ESRD_NETWORK_RFP.pdf

CMS-2016-ESRD-NETWORKS

SOLICITATION, OFFER AND AWARD

4. TYPE OF SOLICITATION2. CONTRACT NUMBER 3. SOLICITATION NUMBER

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than Item 7)

ORDER UNDER DPAS (15 CFR 700)

6. REQUISITION/PURCHASE NUMBER

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

NEGOTIATED (RFP)

SEALED BID (IFB)

5. DATE ISSUED

1. THIS CONTRACT IS A RATED RATING PAGE OF PAGES

1 2

C. E-MAIL ADDRESS

EXT.NUMBERAREA CODE

B. TELEPHONE (NO COLLECT CALLS)A. NAME

10. FOR

INFORMATION

CALL:

CAUTION: LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

(Date)(Hour) local timeuntildepository located in copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the

SOLICITATION

9. Sealed offers in original and

PART IV - REPRESENTATIONS AND INSTRUCTIONS

OTHER STATEMENTS OF OFFERORS

EVALUATION FACTORS FOR AWARD

INSTRS., CONDS., AND NOTICES TO OFFERORS

REPRESENTATIONS, CERTIFICATIONS AND

LIST OF ATTACHMENTS

CONTRACT CLAUSES

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

I

J

K

L

M SPECIAL CONTRACT REQUIREMENTS

CONTRACT ADMINISTRATION DATA

DELIVERIES OR PERFORMANCE

INSPECTION AND ACCEPTANCE

PACKAGING AND MARKING

DESCRIPTION/SPECS./WORK STATEMENT

SUPPLIES OR SERVICES AND PRICES/COSTS

SOLICITATION/CONTRACT FORM

PART II - CONTRACT CLAUSESPART I - THE SCHEDULE

H

G

F

E

D

C

B

A

SEC. DESCRIPTION PAGE(S) (X) DESCRIPTION SEC. (X)

11. TABLE OF CONTENTS

18. OFFER DATE17. SIGNATURE

SUCH ADDRESS IN SCHEDULE.

IS DIFFERENT FROM ABOVE - ENTER

15C. CHECK IF REMITTANCE ADDRESS

EXT.NUMBERAREA CODE

15B. TELEPHONE NUMBER

(Type or print)AND

ADDRESS

OF

OFFEROR

CODE FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER15A. NAME

DATEAMENDMENT NO.DATEAMENDMENT NO.

and related documents numbered and dated):

amendments to the SOLICITATION for offerors

(The offeror acknowledges receipt of

14. ACKNOWLEDGEMENT OF AMENDMENTS

CALENDAR DAYS (%)30 CALENDAR DAYS (%)20 CALENDAR DAYS (%)10 CALENDAR DAYS (%)

(See Section I, Clause No. 52.232.8)

13. DISCOUNT FOR PROMPT PAYMENT

designated point(s), within the time specified in the schedule.

by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the

12. In compliance with the above, the undersigned agrees, if this offer is accepted within ______________ calendar days (60 calendar days unless a different period is inserted

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

OFFER (Must be fully completed by offeror)

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

28. AWARD DATE

(Signature of Contracting Officer)

27. UNITED STATES OF AMERICA

25. PAYMENT WILL BE MADE BY

26. NAME OF CONTRACTING OFFICER (Type or print)

CODE 24. ADMINISTERED BY (If other than Item 7)

ITEM

(4 copies unless otherwise specified)

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

41 U.S.C. 253 (c) ( 10 U.S.C. 2304 (c) (

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

21. ACCOUNTING AND APPROPRIATION20. AMOUNT19. ACCEPTED AS TO ITEMS NUMBERED

AWARD (To be completed by government)

CODE

06/23/2015 X

ASG - DQC

CMS,OAGM,ASG,DQC

7500 SECURITY BLVD., MS: B3-30-03

BALTIMORE MD 21244-1850

1400 ES 07/28/2015

Jeannine Bohlen 410 Jeannine.bohlen@cms.hhs.gov

786-2864

X

X

X

X

X

X

X

X

X

X

X

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PAGE(S)

Michael Milanese

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

Prescribed by GSA - FAR (48 CFR) 53.214(c)

TABLE OF CONTENTS

SECTION B – SUPPLIES OR SERVICES AND PRICES/COSTS

B.1 DESCRIPTION OF SERVICES

B.2 TYPE OF CONTRACT

B.3 CONSIDERATION AND PAYMENT

B.4 SCHEDULE FOR PAYMENT FOR FIXED PRICE

B.5 SPECIAL INNOVATION PROJECTS (SIPS)

B.6 TRANSITION SERVICES

SECTION C – DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

C.1. PURPOSE OF STATEMENT OF WORK (SOW)

C.2. CONTRACT PERFORMANCE OBJECTIVES

C.2.1.DOMAINS

C.2.2.A ROLE OF NETWORK

C.3. GENERAL REQUIREMENTS

C.3.1. COMPLIANCE

C.3.2. INDEPENDENCE

C.3.3. ORGANIZATIONAL STRUCTURE

C.3.4. COMMUNICATION REQUIREMENTS

C.3.5. DATA CONFIDENTIALITY AND DISCLOSURE

C.3.6. INFORMATION COLLECTION/SURVEY ACTIVITIES

C.3.7. REPORTING TO CMS AND OTHERS

C.3.8. MEETINGS

C.3.9. NETWORK COLLABORATIONS

C.3.10. PARTICIPATE IN WORKGROUPS

C.3.11. RECOMMENDATIONS FOR SANCTIONS

C.3.12. REPORTING OF DISCRIMINATION

C.3.13. EMERGENCY AND DISASTER RESPONSIBILITIES OF THE NETWORK

C.3.14. DATA SYSTEMS

C.3.15. INFRASTRUCTURE OPERATIONS SUPPORT AND DATA MANAGEMENT ... 27

C.3.16. HARDWARE/SOFTWARE

C.3.17. SECURITY

C.3.18. INTERNAL QUALITY IMPROVEMENT PROGRAM

C.3.19. PERFORMANCE IMPROVEMENT PLANS (PIP)

C.4. AIMS AND DOMAINS

C.4.1. AIM 1: BETTER CARE FOR THE INDIVIDUAL THROUGH PATIENT AND

FAMILY CENTERED CARE

C.4.2. AIM 2: BETTER HEALTH FOR THE ESRD POPULATION

C.4.3. AIM 3: REDUCE COSTS OF ESRD CARE BY IMPROVING CARE

SECTION D – PACKAGING AND MARKING

D.1 PACKAGING AND MARKING

SECTION E – INSPECTION AND ACCEPTANCE

E.1 CLAUSES INCORPORATED BY REFERENCE

E.2 INSPECTION AND ACCEPTANCE

E.3 PERFORMANCE IMPROVEMENT PLAN (PIP)

SECTION F – DELIVERIES OR PERFORMANCE

F.1 CLAUSES INCORPORATED BY REFERENCE

F.2 PERIOD OF PERFORMANCE (JAN 2014)

F.3 ACCEPTANCE OF DELIVERABLES

F.4 GOVERNMENT POINTS OF CONTACT

SECTION G – CONTRACT ADMINISTRATION DATA

G.1 ACCOUNTING AND APPROPRIATION DATA

G.2 PAYMENTS - INVOICES (FIRM FIXED PRICE CONTRACTS) (AUG 2013)

G.3 CONTRACTING OFFICER (CO) RESPONSIBILITY

G.4 CONTRACTING OFFICER’S REPRESENTATIVE (COR)

G.5 TECHNICAL DIRECTION

G.6 CORRESPONDENCE PROCEDURES

G.7 KEY PERSONNEL HHSAR 352.242-70 (JAN 2006)

G.8 SUBCONTRACT/CONSULTANT CONSENT

G.9 USE OF GOVERNMENT DATA (REPORTS/FILES/COMPUTER TAPES OR

DISCS)

G.10 WORKING PAPERS

G.11 DATA TO BE DELIVERED

G.12 PROPERTY ADMINISTRATION

G.13 PROPERTY ADMINISTRATOR

G.14 GOVERNMENT FURNISHED PROPERTY

G.15 CONTRACTOR FURNISHED PROPERTY

G.16 PROCESS FOR OBTAINING ADDITIONAL HARDWARE (HW)/SOFTWARE

(SW)

G.17 CONTRACTOR PAST PERFORMANCE EVALUATION(S) (OCT 2014)

G.18 ANNUAL WAGE DETERMINATIONS

G.19 SECURITY CLAUSE – BACKGROUND INVESTIGATIONS FOR

CONTRACTOR PERSONNEL

G.20 SUBCONRACTING PROGRAM AND REPORTING

G.21 SITE VISITS

G.22 A-133 INTERIM AUDITS (FOR NON-PROFIT ORGANIZATIONS ONLY)

G.23 CLOSEOUT AUDIT FOR PROFIT AND NON-PROFIT ORGANIZATIONS

G.24 PUBLICITY

SECTION H – SPECIAL CONTRACT REQUIREMENTS

H.1 CONFLICT OF INTEREST

H.2 PRIVACY ACT HHSAR 352.224-70 (JAN 2006)

H.3 HIPAA BUSINESS ASSOCIATE CLAUSE (OCT 2014)

H.4 CMS INFORMATION SECURITY (APR 2013)

H.5 SECTION 508 – ACCESSIBILITY OF ELECTRONIC AND INFORMATION

TECHNOLOGY

H.6 REHABILITATION ACT, SECTION 508, ACCESSIBILITY STANDARDS THE

CONTRACTOR SHALL COMPLY WITH THE REHABILITATION ACTION,

SECTION 508, ACCESSIBILITY STANDARDS AS REFERENCED BELOW

H.7 DATA USE AGREEMENT

H.8 COSTS FOR CONFERENCES, MEETING AND RELATED TRAVEL

H.9 FOOD CLAUSE

H.10 CONTRACTOR COMPLIANCE OFFICER RESPONSIBILITY

H.11 CONDITIONS OF PERFORMANCE

H.12 DISCLOSURE OF INFORMATION

H.13 CHANGES TO PROGRAM INSTRUCTIONS/CONTRACT REQUIREMENTS

H.14 ESRD FINANCIAL SEMI-ANNUAL COST REPORT INSTRUCTIONS

H.15 PARTICIPATION IN SPECIAL INNOVATION PROJECTS (SIPS)

H.16 POST AWARD CONFERENCE

H.17 TRANSITION FROM INCUMBENT TO SUCCESSOR

H.18 DEFINITION OF A NON-PROFIT ORGANIZATION

H.19 OPEN GOVERNMENT PROACTIVE PRE- DISCLOSURE NOTIFICATION 115

H.20 GOVERNANCE AND COMPLIANCE REQUIREMENTS

PART II – CONTRACT CLAUSES

SECTION I - CONTRACT CLAUSES

I.1 CLAUSES INCORPORATED BY REFERENCE FAR 52.252-2 (FEB 1998)

I.2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ACQUISITION

REGULATIONS (HHSAR) HHSAR 352.252-20

HTTP://KNOWNET.HHS.GOV/ACQUISITION/HHSAR/DEFAULT.HTM

I.3 DEFINITIONS HHSAR 352.202-1 (JAN 2006)

I.4 APPROVAL OF CONTRACT FAR 52.204-1 (DEC 1989)

I.5 INCORPORATION BY REFERENCE OF REPRESENTATIONS AND

CERTIFICATIONS FAR 52.204-19 (DEC 2014)

I.6 OPTION TO EXTEND THE TERM OF THE CONTRACT FAR 52.217-9 (MAR

2000)

I.7 STATEMENT OF EQUIVALENT RATES FOR FEDERAL HIRES FAR 52.222-42

(MAY 2014)

I.8 PROVIDING ACCELERATED PAYMENT TO SMALL BUSINESS

SUBCONTRACTORS (DEVIATION) FAR 52.232-99 (AUG 2012)

I.9 ALTERATIONS IN CONTRACT FAR 52.252-4 (APR 1984)

I.10 AUTHORIZED DEVIATIONS IN CLAUSES FAR 52.252-6 (APR 1984)

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS

SECTION J – LIST OF ATTACHMENTS

SECTION K - REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS

OF OFFERORS OR QUOTERS

K.1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

K.2 COMPLETED BY THE OFFEROR: [THE REPRESENTATIONS AND

CERTIFICATIONS MUST BE EXECUTED BY AN INDIVIDUAL AUTHORIZED

TO BIND THE OFFEROR.]

K.3 ANNUAL REPRESENTATIONS AND CERTIFICATIONS FAR 52.204-8 (DEC

2014)

K.4 PART IV - REPRESENTATIONS AND INSTRUCTIONS (FINANCIAL

INFORMATION)

K.5 CERTIFICATE OF INDEPENDENT PRICE DETERMINATION FAR 52.203-2

(APR 1985)

K.6 CERTIFICATION REGARDING RESPONSIBILITY MATTERS FAR 52.209-

5 (APR 2010)

K.7 INFORMATION REGARDING RESPONSIBILITY MATTERS FAR 52.209-7

(JUL 2013)

K.8 PLACE OF PERFORMANCE FAR 52.215-6 (OCT 1997)

K.9 SMALL BUSINESS PROGRAM REPRESENTATIONS FAR 52.219-1 (OCT 2014)142

K.10 PREVIOUS CONTRACTS AND COMPLIANCE REPORTS FAR 52.222-22 (FEB

1999)

K.11 AFFIRMATIVE ACTION COMPLIANCE FAR 52.222-25 (APR 1984)

K.12 PROHIBITION ON CONDUCTING RESTRICTED BUSINESS OPERATIONS IN

SUDAN—CERTIFICATION FAR 52.225-20 (AUG 2009)

K.13 COST ACCOUNTING STANDARDS NOTICES AND CERTIFICATION FAR

52.230-1 (MAY 2012)

K.14 PROPOSAL DISCLOSURE – COST ACCOUNTING PRACTICE CHANGES

FAR 52.230-7 (APR 2005)

SECTION L - INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS OR

QUOTERS

L.1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE FAR 52.252-

1 (FEB 1998)

L.2 RESPONSIBLE PROSPECTIVE CONTRACTOR SUBMISSION

L.3 TYPE OF CONTRACT FAR 52.216-1 (APR 1984)

L.4 NORTH AMERICAN INDUSTRY CLASSIFICATION SYSTEM (NAICS) CODE

AND SMALL BUSINESS STANDARD

L.5 SERVICE OF PROTEST FAR 52.233-2 (SEP 2006)

L.6 ALTERATIONS IN SOLICITATION FAR 52.252-3 (APR 1984)

L.7 AUTHORIZED DEVIATIONS IN PROVISIONS FAR 52.252-5 (APR 1984)

L.8 SECTION 508 ACCESSIBILITY OF ELECTRONIC AND INFORMATION

TECHNOLOGY (EIT) COMPLIANCE

L.9 SMALL BUSINESS SUBCONTRACTING PLAN

L.10 SOLICITATION QUESTIONS

L.11 GENERAL INSTRUCTIONS

L.12 PROPOSAL DELIVERY

L.13 PROPOSAL ORGANIZATION

L.14 TECHNICAL PROPOSAL INSTRUCTIONS (VOLUME I)

L.15 BUSINESS PROPOSAL INSTRUCTIONS (VOLUME II)

L.16 CONFLICT OF INTEREST INSTRUCTIONS (VOLUME III)

SECTION M - EVALUATION FACTORS FOR AWARD

M.1 CLAUSES INCORPORATED BY REFERENCE

M.2 GENERAL PROCEDURES

M.3 EVALUATION FACTORS

M.4 EVALUATION METHODOLOGY

M.5 AWARD/SELECTION PROCESS

M.6 RESPONSIBLE PROSPECTIVE CONTRACTOR DETERMINATION

SECTION B – SUPPLIES OR SERVICES AND PRICES/COSTS

B.1 DESCRIPTION OF SERVICES

The purpose of this contract is to provide healthcare quality improvement services from End Stage Renal Disease (ESRD) Networks for purposes of improving care for persons living with ESRD in a manner that aligns with the work that CMS will be doing in its efforts towards achievement of the National Quality Strategy (NQS) and the CMS Quality Strategy along with carrying out the requirements of Section 1881 of the Social Security Act and the Omnibus Budget Reconciliation Act of 1986.

B.2 TYPE OF CONTRACT

This is a firm fixed price (FFP) contract. The services of this contract will be severable.

B.3 CONSIDERATION AND PAYMENT

A. The total firm fixed price for this contract is $________________.

B. The total firm fixed price for the transition period is $__________________.

C. The total firm fixed price for the base year is $__________________.

D. The total firm fixed price for Option 1 is $___________________.

E. The total firm fixed price for Option 2 is $_______________________.

F. The total firm fixed price for Option 3 is $_______________________.

G. The total firm fixed price for Option 4 is $_____________________.

H. Monthly Invoices

Monthly invoices shall be submitted in accordance with contract Section G.2.

I. Table of Total Estimated Firm Fixed Price

The Contractor shall provide the necessary personnel, materials, services, facilities and supplies (except as may be otherwise specified in the contract) and otherwise do all things necessary for, or incident to, the performance of the work as set forth in Section C. In consideration of successful contract performance, based on the evaluation criteria set forth in Section C, the Contractor will be paid as stated in B.4, Schedule for Payment for Fixed Price.

B.4 SCHEDULE FOR PAYMENT FOR FIXED PRICE

The Government shall pay the Contractor for performing this contract the fixed price specified in the schedule below. Payment of the fixed price will be made in accordance with the schedule provided below:

A. Base Year Transition Period - December 1, 2015 through December 31, 2015 Month Payment Total

1 TBD

Total TBD

B. Base Year - January 1, 2016 through November 30, 2016

2-11 TBD

12 TBD

C. Option 1 – December 1, 2016 through November 30, 2017

13-23 TBD

24 TBD

D. Option 2 – December 1, 2017 through November 30, 2018

25-35 TBD

36 TBD

E. Option 3 – December 1, 2018 through November 30, 2019

37-47 TBD

48 TBD

F. Option 4 – December 1, 2019 through November 30, 2020

49-59 TBD

60 TBD

Note: Regardless of the period of performance of a Special Innovation Project, the associated fixed price shall be allocated across the remaining months of the contract period (not the period of performance for the Special Innovation Project). Therefore, as these projects are incorporated into the contract, the Section B.4, Schedule for Payment of Fixed Price will be modified accordingly.

B.5 SPECIAL INNOVATION PROJECTS (SIPs)

As provided in Section C and in accordance with the procedures contained in Section H.15, CMS reserves the right to direct the Contractor to initiate a SIP not currently defined in the Statement of Work/Services or to approve an application submitted by the Contractor to conduct a SIP.

SIPs will be negotiated and awarded on a FFP basis. The table provided below will be completed (through executed of a formal contract modification) as SIPs are incorporated into this contract.

Special Innovation Project Number

Special Innovation Project Title

Period Of Performance

Funded Amount

B.6 TRANSITION SERVICES

At the beginning and/or end of the contract, in the event that CMS requires transition services from the incumbent Contractor to a successor, the Contractor will participate in transition activities and submit a transition business and technical proposal when requested. Refer to Section H.17 for guidance. These services will be incorporated into the contract, if applicable.

B.7 ESRD NETWORKS

The following table describes the geographic service areas. ESRD Networks s must be uniquely positioned to ensure full participation of the ESRD community in its geographic service area(s).

NETWORK 1 CT, ME, MA, NH, RI, VT

NETWORK 2 NY

NETWORK 3 NJ, Puerto Rico, Virgin

Islands

NETWORK 4 DE, PA

NETWORK 5 DC, MD, VA, WV

NETWORK 6 GA, NC, SC

NETWORK 7 FL

NETWORK 8 AL, MS, TN

NETWORK 9 IN, KY, OH

NETWORK 10 IL

NETWORK 11 MI, MN, ND, SD, WI

NETWORK 12 IA, KS, MO, NE

NETWORK 13 AR, LA, OK

NETWORK 14 TX

NETWORK 15 AZ, CO, NV, NM, UT, WY

NETWORK 16 AK, ID, MT, OR, WA

NETWORK 17 American Samoa, Guam, HI, Mariana Islands, Northern CA

NETWORK 18 Southern CA

SECTION C – DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

C.1. PURPOSE OF STATEMENT OF WORK (SOW)

The purpose of this Statement of Work (SOW) is to delineate tasks to be conducted by each End- Stage Renal Disease (ESRD) Network Organization contractor in support of achieving national quality improvement goals and statutory requirements as set forth in Section 1881 of the Social Security Act and the Omnibus Budget Reconciliation Act of 1986. The term “Network” is used in this SOW to refer to the ESRD Network contractor who shall be a QIO-like entity. The tasks described in this SOW are intended to align Network activities with the Department of Health and Human Services (HHS) National Quality Strategy (NQS), the Centers for Medicare & Medicaid Services (CMS)Three-Part Aim (Better Care, Better Health, Lower Cost), and other CMS priorities designed to result in improvements in the care of individuals with ESRD.

C.2. CONTRACT PERFORMANCE OBJECTIVES

This section outlines the role of the ESRD Network and how the NQS principles should be applied to the ESRD SOW.

C.2.1.Domains The Network shall promote positive change relative to Three-Part Aim outlined in the NQS and CMS priorities. These Aims are interpreted for purposes of this SOW as:

• AIM 1: Better Care for the Individual through Patient and Family Centered Care

• AIM 2: Better Health for the ESRD Population

• AIM 3: Reduce Costs of ESRD Care by Improving Care.

The three Aims are subdivided into multiple domains, as defined in this SOW. (See Table 1.)

Many factors influence these domains, including patient characteristics, patients’ social support/environment, and aspects of the healthcare delivery system. To substantively impact these domains, the Network may need to deploy interventions that target patients, dialysis/transplant providers, other providers, and/or stakeholders.

The Network shall incorporate a focus on disparities in conducting all of the activities outlined in this SOW. In each domain, the Network shall analyze data and implement interventions aimed at reducing disparities. All projects shall use innovative approaches and rapid cycle improvement that incorporates boundariliness, unconditional teamwork, and are customer-focused and sustainable to achieve the strategic goals of the ESRD Network Program.

Contracting Officer’s Representative (COR): is an individual, designated and authorized in writing by the contracting officer to perform specific technical or administrative functions including acknowledgment, acceptance and/or approval of deliverables.

CMS Subject Matter Expert (CMS SME): is an individual who may assist the COR by performing the following:

• Interaction with the contractor on behalf of the COR, while avoiding providing technical direction;

• Monitoring and evaluating the contractor’s performance and providing feedback to the

COR;

http://www.ahrq.gov/workingforquality/nqs/nqs2011annlrpt.pdf

• Keeping the COR informed of substantive communications with the contractor;

• Assisting the COR with the inspection and evaluation of products and services delivered by the Contractor;

• Notifying promptly the COR of any actual or potential contractor performance issues.

Table 1: AIMs, Domains, and Sub-Domains AIM Domain Sub-Domain

AIM 1: Better Care for the Individual through Patient and Family Centered Care

Patient and Family Engagement

Foster Patient and Family Engagement at the Facility Level and involve Patient Subject Matter Experts in Patient Experience of Care and Healthcare Associated Infection QIAs Involve Patients/Families/Caregivers in CMS Meetings Support the ESRD National Coordinating Center (NCC) Patient and Family Engagement Learning and Action Network (LAN)

Patient Experience of Care

Evaluate and Resolve Grievances Conduct QIA to improve Facility Grievance process Promote Use of In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) and/or Any Similar Survey Identified by CMS Address Issues Identified through Data Analysis Recommend Sanctions

Patient-Appropriate Access to In-Center Dialysis Care

Decrease Involuntary Discharges (IVDs) and Involuntary Transfers (IVTs) Address Patients at Risk for IVD/IVT and Failure to Place Report data on Access to Dialysis Care Monthly

Vascular Access Management

Reduce Catheter Rates for Prevalent Patients Support Facility Vascular Access Reporting Spread Best Practices Provide Technical Support in the Area of Vascular Access

Patient Safety:

Healthcare-Associated Infections (HAIs)

Support National Healthcare Safety Network (NHSN) Establish HAILAN

1) Reduce Rates of Dialysis

Events(HAI/bloodstream infection (BSI)/Sepsis)

2) Increase Hepatitis B (HBV)and Pneumococcal

Vaccination Rates

AIM Domain Sub-Domain

AIM 2: Better Health for the

ESRD

Population

Population Health Innovation Pilot Project

Reduce Identified Disparity through:

Project A: Reducing Hospital Utilization or Project B: Improve Transplant Referrals or Project C: Promote Appropriate Home Dialysis or Project D: Support Improvement in Quality of Life

For Option Year (OY)3 – OY4 all Network will conduct Project A; additional Network selected project may occur

AIM 3: Reduce Costs of ESRD Care by Improving Care

Support for ESRD Quality Incentive Program (ESRD QIP) and Performance Improvement on ESRD QIP Measures

Assist Facilities in Understanding and Complying with ESRD QIP Processes and Requirements Conduct Quality Improvement Activities (QIA) to assist Facilities in Improving their Performance on ESRD QIP Measures Assist CMS in Monitoring the Quality of and Access to Dialysis Care Assist Patients and Caregivers in Understanding the

ESRD QIP

Support for Facility Data Submission to CROWNWeb, NHSN, and/or Other CMS- Designated Data Collection System(s)

1) Provide support for CROWNWeb (CW) NHSN, other CMS data systems as directed;

2) Conduct Data Quality QIA for NHSN with hospitals and dialysis facilities

3) Provide necessary CW functions as directed by

SOW

C.2.2.A Role of Network The Networks are critical to achieving bold CMS goals for healthcare transformation and the aims of the NQS.

The successful Networks will be patient care navigators and lead transformation by:

• Serving as conveners, organizers, motivators, and change agents;

• Leveraging technology to provide outreach and education;

• Serving as partners in quality improvement with patients, practitioners, healthcare providers, other healthcare organizations, and other stakeholders;

• Securing commitments to create collaborative relationships with other stakeholders and partners

• Achieving and measuring changes at the patient level through data collection, analysis, and monitoring for improvement;

• Disseminating and spreading best practices including those relating to clinical care, quality improvement techniques, and data collection through information exchange;

and

• Participating in the development of a CMS national framework for providing emergency preparedness services.

The Network is uniquely positioned to ensure full participation of the ESRD community in achieving the aims of the NQS. Therefore, this SOW emphasizes:

• Network relationship with Medicare patients

Ensuring representation of Medicare patients in shared decision making related to ESRD care in order to promote person-centeredness and family engagement (NQS Principle 1)

Protecting Medicare patients’ access to and quality of dialysis care, especially among vulnerable populations (NQS Principle 3)

• Network relationship with ESRD facilities (NQS Principle 4)

Identifying opportunities for quality improvement at the individual facility level and providing technical assistance (NQS Principle 5)

Promoting all modalities of care, including home modalities and transplantation, as appropriate, to promote patient independence and improve clinical outcomes(NQS Principle 5)

Facilitating processes to promote care coordination between different care settings(NQS Principle 8)

Ensuring accurate, complete, consistent, and timely data collection, analysis, and reporting by facilities in accordance with national standards and the ESRD QIP (NQS Principle 6). This also includes the submission of Master Account Holder information for all new facilities to the ESRD Network

• Coordination and sharing across 18 Networks

Using standardized procedures to collect data and address grievances to promote consistency across Networks (NQS Principle 6)

Collaborating to share information such as patient migration across Networks to promote care coordination (NQS Principle 8)

Coordinating with regional Quality Improvement Organizations (QIO) and Hospital Engagement Networks (HEN), as well as other recognized subject matter experts in the quality improvement field

Sharing information to promote care coordination for ESRD patients (NQS Principle 8)

Sharing best practices to improve quality of care for ESRD patients, including Network involvement in LANs (NQS Principle 5)

• Network acting on behalf of CMS

Conveying information from CMS to facilities on HHS and CMS goals, strategies, policies, and procedures including the ESRD QIP

Maintaining integrity of information and tone of messaging consistent with CMS expectations for entities acting on behalf of the agency

Interpreting and conveying to CMS or its designee information relevant to the ESRD healthcare system to assist with monitoring and evaluation of policy and program impacts, including the effects of the ESRD QIP.

C.2.2.B Network activities:

Networks will continue several specific functions through the base and four (4) OYs for the contract. Networks will provide Patient-oriented engagement activities through the Patient and Family Engagement (C.4.1.) and Patient Experience of Care section of the contract. These activities shall include, but not be limited to:

1) Selection of a diverse group of 15 Patient subject matter experts (SME), and integration of these individuals in to the Grievance, ICH CAHPS, and HAI QIAs, at a minimum;

2) Conduct Patient Engagement at the Facility Level;

3) Process of Grievances and Access-to-Care issues;

4) Facilitate grievances and access-to-care cases;

5) Supply the ESRD NCC with patient contact information for those that have agreed to participate in the CMS Grievance Satisfaction Survey;

6) Conduct a QIA directed at one area of the ICH CAHPS survey results;

A major function of the Networks will be to conduct a number of QIAs. These QIAs are listed below: For each of year of the contract, Networks will have eight (8) QIAs. During OYs 3 and 4, all Networks will work on a National Hospital Care Coordination QIA developed during the first three (3) years of the contract. CMS will decide which of seven (7) of the other QIAs will not be completed during OY3 and OY4.

Table 2.QIAs for Base and Option Years AIM QIAs Base OY1 OY2 OY3 OY4 Template to use 1 Grievance Yes Yes Yes Yes Yes Grievance

1 ICH CAHPS Yes Yes Yes TBD TBD QIA SF

1 Vascular Access:

Long-Term Catheter

Yes Yes Yes TBD TBD QIA SF

1 HAI BSI/Sepsis Yes Yes Yes TBD TBD QIA SF

1 HAI Vaccinations Yes Yes Yes TBD TBD QIA SF

2 Network-selected Yes Yes Yes TBD TBD AIM2

Checklist

2 National No No No Yes Yes AIM2 Checklist

3 ESRD QIP Yes Yes Yes TBD TBD QIP QIA

3 Data Quality Yes Yes Yes Yes Yes QIA SF Note: Grievance= Grievance template in J-7; QIA SF=QIA Short Form in J-7; AIM2 Checklist= AIM2 Checklist in J-7; QIP QIA= QIP QIA form in J-7

For each of the three AIMs evaluation for each of these QIAs shall be based on achievement of results by September of the contract period. For the each AIM QIA for the base contract period, unless otherwise specified, all QIA Short Forms (Attachment J-7) and or the AIM2 Checklist shall be reviewed by the CMS SME and approved by the COR by the last business day of March.

During the 4th Quarter (Oct-Dec) of each contact period, Networks will re-assess the membership of the QIAs, and identify potential new facilities or populations to replace those that have achieved success (i.e., those that have achieved the QIA goal). Networks will also re-assess their interventions methods and activities and revise them as necessary. Networks shall provide updated QIA target facility/populations lists to the NCC by the last working day in December for the subsequent contract period. During the Option years all QIA Short Forms and/or the AIM2 checklist, as appropriate, shall be reviewed by the CMS SME and approved by the COR by the last business day in January.

Additionally, Networks will conduct the process of supporting CMS-designated data systems (e.g. CROWNWeb, NHSN, and Patient Contact Utility) and utilizing such systems to support the Patient services and Quality Improvement functions of this contract.

C.3. GENERAL REQUIREMENTS

C.3.1. Compliance The Network shall comply with all requirements outlined in this SOW, all additional instructions from CMS, and all relevant statutory and regulatory requirements.

C.3.2. Independence The Network, acting independently and not as an agent of the Federal Government, shall furnish the necessary personnel, materials, services, facilities, and supplies (except as otherwise specified in the contract) and otherwise do all things necessary for, or incident to, the performance of work as set forth by this SOW.

C.3.3. Organizational Structure The ESRD Network shall establish an organizational structure that supports the Network’s operations and meets all statutory requirements. The corporate structure shall include at minimum a Network Council, Board of Directors (BOD), Medical Review Board, and Patient Advisory Committee. The Patient Advisory Committee may be comprised in part or whole by the 15 SMEs denoted in section C.4.1.A.1. The Network shall have a designated Executive Director. The Executive Director shall devote sufficient time to the Network to ensure satisfactory performance of the contract. The Executive Director shall ensure the appropriate staff hours and staff expertise to ensure satisfactory completion of the contract. The Network shall employ a full-time Registered Nurse (RN) with nephrology experience, and a full-time Master of Social Work (MSW)-level Social Worker with experience in Case Review as a component of the Network staff. The Network shall maintain on file all CMS-furnished ESRD Network Nondisclosure Statements signed by all Network employees and affiliates.

The Network shall disclose all actual, apparent, and potential conflicts of interest to the Contracting Officer during the term of the contract. The Network shall have programs in place to identify, evaluate, and mitigate all actual, apparent, and potential conflicts of interest that preclude, or would appear to preclude, the Network from rendering impartial assistance or advice on work performed under the Network contract.

No member of any Network board, council, committee, or subcommittee member may review the ESRD services of a provider in which he or she has a direct or indirect financial interest, as described in §1126(a) and (b) of the Social Security Act; with which he or she has or had any professional involvement; from which he or she has received reimbursement; or to which he or she has supplied goods. See §1881(c) (1) (C) of the Social Security Act.

C.3.3.A. Network Council The Network shall establish and maintain a Network Council that meets the statutory requirements of §1881(c) of the Social Security Act. The Network Council shall:

• Be composed of individuals representing renal dialysis and transplant centers located in the Network service area;

• Be representative of the geographic distribution and types of dialysis facilities and transplant centers in the Network service area;

• Include at least two dialysis and/or transplant patients receiving services in the Network service area who are representative of the geographic and cultural diversity of the communities served by the dialysis and transplant centers in the Network service area.

At minimum, the Network Council shall meet at least once a year in-person, by teleconference or by electronic communication to provide input into the activities of the Network and serve as a liaison between the Network and ESRD providers.

C.3.3.B. Board of Directors The Network shall establish a governing body (BOD) that sets overall policy and direction for the Network and retains oversight responsibility. The BOD must comply with Section H.20 of this contract.

The Network shall:

• Specify the number of members on its governing body (BOD), which shall not exceed 20 members except when appropriate justification is provided to CMS

• Establish the responsibilities of the members of the governing body and delineate these in http://www.ssa.gov/OP_Home/ssact/title11/1126.htm bylaws that are reviewed annually and updated as necessary. These responsibilities shall include, at minimum:

• Attendance and participation with at least two-thirds of members in participation at each meeting;

• Participation in an ongoing training program that addresses ethics, compliance with CMS goals, cultural competence, healthcare disparities,

• Other relevant topics; and participation in one or more subcommittees of the

BOD;

• Establish committees and subcommittees to support the governing body, as deemed necessary by the governing body

• Specify in writing the roles and responsibilities of the governing body and its committees and any subcommittees, including the relationship of the Board with its committees and any subcommittees

• Document committee meetings, decisions, and actions

• Publish on its website information identifying governing body members including those serving on any committees and subcommittees. The published information should include at minimum:

• Number of members

• Length of appointment

• Term limitations

• When appointments are made

• What percentage of governing body, committee, or subcommittee members is typically appointed each year

• Names, affiliations, and compensation (as compensation is permitted) of members.

The membership of the BOD shall consist of ESRD stakeholders from the Network’s service area, including at least two patient representatives. Section 1881(c) (1) (A) (i) of the Social Security Act requires a minimum of at least two consumer representatives on the governing body. The patient members shall be representative of the diversity of the ESRD population in the Network service area including, but not limited to, diversity in treatment modality, race/ethnicity, education, economic status, gender, rural/urban residence, and other relevant factors to the extent possible.

The Network shall adopt policies ensuring the diversity of the non-patient BOD members. To the extent possible, the non-patient members of the BOD shall include representatives from the various healthcare settings relevant to the ESRD population (e.g., Dialysis Facilities, Transplant Centers, Hospitals, and Nursing Homes) and from a range of professional disciplines as well as individuals from diverse racial/ethnic and socioeconomic backgrounds and individuals with non– healthcare backgrounds.

The BOD shall meet as necessary to ensure the successful operation of the Network. At a minimum, the BOD shall meet at least semi-annually in-person, by teleconference or by electronic communication. In addition, the Executive Committee (EC) of the BOD shall meet as necessary to ensure the smooth operation of the activities of the BOD.

At minimum, the BOD or its EC shall:

• Supervise and be responsible for the performance of Network staff in meeting SOW requirements and deliverables and responding to any CMS requests;

• Supervise and be responsible for the financial operation of the Network, including the IQI Program, as detailed in Section C.3.1 of this SOW;

• Review and approve the Annual Report prior to submission to the Contracting Officer’s Representative (COR);

• Approve requests for modifications to the Network's contract that involve requests for additional funding and/or staffing;

• Review and approve any recommendations from the Medical Review Board (MRB) for sanctions to be imposed on ESRD facilities prior to submission to CMS.

C.3.3.C. Medical Review Board

The Network shall establish a committee that meets the statutory requirements of §1881(c) of the Social Security Act to function as the Network's Medical Review Board (MRB). The MRB shall be composed of at least two patient representatives, as well as representatives of the professional disciplines engaged in ESRD care. The professional representatives shall include one or more of each of the following: nephrologists, vascular and transplant surgeons, registered nurses with experience in the care of patients with kidney disease, dietitians, and social workers. MRB members shall be qualified to evaluate the quality and appropriateness of care delivered to patients with ESRD.

The MRB shall meet at least semi-annually. Meetings shall be held in-person, by teleconference or by electronic communication.

The functions of the MRB shall include the following:

• Serving as an advisory panel to the Network on the care and appropriate placement of ESRD patients on dialysis in the Network service area;

• Serving as an advisory panel for all Network QIAs;

• Assisting Network staff in the development, implementation, and evaluation of all

QIAs;

• Working with Network staff to recommend sanctions to CMS for dialysis facilities when the criteria for a sanction recommendation are met.

C.3.3.D. Patient Advisory Council The Network shall establish a Patient Advisory Council (PAC) consisting of at least 15 patients.

PAC members that shall be representative of the diversity of the ESRD population in the Network service area including, but not limited to, diversity in treatment modality, race/ethnicity, gender, education, economic status, rural/urban residence, and other relevant factors to the extent possible. PAC members shall be of at least 18 years of age, and may be any patient, and/or caregiver or family member directly associated with an ESRD patient. The PAC may establish one or more PAC committees and/or subcommittees, with PAC members able to serve on more than one committee or subcommittee. The PAC will meet at least semi-annually and with enough frequency to provide input to fulfill the designated functions of the PAC. The meetings shall be held by teleconference or by electronic communication.

The Network shall annually contact at least 25% of the dialysis facilities within its Network for recommendations or patient volunteers to serve on the PAC. The Network shall provide an annual updated listing of PAC members to the COR by February 1 of each contract period. The functions of the PAC include, but are not limited to:

• Providing input into the development of informational and educational materials for patients and families/caregivers;

• Offering a patient perspective on the selection and development of Network QIAs for which Patient Engagement is required;

• Offering a patient perspective to the Network in interpreting the results of all Network QIAs and the development of interventions.

C.3.3.E. Other Committees and Subcommittees The Network shall establish other committees or subcommittees as appropriate to meet the requirements of the SOW. To the fullest extent possible, the membership of these committees/subcommittees shall represent the diversity of the patient and practitioner community.

C.3.3.F. Network Staff The Network shall employ sufficient staff to perform the work requirements of the SOW. At minimum, the staff shall include:

• Key Personnel: The Executive Director, who is responsible (under the general direction of the BOD) for the overall management, supervision, and coordination of contract requirements, including meeting deliverable due dates. The Executive Director is responsible for the overall operation of the Network, including program development, business and fiscal management, oversight of the IQI Program, staffing (including staff training, hiring, and firing), and liaison with Network committees, CMS, the State Survey Agency(ies) in the Network’s service area, the QIO(s) in the Network’s service area, and other renal-related agencies/organizations.

• Sufficient support staff (including a full-time registered nurse with nephrology experience, a full-time MSW-level Social Worker with Case Review experience, and other personnel with experience in program planning, implementation, data analysis, and evaluation) to conduct the activities and responsibilities in the Network’s contract and in other CMS directives.

The Network shall require all employees to sign CMS-furnished ESRD Network Nondisclosure Statements and maintain a file of all signed forms. A copy of the Network Staffing Plan shall be provided to the COR by COB, February 1st of each contract period.

C.3.4. Communication Requirements The Network shall work with patients and providers in its service area to improve the quality of care and quality of life of ESRD patients by providing informational material and technical assistance on ESRD-related issues. All Network correspondence to patients and to providers for distribution to patients shall be clear, concise, well-organized, and easily understood on the first reading by readers who are literate in English, regardless of functional or health literacy status and professional or academic background. Materials shall be appropriately translated for non- English speakers, as applicable. In addition, all Network correspondence to patients and facilities for distribution to patients shall contain the following language: “To file a grievance please contact [insert Network name] at [insert Network phone number, e-mail address, mailing address, and website URL].”

The Network shall perform the following functions:

• Maintain a national user-friendly, toll-free telephone number: The Network’s toll-free number shall be answered by a staff person during normal working hours. After hours, the system shall allow messages to be left. Systems shall be in place to ensure that a Network staff member can be reached by telephone in the event of an emergency or disaster.

• Maintain a Network website: The Network website must be Section 508 compliant and follow all CMS standards and guidelines. The Network website shall include, at a minimum: a description of the Network grievance processes; a list of the Network’s goals; the Network’s most recent Annual Report; a link to the Dialysis Facility Compare website (http:www.medicare.gov/dialysis); information on all Network committees, including information on how to become a member of each committee; a link to the ESRD QIP site and other specified federal websites as directed by CMS;

and, in the event of an emergency or disaster, the open and closed case status of providers and other information to assist patients and providers.

• Prepare a cover letter for the New ESRD Patient Orientation Package (NEPOP):

Using Network stationary, the Network shall make a letter available for duplication and distribution to new ESRD patients in the Network’s service area. The letter shall be in English and be provided to the ESRD NCC to distribute in the NEPOP, with a copy to the Network's COR when the content is revised or as otherwise directed by CMS. The letter shall:

Explain the role of Network;

Give the Network’s toll free number, mailing address, and website address;

Provide the address(es) and phone number(s) for the State Survey Agency(ies) in the Network’s service area;

Provide information on the functions of State Survey Agencies, including the role of the State Survey Agency in receiving and investigating grievances;

Include information on how to contact the Network in order to file a grievance (phone number, e-mail address, and mailing address).

• Investigate and resolve situations in which NEPOPs are undeliverable: Using an IQI process, the Network shall track the error rate for distribution of the packet on initial mailing, and set an acceptable target for the error rate. The Network shall report on these activities monthly on the COR Monthly Report, and include any activities taken to decrease the undeliverable rate.

• Provide educational information: The Network shall report monthly all education activities and assessments of materials provided on the COR monthly Report. The Network shall provide information on the following:

The educational materials provided during the month of reporting;

How the Network determined that education activities were effective, including the results of that assessment;

What educational materials are planned for the following month:

The process for distributing informational material shall be based on a thorough knowledge of the specific needs of the ESRD patient population in the Network’s service area. The Network shall use an IQI process to determine the need for educational/informational materials for its community, determine the most effective method of distribution for each type of material, and evaluate the overall effectiveness of the materials and the method of distribution.

To the extent possible and practical, the Network shall utilize information that is already available through CMS, other CMS contractors (e.g., other Networks, the ESRD NCC, QIOs), other federal agencies, renal partners (e.g., renal advocacy groups, provider groups, and provider associations), and other sources. As applicable, the Network shall utilize the PAC and Network Council in fulfilling these requirements. Educational/outreach materials must include information on:

The role of the ESRD Network;

The Network’s process for receiving, reporting, resolving, and tracking patient grievances;

The Network’s role in facilitating patient’s access to care;

Treatment options and new ESRD technologies available to patients, with an emphasis on those that have been shown to support patient independence (e.g., transplantation, home therapies, in-center self-care);

Information to educate facilities/patients on the actions to take during emergency and disaster situations;

Information to educate and encourage patients to achieve their maximum level of rehabilitation and to participate in activities that shall improve their quality of life (e.g., vocational rehabilitation programs, volunteerism);

Contact information for state/regional vocational rehabilitation programs available in the Network’s service area;

Information on vascular access procedures;

The Network’s toll-free number, mailing address, and website address;

Information on how to access and use the Dialysis Facility Compare website;

Information on how to interpret a facility’s ESRD QIP Performance Score Certificate;

Information on all Network committees, including information on how to become a member of each committee;

Information on the importance of receiving vaccinations (including HBV, influenza, and pneumococcal vaccinations) and information related to the importance of disease management, the Welcome to Medicare Physical, heart-healthy living, diabetes self-management, and (if requested) smoking cessation;

Information on the benefits of the Medicare Prescription Drug Program (Medicare Part D) how to enroll, and any other guidance or materials related to this program of specific benefit to the individual with ESRD, as directed by CMS.

In all written communications for internal and external audiences, the Network shall comply with the required guidance in Attachment J-2, Style Guide for the ESRD Network Program. The Network’s internal audience consists of Network staff members and members of Network Boards and committees. External audiences include ESRD patients, family members and other caregivers, physicians and other practitioners, dialysis facilities and other providers, Network subcontractors, CMS, other federal and state agencies, and other members of the renal community.

C.3.5. Data Confidentiality and Disclosure The Network shall adhere to the confidentiality and disclosure requirements set forth in the most recent versions of the following:

• Section 1160 of the Social Security Act;

• 42 Code of Federal Regulations (CFR) Part 480;

• 45 CFR Parts 160 and 164, as they pertain to “oversight” agencies;

• Section H of this contract;

• All J Attachments to this contract;

• The QNet System Security Policy Handbook; and

• Other administrative directives.

C.3.6. Information Collection/Survey Activities Unless otherwise specified, a Network seeking to conduct surveys or collect data as a part of any of the activities included in this SOW shall do so only with prior approval of the COR and in accordance with the Paperwork Reduction Act, Attachment J-3 of this contract, and other administrative directives. No funds from this contract shall be used for data collection activities not specified in this contract without prior approval from the COR and in accordance with other CMS administrative guidance.

C.3.7. Reporting to CMS and Others As applicable, the Network shall maintain meeting minutes required for the tasks identified in the SOW and the Schedule of Deliverables (SOD). These minutes shall be available on request by CMS. As specified in this contract and approved by CMS, the Network may conduct data analysis and produce data reports relevant to the local provider community and/or CMS. The Network shall maintain a repository of all data acquired and reports generated.

The Network shall use CMS-approved templates, if provided, for reporting deliverables outlined in the SOD. The Network shall adhere to all requirements in Attachment J-4, Reporting Requirements, to manage and report work performed under this SOW. The Network shall submit the following reports to the COR for approval and a copy simultaneously to the CMS SME .

• Dashboard: The Network shall utilize the CMS approved template and criteria for the Dashboard. The Network shall update the Dashboard with the latest available data by the 15th day of each month. The Network shall not be more than one month behind in reporting information on Network-controlled projects on the CMS Dashboard Input Form (DIF).

• Monthly Progress and Status Report: The Network shall use the CMS-approved template for its monthly reports. The reports shall be submitted three business days prior to the scheduled monthly calls. The reports shall reflect the previous month’s activities and data.

• Annual Report: The Network shall submit an Annual Report of Network Activities during the second quarter of the year for the previous year’s work using the template provided in Attachment J-4, Reporting Requirements. A draft of the Annual Report is due on the 30th calendar day of April and a final version shall be submitted to the COR for approval by the 15th calendar day of June. The Annual Report shall be sent to the ESRD NCC within two weeks of COR approval by the Network. The Network shall post a copy of its report on its website and notify the COR when this is completed.

• Semi-Annual Cost Report: Each semi-annual cost report shall be submitted so they are received by CMS no later than close of business on the 15th working day of February and August after the close of each semi-annual cost…