SOW--RGWard.doc

June 6, 2015 Statement of Work The Centers for Medicare & Medicaid Services (CMS)

Contractor for Database Analysis of Hearing Decisions Background

In order to evaluate legal opinions regarding the long term care survey and certification process and its impact on the nation’s nursing homes, there is a need for the Centers for Medicare & Medicaid Services to have access to databases that contain nursing home enforcement hearing and appeal decisions.

Such databases are vitally important to CMS to allow identification of decisions that conflict with CMS guidance to survey agencies. These decisions may impact the Federal certification process, laws, regulations, and guidance and the manner in which they are applied.

Purpose The purpose of this contract is to maintain and update searchable databases, analyze hearing decisions by Administrative Law Judges (ALJs) and the Departmental Appeals Board (DAB) related to the nursing home enforcement system, and to provide a report summarizing all decisions for each month. CMS will use the databases to review and evaluate all legal decisions; which deficiencies are most frequently cited; whether ALJs sustain or reject the deficiencies and on what basis; whether expert witnesses are necessary and for which deficiencies; and whether surveyors require additional training to adhere to CMS guidance.

A. Scope of Work (SOW) Independently and not as an agent of the Government, the contractor shall furnish all of the necessary services, qualified personnel, material, equipment, and facilities, not otherwise provided by the Government, as needed to perform the requirements of this SOW.

Task 1: Develop, Maintain and Update Searchable Databases for Administrative Law Judge (ALJ) and Departmental Appeals Board (DAB) Decisions The contractor shall maintain and update a searchable Access database for all ALJ and DAB decisions related to the nursing home enforcement system available to CMS. The database shall contain at a minimum the following fields:

1. Name of facility

2. Case number

3. Date of decision

4. Date of DAB decision

5. Date survey ended

6. Name of panel members [use initials]

7. Type of survey (complaint, standard, Federal) [code for type]

8. Basis of decision (hearing, summary judgment, decision on the written pleadings) [code for type]

9. Whether informal dispute resolution is mentioned (yes/no)

10. If so, effect on deficiencies and recommended remedies [codes for elimination of deficiencies; changes to remedy]

For each deficiency discussed in the decision:

1. Regulatory citation

2. Scope and severity of deficiency, if ascertainable

3. Basis of challenge (what the regulation means, how the regulation was applied in this case) [code for basis]

4. Types of proof (expert witness, surveyor witness, facility witness) [code for type]

5. How many residents discussed in deficiency (one or multiple) [code for one or multiple]

6. Result of appeal (sustained in whole or in part; rejected in whole or in part) [code for type]

7. What panel discussed in terms of evidence (witness testimony, documentary evidence, reports or manual, other) [code for type]

8. What panel discussed in terms of law (DAB or ALJ decisions, preamble to regulations, other) [code for type]

9. Remedy recommended (e.g., civil money penalty, denial of payment for new admissions) [code for type]

10. Whether panel changed the remedy imposed (i.e., whether ALJ reduced amount of CMP

Deliverable The Schedule of Deliverables for Task 2 is detailed in the attached deliverables schedule for this Request for Proposal (RFP).

Task 2: Monthly Progress Report The contractor shall provide a monthly progress report via e-mail by the 15th day of each month. The progress report shall include the name of the contractor, project director, contract number, and work accomplished during the month. The report shall summarize the decisions during the month (how many cases, about what issues, whether the ALJ or panel sustained or rejected the deficiencies, whether the ALJ or panel changed the remedies) and highlight key points or key language from the ALJs or panels. This also applies to DAB decisions. The report shall be 20 pages or fewer. Staff from the Division of Nursing Homes data team reviews Access databases and puts them on the shared drive.

Deliverable The schedule of deliverables for Task 3 is detailed in the attached deliverables schedule of this document.

Task 3: Meetings The contractor shall attend two meetings with CMS staff in Baltimore to discuss contract issues. The contractor shall submit a summary report to the Project Officer (PO) of the discussions held during each meeting.

Deliverable:

Two meetings in Baltimore; meeting report due 15 days after date of meetings

B. Period of Performance The period of performance is one year from the date of award.

C. Government Property There are no specific reporting requirements for this procurement. The contractor shall supply their own copy of a version of Microsoft Office Suite that is compatible with the version currently used by CMS and must upgrade software when CMS upgrades. The contractor must have access to telephone and e-mail. Reports shall be delivered via e-mail.

D. Key Personnel Requirements This contract requires an attorney or a nationally-recognized expert who has a thorough knowledge and understanding of the Federal certification process, laws, regulations, guidance, and the manner in which they are applied. The contractor must be able to develop, maintain, and update searchable databases, analyze hearing decisions by Administrative Law Judges (ALJs) and the Departmental Appeals Board (DAB) related to the nursing home enforcement system, and provide a report summarizing all decisions for each month.

E. Quality Assurance The contractor shall be required to be accessible by telephone to the Contract Officer’s Representative (COR) as required to participate as designated by the COR in meetings at CMS headquarters or elsewhere in Baltimore for discussions and panel meetings. If the contractor is not local to Baltimore, the contractor shall use contract funds to fund travel costs for any in person meetings as designated by the COR, to consist of no more than 2 trips per year. The contractor shall turn in timely work according to the needs of the various tasks of this contract. To assure the quality of the contractor’s performance, the COR shall request progress meetings between the contractor and the COR on an as needed basis via telephone. The dates and times of the progress meetings shall be determined by the COR and the contractor during the period of performance. If the contractor is not local to Baltimore, it is assumed that meetings will be conducted by teleconference except for one or two as designated by the COR that require in person participation for intensive review of materials with CMS staff.

SCHEDULE OF DELIVERABLES

TASK

DESCRIPTION

DUE DATE

Maintain and Update a Searchable

Ongoing

Database for ALJ and DAB Decisions

Monthly Progress Report

15th day of each month

Two Meetings in Baltimore

Dates to be determined;

Reports due 15 days after meetings

All reports shall be delivered via email.

Period of performance: 12 months