BFCC IDIQ 2023 RFI.docx

REQUEST FOR INFORMATION

Agency/Office: Department of Health and Human Services Centers for Medicare & Medicaid Services Center for Clinical Standards and Quality

Type of Notice: Request for Information

Reference No.: HHS-CMS-RFI-2023-BFCC-CONTRACTOR-INTEREST

Title: Request for Information to Determine Interest in Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations (QIOs) Indefinite Delivery Indefinite Quantity (IDIQ) Contract

Classification R – Professional, Administrative, and Management Support Services Code:

NAICS Code: 541618 Other Management Consulting Services

Response Date: By 1:00 pm Eastern Standard Time on January 5, 2023

SUMMARY: The Centers for Medicare & Medicaid Services (CMS) seeks information through this Request for Information (RFI) from the community to gauge interest to initiate an open season to add new contractors to the Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization (QIO) IDIQ contract. Detailed information about the BFCC-QIO Program can be found at (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS019035.html).

Important: CMS will use the information collected through this RFI notice to determine whether or not it would be in the Government’s best interest to initiate an open season to add additional contractors to the BFCC-QIO IDIQ.

RESPONSE FORMAT: CMS requests responses to this RFI in the form of a white paper. White papers shall be submitted in Microsoft Word (Times New Roman, 12-point font). White papers shall be submitted via email only to the primary points of contact listed below. CMS will not accept hard-copy responses.

For responses to be considered, white papers shall consist of two sections and provide the information described below.

· Section I. Contractor’s Name, mailing address, phone number, and email of designated point of contact.

· Section II (NO MORE THAN 10 PAGES). Complete and considered responses to each of the questions listed below. Please note that a submission responding to less than all questions will not be considered.

BACKGROUND: The BFCC-QIO Program is the largest federal program dedicated to improving health quality at the local level. By law, the mission of the QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. Currently, two contractors serve as Case Review BFCC-QIOs that provide coverage in every state, the District of Columbia, and most U.S. territories. BFCC-QIOs are united in a network tied together through CMS’ program direction that strives to give BFCC-QIOs the flexibility they need to provide case review while still contributing to national-level quality improvement goals.

In March 2019, CMS launched its next round of BFCC-QIO Program contracts with a re-engineered approach to essential BFCC operations by entering into IDIQ contracts. In doing so, CMS maximized program efficiency while improving the quality-of-care Medicare beneficiaries received.

The BFCC-QIO Program has been making large strides in improving care for Medicare beneficiaries; however, much more work must be done to improve the quality and efficiency of the U.S. healthcare system. Thus, CMS seeks to add additional contractors to the pool of IDIQ holders.

In particular, CMS seeks input on the capabilities of potential beneficiary and family centered care contractors under the BFCC-QIO Program.

QUESTIONS: Responders should review the following web links for information about the context and policy issues surrounding the questions below.

· https://sam.gov/content/opportunities

· https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS019035.html )

· https://www.cms.gov/Medicare/Medicare-General-Information/BNI/Statutory-Guidance

· https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/HowtoBecomeaQIO CMS asks that each respondent address each of the following questions:

1. Describe your business entity and how it is formed and administered as per federal/state law in order to engage in business activities, charitable work, or other activities allowable. Please state how your entity qualifies to be a BFCC-QIO and state your interest in this work.

2. What is your capability to perform BFCC work? Please review: Appendix A: Regional Structure for BFCC-QIO Jurisdictions; Appendix B: Conflict of Interest; https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS019035.html; and https://www.cms.gov/Medicare/Medicare-General-Information/BNI/Statutory-Guidance .Your statement must demonstrate your capacity and capability to successfully perform the required BFCC-QIO work, including:

· Performance of:

· Case Reviews – inclusive of quality of care reviews, discharge and termination of service beneficiary requested appeals, review of beneficiary complaints, and immediate advocacy

· Emergency Medical Treatment & Labor Act (EMTALA) Reviews

· Ability to involve and have access to physicians and practitioners in the BFCC-QIO area with appropriate expertise and specialization in the areas of health care related to case reviews

· Comply with QIO board membership requirements

· Operate a Call Center that is in operation seven days per week, including holidays, and can handle over 80 thousand calls per month

· Engage beneficiaries in their care management through advocacy and engagement:

· Immediate Advocacy - an informal process used by the QIO to resolve a complaint quickly.

· Collect data regarding these reviews, logically organize that data for sharing and analyzing (such that aspects of the process can be stratified by event level attributes, beneficiary demographic information, facility characteristics, etc.), and use that data to drive innovation and change

· Demonstrate ability to have IT system(s) in place to manage case review and call center activities to meet timelines and requirements and transfer all CMS-required case review data from contractor system(s) to the Government

· Perform IT security, cybersecurity, FISMA and CMS security and security with respect to medical records

· Use beneficiary experience survey results to make improvements with customer service

· Demonstrate ability to implement a Continuity of Operations Plan (COOP)

SPECIAL NOTE TO RESPONDENTS: Respondents are asked to draw their responses from objective and actionable evidence and to cite this evidence within their responses.

THIS IS A REQUEST FOR INFORMATION (RFI) ONLY. This RFI is issued solely for information and planning purposes; it does not constitute an RFP. This RFI does not commit the Government to contract for any supply or service. Further, CMS is not seeking proposals through this solicitation and will not accept unsolicited proposals. Responders are advised that the U.S. Government will not pay for any information or administrative costs incurred in response to this RFI; all costs associated with responding to this RFI will be solely at the interested party’s expense. Not responding to this RFI does not preclude participation in any future procurement, if conducted. It is the responsibility of the potential offerors to monitor this site for additional information pertaining to this requirement.

CMS may or may not choose to contact responders. Such communications would only serve to clarify written responses further.

The information provided in the RFI is subject to change and is not binding on the Government. This RFI should not be construed as a commitment or authorization to incur cost for which reimbursement would be required or sought. All submissions become Government property and will not be returned.

CMS CONTRACTING OFFICE ADDRESS (FOR INFORMATIONAL PURPOSES ONLY):

7500 Security Boulevard Baltimore, Maryland 21244-1850

PRIMARY POINTS OF CONTACT:

Domonique Sparks, Contract Specialist Domonique.Sparks@cms.hhs.gov

Kelley Williams-Vollmer, Contracting Officer Kelley.Williams-Vollmer@cms.hhs.gov

Michael Milanese, Contracting Officer Michael.Milanese@cms.hhs.gov

Appendix A: Regional Structure for BFCC-QIO Jurisdictions

BFCC Regions & States Served Aligned to CMS Regions

Region 1 Boston

CT, ME, MA, NH, RI, VT

Region 2 New York

NJ, NY, PR, USVI

Region 3 Philadelphia

DE, DC, MD, PA, VA, WV

Region 4 Atlanta

AL, FL, GA, KY, MS, NC, SC, TN

Region 5 Chicago

IL, IN, MI, MN, OH, WI

Region 6 Dallas

AR, LA, NM, OK, TX

Region 7 Kansas City

IA, KS, MO, NE

Region 8 Denver

CO, MT, ND, SD, UT, WY

Region 9 Sacramento AZ, CA, HI, NV, Pacific Territories

Region 10 Seattle

AK, ID, OR, WA

Appendix B: Conflict of Interest:

H.1 CONFLICT OF INTEREST (OCT 2020)

a. General: The contractor and the services provided under this contract shall be free, to the greatest extent possible, of all Organizational and Personal Conflicts of Interest. Consistent with these terms and conditions, all references to Organizational and/or Personal Conflicts of Interests will be referred to individually or collectively, as Conflicts of Interest (COI). Except as defined by these terms and conditions and in accordance with FAR 9.503, the Contracting Officer shall not maintain a contract with a contractor the Contracting Officer (CO) determines has, or has the potential for, an unresolved COI.

b. Definitions:

Actual COI– The COI is either currently in existence as determined by the contractor or CMS. This form of COI will require avoidance, neutralization or mitigation acceptable to CMS.

Affiliates –Associated business concerns or individual(s) if, directly or indirectly, either one controls or can control the other; or a third party controls or can control both.

Apparent (Perceived) COI – The COI on first observation appears to be an actual or potential COI, but may or may not be after analysis.

Avoidance – To prevent the occurrence of a COI through actions such as exclusion of sources or modification of requirements. Avoidance precludes the conflict.

Contractor – The term contractor is used synonymously with offeror.

Financial Relationships – A direct or indirect ownership or investment interest (including a stock option or non-vested interest) in any entity that exists through equity, debt, or other means and includes any indirect ownership or investment interest no matter how many levels removed from a direct interest.

Mitigation– To reduce the effects of a COI to an acceptable level of risk so that the Government’s interest with regard to fair competition and/or contract performance are not impaired. The conflict remains but action was taken that minimizes the impact of the conflict to an acceptable level of risk.

Mitigation Plan – The contractor’s written approach to mitigating a COI as documented in J.19 Section B.4.

Neutralization – To counteract, through a specific action, the effects of potential or actual COI. The conflict remains, but the impact of the conflict has been negated.

Organizational Conflict of Interest – Occurs when other activities or relationships with other persons, a person is unable or potentially unable to render impartial assistance or advice to the Government, or the person’s objectivity in performing the contract work is or might be otherwise impaired, or a person has an unfair competitive advantage.

Personal Conflicts of Interest – A situation in which a person has a financial interest, personal activity, or relationship that could impair the person’s ability to act impartially and in the best interest of the Government when performing under this contract.

Potential COI – A future situation or circumstance that would create a conflict of interest.

Three (3) Types of COIs include:

c. Significant Potential Conflict of Interest:

1. Nature of Conflict: Although not all inclusive, the Contracting Officer has determined that the following activities are considered to be an actual, potential or apparent COI with the work to be performed under this Quality Improvement Organization (QIO) contract.

For the purpose of identifying entities with actual, potential or apparent COIs, at a minimum, the entity is one that—

(a) Although not all inclusive, Federal contracts/grants involved in reviews, appeals, payment of claims, Medicaid, Health Information Exchange, Regional Extension Center, Health Information Technology, or the Beacon Community Program.

(b) For Quality Innovation Network (QIN)-QIOs and Beneficiary and Family Centered Care (BFCC)-QIOs:

(i) Prepared work or is under contract to prepare work that would be reviewed under the QIN-QIO or BFCC-QIO contract (inability to review one’s own work); or

(ii) Any entity (prime or subcontractor) which is, or is affiliated with (through management, ownership, or common control), a health care facility, within the area served by such entity or which would be served by such entity if it entered into a contract with the CMS under this part; or

(iii) Any entity affiliated with a health care facility by reason of management, ownership, or common control if the management, ownership, or common control consists of no more than twenty (20) percent of the members of the governing board of the entity being affiliated (through management, ownership, or common control) with one or more of such facilities; or

(iv) Is affiliated or has a financial relationship, as these terms are explained above, with a provider of services, payor organization or health plan as described in the Social Security Act [42 U.S.C. 1320c–2], Sections 1153(b) (2)(A) and (3)(A); or

(v) Is a provider of services located inside of the area for which the QIN-QIO or BFCC-QIO is required to perform services under the terms of this contract; or

(vi) Is a payor organization that has a contract with the Federal Government to perform services as a Medicare Administrative Contractor (MAC)/Subcontractor inside of the area for which the QIN-QIO or BFCC-QIO is required to perform services under the terms of this contract; or

(vii) Is a health plan located in the area for which the QIN-QIO or BFCC-QIO is required to perform services under the terms of this contract.

2. Proposed Restraint on Future Contractor Activities: CMS is proposing to restrain future contractor activities as follows:

(a) Limitations on Network of Quality Improvement and Innovation Contractors (NQIICs) and BFCC-QIOs:

(b) A BFCC-QIO may not become a Medicare Administrative Contractor (MAC), Recovery Audit Contractor (RAC), Unified Program Integrity Contractor (UPIC)* formerly Zone Program Integrity Contractor (ZPIC), Qualified Independent Contractor (QIC), or Quality Payment Program-Small Underserved and Rural Support (QPP-SURS) Contractor at any time in the jurisdiction where the BFCC holds a QIO contract.

*For purposes of this proposed restraint, a “UPIC” is defined as any of the Jurisdictional task orders awarded under the UPIC IDIQ (e.g. Northeastern Jurisdiction, Midwestern Jurisdiction, etc.)

By execution of this contract, the contractor agrees to comply with the mitigation plans contained in its COI proposal submission and any revisions. Any future post award mitigation strategies that present a questionable or reasonable doubt should be presented to the Government.

The following chart indicates the contract limitations for the structure of the QIO Program, the Medicare Fee-for-Service Compliance Program Contractors, and the Network of Quality Improvement and Innovation Contractors (NQIIC). These contract limitations also include any subcontracting arrangements or corporate affiliates.

The purpose of these limitations are to put the community on notice that these are concerns of CMS. These concerns may or may not come to fruition and would need to be identified in a mitigation plan. CMS’ goal is to minimize restrictions but still protect against COIs.

Includes but is not limited to Quality Innovation Networks – Quality Improvement Organizations (QIN-QIOs), End Stage Renal Disease (ESRD) Networks, and Hospital Quality Improvement Contractors (HQICs).

May be ineligible for award of the following contracts:

· Any BFCC-QIO Area

· BFCC NCORC

· BFCC SC

· IEC

· DVA

· Medicare Fee-for-Service Compliance Program Contractor Service Area(s)

Includes National Coordinating Center (NCC), Independent Evaluation Center (IEC), and Data Validation and Administration (DVA).

May be ineligible for award of the following contracts:

· Any BFCC-QIO Area

· BFCC NCORC

· BFCC SC

· Medicare Fee-for-Service Compliance Program Contractor Service Area(s)

· Any NQIIC awardee

· NQIIC Strategic Partners

· BFCC NCORC

· BFCC SC

· Medicare Fee-for-Service Compliance Program Contractor Service Area(s)

BFCC National Coordinating & Oversight Review Center

(BFCC NCORC)

· Any NQIIC awardee

· NQIIC Strategic Partners

· Any BFCC-QIO Area

· Medicare Fee-for-Service Compliance Program Contractor Service Area(s)

BFCC Survey Center

(BFCC SC)

· Any NQIIC awardee

· NQIIC Strategic Partners

· Any BFCC-QIO Area

· Medicare Fee-for-Service Compliance Program Contractor Service Area(s)

d. Conflict of Interest Oversight and Mitigation Plan:

1. Conflict of Interest Oversight Program: The contractor shall maintain an effective COI Oversight Program throughout the performance of the contract which includes procedures to monitor and disclose all Organizational and Personal Conflicts of Interest. A COI oversight program should include the monitoring of personal conflicts of interest such as, but not limited to:

a) Managers or Key Personnel who would be, or are involved with, the performance of this contract;

b) Governing Body Members (e.g., Board of Directors; Trustees); and

c) Principals of the organization as defined by FAR 52.203-13, Contractor Code of Business Ethics and Conduct.

2. Mitigation Plan: At any time during the performance of the contract if an actual, potential, or apparent COI is identified whether by the CO, the contractor or otherwise, the contractor shall submit a mitigation plan (J.19 Contractor/Offeror COI Submission Template) within 30 days unless otherwise specified by the CO. It is the contractor’s responsibility under the terms and conditions to provide timely notification to the CO those COIs that are self-identified. The CO will notify the contractor regarding the specifics for submission. The Government will review the submission at which time a determination will be made whether a COI has been satisfactorily mitigated or if further action is necessary and will notify the contractor accordingly. In cases where a COI cannot be, or has not been, mitigated to the Government’s satisfaction, the Government may take the following actions (this list is not all inclusive):

a) Request a waiver in accordance with FAR 9.503 Waiver, from the Head of the Contracting Activity;

b) Make changes to the requirements of the contract;

c) Require a subcontractor change (if the conflict lies with the subcontractor); and/or

d) Terminate the contract in whole or in part.

e. Subcontractor Flow-Down Terms and Conditions: The prime contractor is responsible for avoiding, neutralizing and mitigating all actual, potential, or apparent COIs of its subcontractors, in accordance with these terms and conditions. Therefore, the prime contractor shall flow-down terms and conditions H.1 Conflict of Interest and Compliance, of this contract in all subcontracts. For subcontractors, wherever the term “contractor” is used, insert “subcontractor.”