E.3 - Assumptions.docx
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- Solicitation number
- 260656J
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This is an Assumptions document outlining the anticipated workload projections for the PPI MEDIC contract (75FCMC26R0041) for a 12-month period covering both Base and Option Years. The projections are subject to a variance of +/- 10% due to timing of audits and medical record submissions.
The workload encompasses multiple audit categories: Part C audits include 4 self-audits (exploratory), 4 PI audits, and 22 ad hoc audits; Part D audits include 6 national audits, 6 self-audits, and 4 PI audits. Appeals activities project 57 reconsiderations and 100 CMS support requests in the Base Year, increasing to 115 reconsiderations and 200 support requests in the Option Year. Plan sponsor reporting requirements include 10 total releases and 2 discrete quarterly reports for Part C, and 18 releases with 4 discrete quarterly reports for Part D. Recurring internal reporting consists of ROI reports (4 quarterly), status reports (12 monthly), audit activity and issues logs (quarterly and ongoing), and various other reports. The contractor must conduct 26 biweekly project meetings with CMS, 26 biweekly MEDIC/IMEDIC collaboration calls, 90 virtual and 2 in-person PIDUG meetings, 12 monthly IDR user group meetings, 12 monthly CMS DASG collaboration calls, and 4 quarterly coordination meetings. Additional responsibilities include 1 FWA training presentation, 3 outreach and education missions, 4 conferences, development of Part C and D audit protocols, 2 data analysis projects per program, 250 ad hoc deliverables, 4 model vulnerability feedback items, 15,000 Part D and 200 Part C correspondence items, 4 plan sponsor alerts, 10 RFIs and investigations, 6 OIG recommendation requests, 2 congressional inquiries, and 4 FOIA requests annually.
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Exhibit E.3 - Assumptions 75FCMC26R0041
Assumptions: Workload Projections
For budgeting purposes, the PPI MEDIC workload projections for a 12 month period (Base and Option Year) are as follows. Note: The workload projections are subject to change based on an anticipated variance of +/- 10% for the base and option years due to when audits will start, how many medical records are submitted for audits, etc.
The workload projections for Audits, Recurring/Discrete Reports, Internal Reports, Meetings, and Presentations/Conferences for a 12-month period are as follows:
Audits- Part C
12-Month Period (Base & Option Years)
Self-Audits – Exploratory (to include preliminary data analysis, any data/non-data assignments or meetings related to the audit)
PI Audits (to include preliminary data analysis, any data/non-data assignments or meetings related to the audit) Ad hoc Audits (to include preliminary data analysis, any data/non-data assignments or meetings related to the audit)
| 4 |
| 4 |
| 22* |
Audits-Part D
12-Month Period (Base & Option Year)
| National Audits (to include preliminary data analysis, any data/non-data assignments or meetings related to the audit) |
| Self-Audits (to include preliminary data analysis, any data/non-data assignments or meetings related to the audit) |
| PI Audits (to include preliminary data analysis, any data/non-data assignments or meetings related to the audit) |
| 6 |
| 6 |
| 4 |
Audit- Appeals
12-Month Period (Base)**
| Reconsiderations |
| CMS Support Requests (first, second and third level) |
| 57 |
| 100 |
12-Month Period (Option Year)
| Reconsiderations |
| CMS Support Requests (first, second and third level) |
| 115 |
| 200 |
Recurring/Discrete Reports for Plan Sponsor Release -Part C
12-Month Period (Base & Option Year)
| Total Releases |
| Quarterly (separate reports) |
| Discrete |
| 10 |
| 2 |
| 2 |
Recurring/Discrete Reports for Plan Sponsor Release -Part D
12-Month Period (Base & Option Year)
| Releases |
| Quarterly (separate reports) |
| Discrete |
| 18 |
| 4 |
| 2 |
Recurring Internal Reports
12-Month Period (Base & Option Year)
| ROI Reports |
| Status Report |
| Audit Activity Project Management |
| Audit Issues Logs |
| Self-Assessment Report |
| Workload and Costs Reports |
| Medicare Prescription Payment Plan (M3P) Report |
| 4 (Quarterly) |
| 12 (Monthly) |
| 1 |
| 4 (Quarterly) |
| 1 (Annual) |
| 12 (Monthly) |
| 1 (One time report, may repeat at CMS discretion) |
Meetings (All meetings are anticipated to be 60 minutes in duration and take place virtually unless indicated differently below)
12-Month Period (Base & Option Year)
| Project Contractor Meeting with CMS |
| PAR |
| Ad-Hoc (as needed) |
| PPI MEDIC/ IMEDIC Collaboration |
| PIDUG (PI Data User Group) |
| IDR (Integrated Data Repository) User Group |
| CMS DASG (Division of Analytics and Systems Group), PIMASC and PPI MEDIC Collaboration Calls |
| 26 (Biweekly) |
| 26 (Biweekly) |
| 90 Virtual; 2 In-person |
| 12 (Monthly) |
| 12 (Monthly) |
| 12 (Monthly) |
| 4 (Quarterly) |
Presentations/Conferences (assume travel is required for all)
12-Month Period (Base & Option Year)
| Fraud Waste and Abuse (FWA) Parts C & D Training |
| Outreach and Education Missions |
| Conferences Outside of CMS Hosted Events (may include, but not limited to: PIAM, NHCAA and Durable Medical Equipment (DME) Coordination Meeting (DCM)) |
| 1 |
| 3 |
| 4 |
Additional workload projections for other PPI MEDIC activities for a 12-month period are noted in the following table:
Audit Protocols (to include protocols for each type of audit conducted under the program)
12-Month Period (Base & Option Year)
1 Part C Audit Protocol 1 Part D Audit Protocol
Data Analysis Project – PAR Projects
12-Month Period (Base & Option Year)
2 Part C PAR Projects 2 Part D PAR Projects
Ad Hoc Deliverables as Requested by CMS (Data and non-data analysis including but not limited to: special studies, UAT testing, SWIFT Requests, ligation holds, and HPMS memos outside of audits)
12-Month Period (Base & Option Year)
Model Development (Feedback on AICE-FWA models)
12-Month Period (Base & Option Year)
Vulnerabilities
12-Month Period (Base & Option Year)
Part D Correspondence Mailbox
12-Month Period (Base & Option Year)
15,000
Part C Correspondence Mailbox
12-Month Period (Base & Option Year)
Plan Sponsor Alerts
12-Month Period (Base & Option Year)
RFIs, investigations, complaints, and referrals
12-Month Period (Base & Option Year)
OIG Recommendation Requests***
12-Month Period (Base & Option Year)
Congressional Inquiries
12-Month Period (Base & Option Year)
FOIA Requests
12-Month Period (Base & Option Year)
* 20 of the 22 audits require no data analysis but will include follow-up and communications with plan sponsors.
**Once CMS has approved the contractor to proceed, the appeal reconsiderations and support requests would not begin until January 1, 2027.
***Many OIG recommendations are included in audits and reports.
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