FINAL RFP Questions and Responses (JF RFP 75FCMC24R0002).pdf

Document Section Page # Question CMS Answer/Action

DRAFT RFP H.20, 1.6a 58,59,73

Background:

• H.20, Page 58 – Store any Information/Data (includes “Cloud” computing services)…

• H.20, Page 58, 59 – Federal Risk and Authorization Management Program (FedRAMP)…

• 1.6.a, Page 73 – Information technology, as defined in 40 U.S.C. 11101, including cloud computing services of all types…

Question:

There are three references to Cloud Computing in the RFP. Will the use of the FedRAMP-compliant Cloud resource be permitted in the execution of this contract?

CMS confirms the language in section H.20 is security language that is also in the MAC A/B and DME Statements of Work (SOWs) and the I.6 reference from the Federal Acquisition Regulation (FAR). Both references are included in this RFP in the event that a MAC wants to use a cloud environment. Direction to MAC contractors, provided in the Internet Only Manual (IOM) 100-17, directs that MACs shall formally notify CMS of their desire to use a cloud environment and CMS will review and evaluate the proposed cloud based solution.

DRAFT RFP G.5 18

We understand we need to submit our subcontracting plan information in the SBCX portal prior to submission of our proposal. Will CMS open SBCX portal upon release of the final

RFP?

CMS confirms that SBCX portal will be opened upon release of the final Request for Proposal (RFP) and will be available to Offerors well in advance of the proposal submission deadline.

07/30/2024 Jurisdiction F

DRAFT RFP L 130

The RFP references a pre-COVID 5 year lifecycle. Can CMS provide clarification on the specific dates requested?

CMS is seeking a description of each Offeror's proposed approach to the revalidation workload of the jurisdiction and further short and long term concerns that may potentially impact your approach to revalidation. There are no specific dates requested, unless dates are an integral part of an Offeror's proposal. Per CFR424.515, to maintain Medicare billing privileges, a provider or supplier (other than a DMEPOS supplier) must resubmit and recertify the accuracy of its enrollment information every 5 years.

DRAFT RFP L.14.3.1 #3.c 125

The RFP states that offerors are to identify the "..proposed operational sites for the contract, inclusive of the work/SOW function to be performed at each location and total FTEs at each site for all CLINs of Base Year and Option Year 1."

Can the Government confirm that the offeror is NOT required to disclose the location of every employee that is a remote employee?

CMS confirms that section L.14.3.1 #3.c is specifically intended to request the locations of operational sites for the proposed contract, the operations/SOW functions performed and/or managed from those various sites and the total FTE/staff that will be located at each site.

For proposal purposes, this specific section is not asking for Offerors to disclose the location of every remote employee.

DRAFT RFP

L.11 Submission, Delivery, Organization and General

Instructions

The solicitation states: Proposal Graphics shall be no smaller than 10-point Arial, single-line spacing, and no compression. Instructions below direct the page limits for Volume II and Volume III. The sections that have a page limit are so noted. Volume I, Volume IV, Volume V and Volume VI do not have page limits. Pages that exceed the required page limitations may not be evaluated. Each page shall be counted except for the following:

Volume Cover pages Summary Section Dividers Blank Pages

The solicitation dictates the summary section is not included in the page count but does not specify the summary section requirements or a location for its inclusion. Will CMS please provide requirements for the contents of the summary section and the desired location of its inclusion in the proposal response?

CMS confirms section L.11 has been updated to remove summary section from the list of items excluded from page count.

B. Section L-M 2

DRAFT RFP

L.12.3 Tab C, Completed SF 33, Solicitation, Offer and Award

The RFP states: The SF 33 and all applicable SF 30 solicitation amendments must be signed by an official authorized to bind the Offeror and be included in the Offeror’s Volume I response.

The SF 33 is not included in the draft solicitation. Please confirm this will be added as part of the final solicitation.

CMS confirms the SF33 and SF30 applicable to this solicitation must be signed by an official authorized to bind the Offeror.

DRAFT RFP

L.14.3.3 VOLUME III, Tab

E, Operations, Proposal Instructions

129-130

The RFP states: If applicable, the Offeror shall describe its proposed innovative methods, emerging technologies or operational enhancements that are worthy of note and that exceed the SOW requirements for this solicitation for the mission essential functions listed above or for any other SOW area. Describe how each proposed innovative method, emerging technology or operational enhancement affects the mission essential function(s) and/or other SOW area and why it represents added value to the Government. Include all costs (in Volume IV) for development and operations of the proposed innovative methods, emerging technologies or operational enhancements that will be incurred during the contract.

Please confirm cost figures are to be included in the Volume IV Business Proposal and referenced in the Volume III Written Technical Proposal. Additionally, would CMS please provide instruction on where costs specific to proposed innovative methods, emerging technologies or operational enhancements should be located in the Volume IV Business Proposal?

CMS confirms all proposal costs shall be documented in cost templates as directed throughout the RFP and specifically in section L.15 and provided in proposal Volume IV.

Cost Templates are to be complete and inclusive of your proposal for the full width and breadth of the JF MAC SOW and extensive ancillary direction in IOMs, etc. Offerors shall include in the cost templates costs/impact specific to proposed innovative methods, emerging technologies or operational enhancements. Further, as directed and described throughout section L.14, Offerors shall document their Technical Approach in Volume III and may use this section to explain and describe any aspects of proposed innovative methods, emerging technologies or operational enhancements included in the business proposal that you want to emphasize or explain to evaluators. Offerors may also utilize Volume II, Assumptions section to document aspects of their proposed innovative methods, emerging technologies or operational enhancements also.

B. Section L-M 3

DRAFT RFP

L.11 SUBMISSION,

DELIVERY,

ORGANIZATION AND

GENERAL

INSTRUCTIONS, f.

Page Size, Typing, Spacing, and Page

Numbering

Please clarify whether restrictions apply to page orientation, and if so, whether a landscape-oriented page would be considered 1 or 2 pages as the term "foldover" would not apply to a response submitted electronically.

CMS confirms all L.11.f direction including a requirement to use portrait orientation and further that "foldouts” count as two pages.

DRAFT RFP

M.3 Technical Evaluation Factors (Non-Cost/Price

Factors)

There are references to L.14.3.5 for AbilityOne, but no corresponding section exists with this number. Please confirm this reference should be L.14.5.

CMS confirms the RFP is updated and both the reference to L.14.5 and L.14.4 are updated is section M.3.

DRAFT RFP L.11.a. 108

"The Offeror shall submit one copy of its entire proposal, including signed annual reports, corporate policies and organizational charts, in Adobe Acrobat PDF format." Please confirm that the PDF format requirement is for proposal narratives and other documents named here, but the cost spreadsheets should be submitted as Microsoft Excel workbooks and do not need to be submitted in PDF format.

CMS confirms direction in section L.11.a., Offerors shall submit the entire proposal in Adobe Acrobat PDF, including the cost templates. Offerors are directed to the same section for additional direction for second copies of several documents in other formats, including cost templates.

DRAFT RFP

end of Section M; h. Workload Table

The Estimated Solicitation Release Date Range for at least the next several jurisdictions (J8, JH, J5) does not appear to be consistent with recent solicitation release dates provided by CMS. Can CMS please confirm this Workload table contains the most up-to-date solicitation release dates?

CMS confirms the dates in the table in section M.9.h are the current estimated dates for future solicitations.

B. Section L-M 4

J.01 DRAFT Statement of Work (SOW)

C.7.29 178-179

Regarding the Medicare Essential Hospital Payment Program (MEHPP), the SOW indicates the payments for Regional Preferred Provider Organization’s (RPPO) claims is not to be commingled with the fee for service payments. Will there be a separate HIGLAS org established for this account to handle the fund disbursement, overpayments, and the corresponding financial reporting?

CMS confirms there will not be a separate HIGLAS org for fund disbursement. Rather there will be an account, specific to Essential Hospitals, for funds disbursement and the corresponding financial reporting. For proposal purposes, Offerors shall assume that any needed processes exist, are current and in a usable format and will be made available during the Implementation Period. CMS anticipates that the overall impact to the procurement is likely to be very small.

C. Section J.1 SOW 5

J.03 HHS DRAFT

Subcontracting Plan

Template 2a-2h 2,3,4

Attachment J.03 HHS Subcontracting Plan Template outlines options for the allocation of funds for Base Year through Option Period 4. Would CMS Please confirm we should also be including Implementation, Closeout Period and Option Period 5-6? Additionally, would CMS please confirm any changes to Attachment J.03 HHS Subcontracting Plan Template will be reflected in the SBCX portal?

CMS confirms the Final RFP will provide the updated Subcontracting Plan template which will be in the SBCX portal.

J.03 HHS DRAFT

Subcontracting Plan

Template 2a-2h 2,3,4

The right-side columns of Attachment J.03 HHS Subcontracting Plan Template state "If required by CO". Would CMS please confirm these columns are to be completed for this procurement?

CMS confirms the CO will not require these columns to be completed for this procurement. The CO will be requiring the completion of these columns for all individual plans only.

J.03 HHS DRAFT

Subcontracting Plan

Template

Subcontract Plan Requirements

Attachment J.03 HHS Subcontracting Plan Template does not align with the updated solicitation requirements. The solicitation requirements establish a percentage of TCV for Small Business Goals but it appears the template is calculating the goals based on percentage of subcontracting dollars. Will CMS please provide an updated template to accurately reflect the requirements of the solicitation?

The Offeror will be evaluated on meeting or exceeding a Small Business usage of 5% of the total contract value. Out of the 5% of total contract value for Small Business goals, Section L.12.6 provides the minimum recommended breakdown of each individual Small Business component.

See revised RFP section L.12.6 that reflects current HHS Small Business Subcontract Goals.

D. Sections J.1-J.11 6

J.22 DRAFT Basis of Estimate

N/A N/A

Background: There are several instances in which the CLIN Pricing Schedules (e.g., J.36) requires staffing estimates at a lower level SOW than is requested in the BOE (i.e., J.22). For example, CLIN Pricing Schedules (e.g., J.36) requires staffing estimates for C.5.12.1.2 Medical Review Data: Edit Effectiveness; however, C.5.12.1.2 does not exist in the BOE (Attach. J.22). The BOE (Attach. J.22) requests staffing estimates for C.5.12.1.6 and C.5.12, but not C.5.12.1.2.

The instructions in RFP Attach. J.22 Section II.B (i.e., SOW/TD WBS Code) seem to indicate that offerors should only update the pre-populated SOW numbers in the BOE on an exception basis.

Question: Can the Government clarify if offerors are allowed to change the pre-populated SOW numbers in the BOE to provide staffing estimates at the same SOW level as required in the CLIN Pricing Schedules? OR Should offerors include these staffing estimates in the higher-level SOW that is pre-populated in the BOE (e.g., include the C.5.12.1.2 staffing estimates in the BOE line for C.5.1.12)?

CMS confirms section L.13.2 information and direction acknowledging that the BOE intentionally does not include all workloads. Offerors are instructed to use their business judgement to determine workloads/level of effort for the SOW/WBS workloads not provided in the BOE and document the forecasting logic. This section is also clear that Offerors are prohbited from changing workloads in the BOE with the exception of the three workloads noted in section L.13.2. The BOE Instructions Attachment, J.22.C, directs Offerors may change the WBS only as necessary to accurately reflect where it has charged costs for a given workload in its historic baseline contract. If the Offeror proposes a change to the SOW WBS code for a given workload compared to where it has charged costs in its historic baseline contract, it shall describe this change in Column S of the BOE for the affected row(s). CMS also confirms the direction in section L.15 that speaks to the requirement that the cost templates document the entire width and breadth of the Offerors proposal - ultimately this will be more than what is the BOE.

J.22 DRAFT Basis of Estimate

N/A N/A

Background: There are several instances in which the CLIN Pricing Schedules (e.g., J.36) requires staffing estimates at a lower level SOW than is requested in the BOE (i.e., J.22).

Question: Are offerors allowed to add lines to the BOE to provide staffing estimates at the same SOW level as required in the CLIN Pricing Schedules? OR Should offerors include these staffing estimates in the higher-level SOW that is listed in the BOE (e.g., include the C.5.12.1.2 staffing estimates in the BOE line for C.5.1.12)?

CMS confirms that Offerors shall include staffing estimates in the higher-level WBS that is listed in the BOE.

J.22 DRAFT Basis of Estimate

N/A N/A

Background: There are several instances in which the BOE (i.e., J.22) requires a staffing estimate for both Part A and Part B workloads in the same BOE Line Item. However, the CLIN Pricing Schedules (e.g., J.36) requires separate staffing estimates for Part A and Part B. For example, the BOE request a staffing estimate for both Part A and Part B Complex Beneficiary Inquiry Responses (i.e., SOW C.5.4.5.3). In this example, the BOE only provide a combined Part A and Part B workload volume.

However, the CLIN Pricing Schedules (e.g., J.36) requires separate staffing estimates for Part A and Part B.

Questions: Should offerors add lines to the BOE to provide staffing estimates for Part A and Part B separately, as required in the CLIN Pricing Schedules? If so, how would the Government like offerors to split the RFP workload between Part A and Part B?

If offerors are NOT to provide separate staffing estimates for Part A and Part B; how should offerors split their staffing estimates between Part A and Part B in the CLIN Pricing Schedules (e.g., J.36)?

CMS confirms that Offerors shall document their BOE to relay the specific information requested on each line. Additional information and clarification can be provided in the BOE or in the Technical Proposal volume. Offerors shall also accurately complete the cost templates. These documents (BOE, Technical Proposal and Busines Proposal) must not be in conflict but the information requested in each is not exactly the same. Offerors have flexibility to determine and document any unique proposal supportive information to provide clarity to evaluators.

E. Section J.22 BOE 7

J.22 DRAFT Basis of Estimate

N/A N/A

Background: Per RFP Attach. J.23 - GPAA, the Part A cutover is 4 months after contract award. Accordingly, most of the Part A RFP workload volumes in Base Year are 68% (i.e., 8 months / 12 months) of the RFP workload volumes for Option Year 1.

However, the following Base Year workload volumes in the BOE (J.22) are less than 68% of the Option Year 1 RFP workload volumes:

- C.5.12.2.21 Medical Review OPD PA Requests (BY workload volumes are 50% of Option Year 1 workload volumes).

Question: Can CMS confirm that the 50% BY workload volume is correct or if 68% of the workload volume should be used?

CMS confirms the BOE is updated for C.5.12.2.21 Part A Medical Review of OPD PA workloads for the Base Year.

J.22 DRAFT Basis of Estimate

N/A N/A

Background: Per RFP Attach. J.23 - GPAA, the Part A cutover is 4 months after contract award. Accordingly, most of the Part A RFP workload volumes in Base Year are 68% (i.e., 8 months / 12 months) of the RFP workload volumes for Option Year 1.

However, the following Base Year workload volumes in the BOE (J.22) are more than 68% of the Option Year 1 RFP workload volumes:

- C.5.5.2 Changes of Information and SHOWS [855A] - Paper - Returns (BY workload volumes is 80% of the OY1 workload volumes)

- C.5.11.3.2.9 S-10 Audits (BY workload volumes are 100% of the OY 1 workload volumes)

Question: Can CMS confirm that the BY workload volumes in the BOE are correct or if 68% of the workload volume should be used?

CMS confirms that rows for C.5.5.2 Changes of Information and CHOWS [855A] and C.5.11.3.2.9 S-10 Audits workloads for Base Year are updated in the BOE, Attachment J.22.

Further, the S-10 Audits workloads are updated for every Period of Performance (POP) in the

BOE.

J.22 DRAFT Basis of Estimate

N/A N/A

Background: Per RFP Attach. J.23 - GPAA, the Part B cutover is 6 months after contract award. Accordingly, most of the Part 6 RFP workload volumes in Base Year are 50% (i.e., 6 months / 12 months) of the RFP workload volumes for Option Year 1.

However, the following Base Year workload volumes in the BOE (J.22) are 100% of the Option Year 1 RFP workload volumes:

- C.5.12.2.22 PA RSNAT - Requests Reviews that Resulted in a Decision

- C.5.12.2.22 PA RSNAT - Outreach and Education to Ambulance Suppliers

- C.5.12.2.22 PA RSNAT - Educational Events (Webinars/Videos/Teleconferences/etc.)

Question: Can CMS confirm that the BY workload volumes in the BOE are correct or if 50% of the workload volume should be used?

CMS confirms that C.5.12.2.22 PA RSNAT workloads for the Base Year are updated.

J.22 DRAFT BOE

Instructions

I. 5

Can the Government confirm if offerors should include labor categories that are not impacted by workload volumes on the BOE row where Column I is marked as "Labor Mix" OR is it appropriate for offerors to include these non-workload driven positions in the BOE line of a higher level SOW where Column I is marked as "Total FTE’s”?

For Example: The Provider Enrollment workloads categories for SOW C.5.5.1.1 – C.5.5.2 are marked as “Labor Mix.” If certain direct labor categories support these SOWs but their staffing is not driven by workload volumes, would it be appropriate to include the staffing estimates associated with these support positions in BOE C.5.5, which does not require estimates by Labor Category?

CMS confirms that Offerors may include all FTEs, workload driven or not, at the C.5.5.1.1 and C.5.5.2 levels.

E. Section J.22 BOE 8

J.22 DRAFT Basis of Estimate

Spreadsheet Line 264; BOE Number 255

NA

We have reviewed the J.22 BOE related to medical review volumes in conjunction with instructions provided in J.23 GPPA, number 23. While we understand the workload volume is reflective of several types of workload, the workload in the J.22 BOE indicates the work is allocated to WBS C.5.12.2.5. However, per CR 10249 Targeted Probe and Educate, MACs shall replace this review with TPE review under WBS C.5.12.2.7.

Will CMS please confirm bidders are to use their judgment related to allocation of workload across WBS? Or would CMS prefer to issue clarification to assist all bidders in allocating workload to the right WBS?

CMS confirms the medical review volumes in the BOE. Further, Offerors shall document the BOE clearly to provide their proposal for completing the workloads in the BOE and an accurate historical baseline for this workload. Offerors shall follow BOE instructions and further have the ability to document any unique proposal aspects and to provide clarity to evaluators in the BOE and/or in the technical proposal/Volume III.

J.22 DRAFT Basis of Estimate

Spreadsheet Line 336; BOE Number 327

NA

We have reviewed the J.22 BOE related to medical review volumes in conjunction with instructions provided in J.23 GPPA, number 23. While we understand the workload volume is reflective of several types of workload, the workload in the J.22 BOE indicates the work is allocated to WBS C.5.12.2.5. However, per CR 10249 Targeted Probe and Educate, MACs shall replace this review with TPE review under WBS C.5.12.2.7.

Will CMS please confirm bidders are to use their judgment related to allocation of workload across WBS? Or would CMS prefer to issue clarification to assist all bidders in allocating workload to the right WBS?”

This question and item above can be combined, the only difference is the lines of the BOE, Part A vs. Part B.

CMS confirms the medical review volumes in the BOE. Further, Offerors shall document the BOE clearly to provide their proposal for completing the workloads in the BOE and an accurate historical baseline for this workload. Offerors shall follow BOE instructions and further have the ability to document any unique proposal aspects and to provide clarity to evaluators in the BOE and/or in the technical proposal/Volume III.

E. Section J.22 BOE 9

J.22 DRAFT Basis of Estimate

SOW C.7.24 Lines 481 and 482; BOE Number 472 and

N/A

We note historical MPPARD workload volumes are provided via J.23 GPPA. However, we see these workloads are not included in the J.22 BOE. Would CMS consider adding workloads for this category to the J.22 BOE document to encourage all bidders to bid to the same workload?

CMS confirms the MPPARD workloads are in the GPPA intentionally and not in the BOE. All Offerors shall propose to the MPPARD workloads provided in the GPPA.

J.22 DRAFT Basis of Estimate

N/A N/A

We note the bankruptcy workload described in Section C.5.11.8 of the SOW does not have a corresponding section in the BOE.

Please confirm bidders are responsible for calculating the bankruptcy workload based on their past experience, and not that the workload should be excluded from the BOE.

CMS confirms the BOE intentionally does not include a workload for SOW section C.5.11.8 of the SOW. Offerors are instructed to use their business judgement to determine workloads/level of effort for the SOW/WBS workloads not provided in the BOE and further to document the forecasting logic as necessary. CMS also confirms the direction in section L.15 that requires that cost templates document the entire width and breadth of the Offerors' proposals.

J.22 DRAFT Basis of Estimate

N/A N/A

We note that J.22 BOE does not include a line or workload to address C.5.6.8 Incentive Payments. Would CMS please confirm whether bidders are instructed to add this to the BOE, using bidders’ experience to estimate the workload? Or, would CMS prefer to issue an updated J.22 BOE providing clearer instructions and enabling bidders to propose solutions using a common set of workload assumptions?

CMS confirms the BOE intentionally does not include a workload for SOW section C.5.8.6 (C.5.6.8 is incorrect) of the SOW. Offerors are instructed to use their business judgement to determine workloads/level of effort for the SOW/WBS workloads not provided in the BOE and further to document the forecasting logic as necessary. CMS also confirms the direction in section L.15 that requires that cost templates document the entire width and breadth of the Offerors' proposals.

J.23.A DRAFT Audit & Reimbursement Tables and

J.22 Basis of Estimate

(BOE)

Table 20 on both Estimated Annual workload tabs.

n/a

In both tabs (Estimated Annual Workload OY1-OY3 and Estimated Annual Workload OY4-OY6) the workload for S10 is listed as 37 full units and 130 limited units with a total S10 reviews of 167. The table then states total S10 audits of 334. This appears to be a duplicate of the workload. Please advise which number is correct. Also note that depending on which number is correct, the J.22 BOE needs to be corrected to reflect this change.

CMS confirms that both the Estimated Annual Workload OY1-OY3 and Estimated Annual Workload OY4-OY6 tabs in the Audit and Reimbursement Tables, Attachment, J.23.A, are updated. Further, S-10 Audits (C.5.11.3.2.9) workloads are updated for every Period of Performance (POP) in the BOE.

J.22 DRAFT Basis of Estimate 04152024

Line 228 and 234 All Years

These are workloads related to Voluntary Refunds. Should the SOW code be reflected as C.5.11.7.1 as stated in the SOW instead of C.5.11.5?

CMS confirms the BOE WBS for Voluntary Refunds. The BOE Instructions Attachment, J.22.C, directs Offerors may change the WBS only as necessary to accurately reflect where it has charged costs for a given workload in its historic baseline contract. If the Offeror proposes a change to the SOW WBS code for a given workload compared to where it has charged costs in its historic baseline contract, it shall describe this change in Column S of the BOE for the affected row(s).

E. Section J.22 BOE 10

J.22 DRAFT Basis of Estimate 04152024

Line 96 and 97 All Years

There appears to be an ODC line missing between Lines 96 and 97 for LCDs Part B ODC, Indirect, Overhead, and G&A FTEs.

Should there be a Part B ODC line between lines 96 and 97, similar to the Part A ODC line that appears in line 95?

CMS confirms the BOE is updated to add the missing lines for LCDs.

J.22 DRAFT Basis of Estimate 04152024

Line 334 All Years

The SOW code listed is for C.5.12.2.20, however the workload is for Data Requests. Should the SOW code be C.5.12.2.14? CMS confirms the BOE is updated to correct the Part B Data Requests' WBS.

J.22 DRAFT Basis of Estimate 04152024 compared to the J.23 Audit and Reimbursement Tables

J.22 Line 210 vs J.23.A Table 20

For OY1 the total S-10 Audits in the J.22 shows 334. However when looking at the Audit and Reimbursment tables there are Full S-10 Reviews: 37, and Limited S-10 reviews: 130; for a Total of 167 reviews. But then there is a 2nd Total S-10 audit line where it appears it is doubling the 167 review total to 334. Is the total of 334 correct or should it be 167 total S-10 audits in J.22 and J.23.A?

CMS confirms that both the Estimated Annual Workload tabs, OY1-OY3 and OY4-OY6 are updated. Further, S-10 Audits (C.5.11.3.2.9) workloads are updated for every Period of Performance (POP) in the BOE.

E. Section J.22 BOE 11

J.23 DRAFT Government Provided Proposal

Assumptions (GPPA)

#14 Participation in Conferences

The Government Provided Proposal Assumptions (GPPA) instructs offerors to participate in various conferences in accordance with C.5.4.7. However, the BOE (J.22) does not require a staffing estimate for SOW C.5.4.7. The BOE does request staffing estimates for C.5.4 Administrative Requirements. Should offerors add lines to the BOE to provide staffing estimates for C.5.4.7 OR should offerors includes these staffing estimates in the higher level SOW (.e.g. C.5.4) that is listed in the BOE?

CMS confirms that staffing for C.5.4.7 can be included at the C.5.4 level in the BOE. Staffing and associated costs for C.5.4.7 should be provided at the C.5.4.7 level in the cost templates.

J.23 DRAFT Government Provided Proposal

Assumptions (GPPA)

#17 PARTICIPATING

PHYSICIANS PART B

WORKLOADS

Background: The Government Provided Proposal Assumptions (GPPA) (RFP Attach.

J.23) states that the contractor "...will be responsible for Participating Physicians Part B activities/workloads during the BY (i.e., Offerors will disregard the timeline in item #2 above for this one purpose only)."

Question: Can the Government clarify if this assumption impacts the staffing estimates associated with a specific workload volume in the BOE (J.22) and/or a specific SOW in the CLIN Pricing Schedules (e.g., J.36)?

NOTE: In the BOE (J.22), most of the Base Year Part B RFP workload volumes are 50% of the Option Year 1 RFP workload volumes, which is consistent with the timeline provided in J.23 GPPA #2.

CMS confirms this assumption is provided specific to proposal development. Offerors' shall include all aspects of the Participating Physicians Part B activities/workloads for every period of performance, beginning with the BY. This assumption may impact completion of the BOE.

CMS also confirms the direction in section L.15 that speaks to the requirement that the cost templates document the entire width and breadth of the Offerors proposal.

J.23 DRAFT Government Provided Proposal

Assumptions (GPPA) 5 5 & 6

Background: The J.23 Gov. provided assumptions (RFP Attach. J.23) states that the Government provided hour estimate per desk review (Tables 11 & 12) and per audit (Table 13) will be used to evaluate proposals for these workloads. Further, J.23 states that offers that propose to adjust the CMS-estimated hours for these workloads must explain why the adjustment is reasonable.

Question: To be consistent with other workloads in the BOE, does CMS consider it reasonable for offerors to propose their historical productivities as a basis for adjusting the CMS-estimates hours for these workloads? If historical productivities are used, does CMS still intend to evaluate based on the CMS-established hours for these workloads?

CMS confirms evaluators will consider all information included in the proposal including explanations/support of any adjustment to CMS-establsihed hours for the Table 11, Table 12 and Table 13 workloads.

F. Section J.23 GPPA 12

J.23 DRAFT Government Provided Proposal

Assumptions (GPPA) and J.22 Basis of Estimate

(BOE) and J23.A Audit & Reimbursement Tables

32. Medicare Cost Report Workload Initiative and BOE

OY4-OY6

The GPPA indicates that the workload for Full Desk Reviews, Limited Desk Reviews and Cost Report Settlements were increased in Base Year and Option Year 1-3 to account for direction provided in CR 13489 and that Option Year 4-6 provides the typical anticipated workloads on the BOE, Attachment J.22. Please note that the J23.A Audit & Reimbursement Tables tab EstimatedAnnualWorkload_OY1-OY3 (table 16) matches the volumes in the J.22 BOE (row 209) but the volumes for Cost Report Settlements in the J23.A Audit & Reimbursement Tables tab EstimatedAnnualWorkload_OY4-OY6 (Table 16) and the J.22 BOE (row 209) do not match. Table 16 has 2,044 and the row 209 has 1,711. Please advise which number is correct.

CMS confirms that Option Years 4, 5, and 6 in the BOE, Attachedment J.22, are updated for Cost Reports Settlements workload.

J.23 DRAFT Government Provided Proposal

Assumptions (GPPA) 27 13

Please confirm that claims processing for ENVIRONMENTAL HEALTH HAZARDS PILOT PROJECT (SOW C.7.24) is performed within JF FISS and MCS systems.

CMS confirms that all claims for the the Environmental Health Hazards Pilot Project, in the SOW as Medicare Pilot Project for Asbestos Related Disease (MPPARD) (C.7.24), are submitted via paper claims with suporting documentation and most are beneficiary submitted claims. The claims are generally not entered into FISS or MCS and no additional coordination with other isurers occurs. MSNs are manually created. As noted in the GPPA, for proposal purposes Offerors shall assume a process exists to price and pay claims and all information will be shared during the Implementation Period.

J.23.A. DRAFT Audit & reimbursement Tables

Table 20 - S-10 Audits EstimatedAnnualWor kload_OY1-OY3

Estimated Annual Workload for S-10 Audits, (Limited, line 323, and Full, line 322 on the EstimatedAnnualWorkload_OY1-OY3 tab) total 167 units. However, the total S-10 Audits is reflected as 334, which appears to be doubled. Would CMS please confirm the total S-10 audits should be 167 unit?

CMS confirms that both the Estimated Annual Workload tabs, OY1-OY3 and OY4-OY6 are updated. Further, S-10 Audits (C.5.11.3.2.9) workloads are updated for every Period of Performance (POP) in the BOE.

J.23 DRAFT Government Provided Proposal

Assumptions (GPPA) 04052024

28, Table 34 14 of 15

Table 34 lists the Total Claims Processed for the Medicare Essential Hospital Payment Program. Can CMS confirm that this is an annual workload volume for proposal purposes?

CMS confirms the workload volume provided in the Table 34 is an annual value. The GPPA label is updated to reflect that detail.

F. Section J.23 GPPA 13

J.23.A DRAFT Audit & Reimbursement Tables

Estimated Annual Workload tabs, Tables 11, 12 and 24

Historically, the Independent ESRD Facility count in the Full Desk Review workload assumption equaled the BBA 1/3 Audits under ESRD Special Audits. In the JF J.23.A document, the amounts are not equal. Also, there are 315 Independent ESRD facilities noted on the "Facilities by Type" tab, so 1/3 of that would be 105. The ESRD Special Audit count in Table 24 is 283. Will CMS provide clarification on the difference in workload counts?

CMS confirms both the Audit and Reimbursement Tables, Attachment J.23.A and the BOE, Attachment J.22 have been updated, to correct the ESRD Special Audit workload numbers and the Full Desk Review total workload numbers.

F. Section J.23 GPPA 14

J.32 DRAFT Systems of Record

Entire Document (1 page) 1

Attachment J.05 Government Systems Provided for Use outlines additional systems, including HIGLAS, STAR, PS&R, and others, which are not included in Attachment J.32 Systems of Record. Would CMS please confirm the systems in Attachment J.32 should include all others mentioned in Attachment J.05?

CMS confirms the accuracy of both the J.05 and the J.32, the J.05 includes more systems than those officially labeled as Systems of Record by the Federal Government.

G. Section J.23.A-J.32 15