a Microsoft Excel list of 5-digit ZIP Codes displayed as a major to dental HPSA

5. Schedule of Deliverables/Reporting Requirements http://www.hrsa.gov/ http://datawarehouse.hrsa.gov/data/datadownload/hpsadownload.aspx

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The same deliverables shall be required for each of the 4 option years. Delivery dates will be November 1st of each year, or the first working weekday after November 1st of each year for the first file delivered each year.

The contractor shall deliver the following:

Required Task 1:

• Provide a Microsoft Excel list of 5-digit ZIP Codes displayed as a major to primary medical care HPSA.

• Provide a Microsoft Excel list of 5-digit ZIP Codes displayed as a major to minor sort by ZIP Code and state that fall fully within a HRSA designated mental health HPSA.

• Provide a Microsoft Excel List of 5-digit ZIP Codes displayed as a major to geographic dental HPSA.

File Delivery:

Delivery of the above Excel files/deliverables shall be made to the CMS Contracting Officer’s Representative (COR).

A copy of email delivery notice only, (no copies of files/attachments) shall be sent to the Contract Specialist.

Communications:

• Respond to CMS inquiries and questions by the close of business of the next business day. Responses shall include the COR, or the COR’s designee.

• Attend teleconferences as requested by CMS.

6. Quality of Deliverables

CMS will subjectively assess the contractor’s performance in the Deliverable/Reporting area, which may include, but not be limited to:

• Format (grammatically, and typographically correct).

• Coverage (contains all required deliverable and reporting requirements

• Quality (usability and readability of the content)

7. Quality Assurance Requirements

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The contractor shall provide to CMS a project work plan that demonstrates the correctness of the data obtained. The project work plan shall include a key document that will provide a detailed explanation of the process used to capture the data from HRSA, verify its accuracy, and show that the data has been correctly cross walked to the USPS ZIP Codes.

Weekly progress meetings shall be held between (but not limited to) the contractor and the COR on an as needed basis. The dates and times of the meetings shall be established mutually between all parties. These meetings shall be used to review the status of the project work plan, and to discuss outstanding issues, The contractor shall provide to CMS monthly status reports which will document the progress of work, the status of open action items, the identification of existing or potential problem areas, root cause, impact, and corrective action plans.

CMS, through the COR, shall review and approve all work products and deliverables submitted by the contractor.

8. Special Considerations

Appendix A: Identification of ZIP Code Areas Eligible for Medicare HPSA Bonus Payments

9. References

HRSA website (http://www.hrsa.gov/index.html)

USPS website (https://www.usps.com/) and ZIP Code information (ZIP Code dominance in county) http://www.hrsa.gov/index.html