Final RFP Questions and Responses (JA RFP 75FCMC23R0013) .xlsx

A. Section B-K

B. Section L-M

Applicable Thresholds Following receipt of proposals, CMS will consider executing a D&F to exclude a specific source (or sources) only if CMS determines that awarding the DME MAC Jurisdiction A contract to the specific source (or sources) would exceed the following Applicable Threshold:

• The award will result in a single contractor (single corporate entity) obtaining more than 2 DME MAC prime contracts.

In comparing the “single corporate entity” definition to how that language was used in the A/B MAC procurements we note the recent A/B MAC RFP, Jurisdiction N in Section M.9 (c) states:

Applicable Thresholds Following receipt of proposals, CMS will consider executing a D&F to exclude a specific source (or sources) only if CMS determines that awarding the A/B MAC Jurisdiction N contract to the specific source (or sources) would exceed one or both of the following Applicable Thresholds:

The award will result in a single contractor (single corporate entity) obtaining more than 26% of the national A/B Medicare workload in A/B MAC prime contracts; or, The award will result in any one set of affiliates obtaining more than 40% of the national A/B Medicare workload in A/B MAC prime contracts.

This reading of the 26% limit as a “single corporate entity” intentionally doesn’t include affiliates because there is a second rule concerning the 40% that addresses affiliated entities.

We understand that it is CMS’s intent to prohibit the award of all four DME MAC contracts to affiliates, as defined in section 2.101 of the Federal Acquisition Regulations, because the affiliated organizations would be under the common control of a third party. This would create unacceptable risks to the Medicare program should a significant issue arise with the parent organization that would require the termination of the affiliates’ MAC DME contracts. However, the proposed clause in Section M.9(c) of the draft JA MAC RFP is ambiguous and can be read to permit the award of all DME MAC contracts to affiliated entities that are under the common control of a third-party. We believe that this ambiguity creates an undue risk of protest. More importantly, the proposed language could result in DME MAC contract awards to affiliated entities that would create unacceptable risks for CMS.

B.8 Draft RFP

J.35 CLIN 0002

J.36 CLIN 0003 L.15.2 122 Attachments J.35 and J.36 include a reference to SLIN 000XAE for IVIG Demo which is expected to end on 12/31/23. Will the IVIG Demo continue in the next contract? CMS confirms the cost templates are updated to remove IVIG Demonstration.

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C. Section J.1 SOW

Specific to the ITMRA - This is an agency applicable requirement. What, if any, controls are intended to be the responsibility of the contractor? CMS confirms the Information Technology Management Reform Act of 1996 (ITMRA) is focused on budgeting for system investments and spending, system development risks, and the naming of agency IT management. Regarding system security controls, the MACs need to be compliant with FISMA requirements which are implemented via the Acceptable Risk Safeguards. Both regulations and other items listed in this section are provided as key examples of federal requirements and regulations that can flow down and effect Agency contractors.

C.7 J.01 SOW C.3.1 41 Will the model language be provided by the CO in the solicitation or contract for the IT Procurements, as required in the tool? CMS is directing Offerors to SOW section C.3, RFP Attachment J.01.H and the CMS Business Partner System Security Manual (BPSSM) for IT guidance and for the model language and classification addressed in SOW references (NIST) Special Publication (SP) 800-60, Volume II: Appendices to Guide for Mapping Types of Information and Information Systems to Security Categories along with FIPS 199. Both provide a model for risk ranking data that will be used within this contract.

C.8 J.01 SOW C.3.1.e.iii 44 "Protected in accordance with NIST SP 800-53, Security and Privacy Controls for Information Systems and Organizations applicable baseline if handled by a Contractor system operated on behalf of the agency, or NIST SP 800-171, Protecting Controlled Unclassified Information in Nonfederal Information Systems and Organizations if handled by internal Contractor system; and"

Will subcontractor systems utilized then be required to meet NIST SP 800-171 rather than the MAC ARS? CMS confirms all MACs will have to comply with Controlled Unclassified Information (CUI) requirements at some point in the future. The Department of Health and Human Services (HHS) is in the process of finalizing policy that will then need to be tailored by CMS’s Office of Strategic Operations and Regulatory Affairs (OSORA). Until then, MACs are not required to take any steps to implement CUI and shall not include costs to implement CUI in proposals. CMS will issue a change request (CR) to formalize the requirements for the MACs in the future, after award of this contract.

C.9 J.01 SOW C.3.1.l 45 "Contractor Non-Disclosure Agreement (NDA). Each Contractor (and/or any subcontractor) employee having access to non-public government information under this contract must complete the CMS non-disclosure agreement. Contractors (and/or subcontractors) must submit a copy of each signed and witnessed NDA to the Contracting Officer (CO) and/or CO Representative (COR) prior to performing any work under this acquisition."

C.14 J.01 SOW D.1.1.1 93 Can CMS provide the volume of CEDI support questions that will be directed to the DME MAC versus DME Enrollment contractor? Is this volume already included in the J23B? CMS confirms call volumes in J.23.B include all calls, including any that may be referred by the CEDI contractor. The JA DME MAC and CEDI contractors will sign a Joint Operating Agreement (JOA).

C.15 J.01 SOW D.1.1.2 93 Can CMS please provide the volume breakdown of paper vs. Electronic claims, as well as the average page count per claim? CMS is providing the estimated volume breakdown of paper and electronic claims for each period of perofrmance (POP) in the Government Provided Proposal Assumptions document, Attachment J.23. CMS is not providing an average page count as the page count for each claim varies by type and complexity of the DME item or service, the documentation required to support the medical necessity and coverage criteria, and the format of the claim submission. Offerors are encouraged to document the assumptions used in their proposal to estimate claims page counts for evaluators to consider during proposal review.

C.16 J.01 SOW D.1.2.6.1 97 Can CMS please provide the average volume of claims that require development by the Contractor? CMS confirms that the Investigated claims workload volumes provided in the Basis of Estimate, Attachment J.22, are claims that require development by the MAC.

C.17 J.01 SOW D.2.1.2 108 "Contractors shall process and mail all redeterminations within 60 calendar days of the date the Contractor receives a timely filed request for redetermination. When a party submits additional evidence after filing the request for redetermination, the Contractor’s 60 day decision-making time frame is extended by 14 calendar days for each submission. The decision making timeframe is also extended if the Contractor grants an appellant’s request for an extension of the 120 day filing deadline in accordance with 42 CFR 405.942(b). The 60 day decision making timeframe begins on the date the contractor receives the late-filed request for redetermination, or when the request for an extension is granted, whichever is later"

How many appeals are sent electronically, via fax, and/or on paper? CMS confirms that Offerors are instructed to use their business judgment to determine the proposal breakdown values for paper vs. electronic appeals receipts and further the receipt methods, e.g. fax, etc. Offerors shall describe their methodology for the breakout for appeals receipts within their proposal and document their forcasting method for evaluators to consider during proposal review.

C.20 J.01 SOW E.4.8 142-143 Section E.4.8 of the SOW states, "at a minimum, one DME MAC Medical Director (DMD) shall be present at each of these meetings." Does CMS expect one DMD from any of the DME MACs to be present, or does CMS require one DMD from each MAC to be present? CMS confirms that the SOW does not require one DMD from each of the DME MACs to attend DME Coordination Meetings (DCMs). However, common practice is that all DMDs do participate/attend in support of SOW section B.11.

C.21 J.01 SOW F.2.11 157 What is the anticipated volume per option year? CMS confirms the DMEPOS Competitive Bidding Implementation Contractor (CBIC) activity is in a temporary gap period, the CBIC will not refer any cases or requests to any of the DME MACs at this time and for the foreseeable future. For proposal puroses, Offerors shall assume no workload associated with this SOW requirement. Future CBIC-related direction and activity will be provided to MACs via Change Requests (CRs).

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D. Sections J.1-J.11

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E. Section J.22 BOE

E.4.7.5 - Prepay Provider-Specific MR Number of Claims Reviewed workload NA - line number 109 (not page number) The J.22 Basis of Estimate document provides a 6,312-review workload associated with WBS E.4.7.5. However, MACs are precluded from performing the reviews for E.4.7.5 per CR 10249 Targeted Probe and Educate which explicitly states MACs shall replace this review with TPE (E.4.7.7). Based on our understanding of the workload and the SOW definitions, we believe the 6,312-workload should be allocated to E.4.7.7 Prepay Provider Specific Probe Medical Record Review instead of E.4.7.5.

Would CMS please confirm the workload should be allocated to the E.4.7.7 WBS instead of the E.4.7.5 WBS? CMS confirms that the Basis of Estimate (BOE), Attachment J.22 is updated. The SOW WBS for Prepay Provider Specific Provide Medical Record Review is updated to E.4.7.7.

E.2 J.22 Basis of Estimate Spreadsheet line number 92, BOE line-item number 83

Number of Overpayment recoupment actions received from the UPIC NA - line number 92 The J.22 Basis of Estimate document provides a 100-unit workload for Number of Overpayment Recoupment Actions Received from the UPIC under the E.2 WBS falling under the SOW Program Integrity UPIC Support Services definition. However, the staff supporting this effort allocate similar efforts to Overpayment Recoupment Actions under the C.5.4.1 WBS.

Would CMS please confirm which WBS the Number of Overpayment recoupment actions received from the UPIC workload should be allocated? CMS confirms that the BOE, Attachment J.22, is updated, the correct SOW WBS for reporting the Number of Overpayment Recoupment Actions Received from the UPIC is C.5.4.1.

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F. Section J.23 GPPA

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G. Section J.23.A-J.32

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H. Section J.33-J.49

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I. Cost Realism

J. Other TBD

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