SOW_DAB.docx

June 29, 2016 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 CMS’ Division of Nursing Homes (DNH) to have access to databases that contain nursing home enforcement hearing and appeal decisions.

Such databases are vitally important to the CMS to allow identification of decisions that conflict with the 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. The 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 the 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 ALJ and 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 the CMS. The database shall contain at a minimum the following fields:

1. Facility name

2. Case number

3. Decision date

4. Survey end date

5. Panel member names [use initials]

6. Survey type (complaint, standard, Federal) [code for type]

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

8. Mention of informal dispute resolution (yes/no)

9. If mention of informal dispute resolution, its 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. Number of residents discussed in deficiency (one or multiple) [code for one or multiple]

6. Appeal results (sustained in whole or in part; rejected in whole or in part) [code for type]

7. Panel discussion of evidence (witness testimony, documentary evidence, reports or manual, other) [code for type]

8. Panel discussion 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 schedule of deliverables section of this document.

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. The DNH data team reviews Access databases and places them on the shared drive.

Deliverable

The schedule of deliverables for Task 2 is detailed in the schedule of deliverables section of this document.

Task 3: Meetings

The contractor shall attend two meetings with the Contracting Officer’s Representative (COR) in Baltimore or the metropolitan District of Columbia (DC) area to discuss contract issues. The contractor shall submit a meeting summary report to the COR for each meeting.

Deliverable

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

B. Period of Performance

The total period of performance is base plus 2 option years. The initial period of performance is from 09/28/2016 to 09/27/2017.

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 the CMS and must upgrade software when the 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 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 ALJs and the 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 COR as required and to participate as designated by the COR in meetings at the CMS headquarters or elsewhere in the metropolitan DC area for discussions and panel meetings. If the contractor is not local to Baltimore or the metropolitan DC area, 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 work in a timely manner and in accordance with 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 as needed. 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 or the metropolitan DC area, it is assumed that ad hoc 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

1 Maintain and Update a Searchable Ongoing Database for ALJ and DAB Decisions

2 Monthly Progress Report 15th day of each month

All reports shall be delivered via email.

Period of performance: 12 months with 2 option periods of 12 months each