Amendment_0003_final.docx

HHSM-500-2014-RFP-QIN-QIO

Amendment 0003 Responses to Solicitation Questions and Solicitation Amendments

1. Under SECTION B – SUPPLIES OR SERVICES AND PRICES/COSTS, the following change shall be made:

a. Under Subsection B.3 QIN-QIO CONTRACT LIMITATIONS, the following changes shall be made:

i. The first sentence in this section is REVISED so that the requirement for the governing body to be less than twenty (20) percent affiliated with a health care facility, applies only to Prime offerors, and not subcontractors. The first sentence in this section is REVISED to read as follows:

“The QIN-QIO Award Limitations are listed below. These contract limitations (with the exception of item e) also include any subcontracting arrangements or corporate affiliates (as defined in H.3.C.4).”

ii. Paragraph e. is REVISED to read as follows, in order to DELETE the words “only if” from line 3, so the paragraph reads more clearly:

“e. An entity shall not be considered to be affiliated with a health care facility by reason of management, ownership, or common control if the management, ownership, or common control consists of not more than twenty (20) percent of the members of the governing board of the entity being affiliated (through management, ownership, or common control) with one or more of such entities.”

iii. Paragraph f is ADDED to read as follows:

“f. Overall, the task order awards in total under any QIN-QIO IDIQ, may not cover more than 25% (or some range) of the Medicare Beneficiary population.”

iv. The limitations table is REVISED to ADD “IEC” under the Contract Limitations table for the VIQRC: Appeals contract.

v. The words “or subcontractor” are DELETED from the first paragraph after the limitations table on page 12 of the RFP. This paragraph is REVISED to read as follows:

“CMS shall not enter into a contract under this part with any entity (Prime) which is, or is affiliated with (through management, ownership, or common control), a health care facility, within the area served by such entity or which would be served by such entity if it entered into a contract with the CMS under this part.”

b. Under Subsection B.4 TYPE OF CONTRACT, the following changes shall be made:

i. The second paragraph is REVISED to incorporate language to clarify the type of supporting documentation required to prove the adequacy of an offeror’s accounting system. Paragraph two is REVISED to read as follows:

“NOTE: Please be advised that if the Offeror does not have an accounting system that is adequate for determining costs applicable to the contract (FAR 16.301-3) and for accumulating and segregating costs under a Cost Reimbursement (CR) contract (as evidenced by a Contracting Officer determination from any agency or Government audit report), it will not be eligible to receive CR Task Orders. Therefore, no CR Task Orders will be awarded pending approval of accounting system(s).”

2. Under SECTION C – DESCRIPTION/SPECIFICATIONS/WORK STATEMENT, the following changes shall be made:

a. Subsection C.3.2.1 HARDWARE/SOFTWARE is amended to incorporate a listing of CMS provided equipment and additional language. This section is DELETED and REPLACED in its entirety with the following:

C.3.2.1 HARDWARE/SOFTWARE

CMS, either directly or through a CMS contractor, shall provide each QIN-QIO with a file/print server, a domain controller, a database server, network/telecomm equipment, and a workstation and/or laptop for each 0.5 or greater full-time-equivalent (FTE) employee at award of contract to cover their base needs. The servers, workstations, and laptops shall be equipped with a standard operating system and a software suite following the approved CMS Federal Desktop Core Configuration (FDCC) standard which is also referred to as the United States Government Configuration Baseline (USGCB). Please refer to attachment J.16 (HCQIS QIO Basic IT Procurement List) as it provides a standard list of basic IT HW/SW and the associated pricing that is used within the HCQIS environment. Please note that this listing in not an all-inclusive list and should be used to identify basic IT needs and current associated costs for a startup office. The list and pricing identified should be used for budgeting purposes only as they are subject to change. All HW/SW required will be procured via the HCQIS Remedy Purchase System/Engineering Review Board (ERB) process which is used to help track and maintain all Government Furnished Equipment (GFE). The amount of hardware & software provided will be dependent on the agreement between CMS and the contractor based on the work identified. Any additional resources required including, but not limited to, printers, faxes, etc. the contractor will be responsible for funding the procurement of the equipment.

The contractor must receive approval from their CMS Contracting Officer Representative (COR) prior to submitting a purchase request via the HCQIS procurement process, currently identified as the Remedy Purchase Request/Engineering Review Board (ERB) to be procured. No additional hardware peripherals or non-approved software may be connected or installed to any GFE or on the QualityNet infrastructure without prior written approval by CMS. If there are items that are not listed in Section J, Attachment J.16 in which the contractor would like to use in support of their contract, a request will have to be submitted thru their CMS COR to begin the approval process.

The contractor shall update Remedy inventory for all procured GFE and maintain the necessary documentation such as HHS-565 and HHS-22’s located in the Remedy Purchase System to ensure proper asset management and tracking of all GFE.

Below is a listing of what equipment CMS will provide to the contractor’s CORE primary location of operations at the start of the contract.

Example of CMS provided equipment to the contractor

Item

Number based on initial award needs

The contractor is responsible for covering the cost for any additional hardware/software out of their contract funds. This means that the contractor is responsible for bidding back, within their proposal, the expected costs for non-inclusive HW/SW items. If the contractor requires additional hardware and/or software outside of the CMS provided equipment in the base award listed above for its core site of operations, the contractor must receive approval from its COR and then submit a request via the HCQIS procurement process, currently identified as the Remedy Purchase Request/Engineering Review Board (ERB) to be procured. Within the Remedy system, there is an inventory of approved HW/SW that can be procured. Any items outside of the approved listing will need to be submitted through the approval process before procuring and using within QualityNet. These items include, but are not limited to, printers, fax machines, software outside the standard issue, etc. Please refer to the following table “Examples of non-provided IT items” that the contractor will be responsible for funding and the estimated current cost for each. Note that this list is not all-inclusive so any specific HW/SW needs to support this contract award will need to be budgeted for within your contract. No additional hardware peripherals or non-approved software may be connected or installed to any Government Furnished Equipment (GFE) without prior written approval by CMS. If there are items that are not listed below in which the contractor would like to use in support of their QIN-QIO contract, a request will have to be submitted thru their COR to begin the approval process. No equipment, such as non-CMS approved equipment or corporate equipment, shall be connected to the HCQIS environment unless specifically approved by CMS.

Example of non-provided IT items

The following chart below provides examples of non-provided IT items or equivalent the contractors would need to include in their proposal.

b. Subsection C.4.5 COORDINATION WITH STAKEHOLDERS OUTSIDE THE QIO PROGRAM, is DELTED and REPLACED in its entirety with the following, in order to remove the requirement for advanced CO approval of stakeholders and to correct the reporting requirements.

C.4.5. COORDINATION WITH STAKEHOLDERS OUTSIDE THE QIO PROGRAM:

The QIN-QIO must coordinate certain of its activities with those of stakeholder organizations in its service area that are working on comparable efforts or interested in teaming with the QIN-QIO. Stakeholders are government entities and private organizations that have common goals with those of the QIN-QIO program to work on measures/interventions related to healthcare quality.

Coordination with stakeholders may involve creating, joining, and/or supporting partnerships with organizations with similar goals and objectives, or facilitating ongoing discussion among the various stakeholders. The nature of the activity to coordinate must be consistent with the terms of the contract to avoid any perceived or actual conflicts of interests and requires notification to the COR on the QIN-QIO contract. If there are any potential conflicts of interest (either perceived or actual) regarding a particular stakeholder, it shall be reviewed by the contractor’s Compliance Officer in accordance with H.21. At a minimum, the QIN-QIO must participate annually in collaborative activities that are sponsored by the applicable CMS Regional Office and focus on CMS-identified priority initiatives. Subsequently, the QIN-QIO will assist in the facilitation and dissemination of information about the Regional Office collaborative activities related to the SOW within the QIN-QIO’s performance area or region. Other activities for which the QIN-QIO wishes to facilitate collaboration must be approved by the CO with notification to the COR and be related to the SOW.

The QIN-QIO shall work together with stakeholders to identify and mitigate any duplication of effort identified in their geographic area. This activity shall be reported in the QIO’s Monthly COR report (See Attachment J.1(a) A.1.7.a Reporting Requirements).

In particular, the QIN-QIO shall partner with other CMS contractors in the Medicare program (such as the Medicare Administrative Contractors (MACs)) and collaborate with them on information and education materials regarding QIO Program initiatives. The MACs may use the information and materials as they provide customer service and education to beneficiaries, providers/physicians/suppliers in the QIN-QIO area.

c. Subsection C.4.6 COMMUNICATIONS, is DELETED and REPLACED in its entirety with the following, in order to restructure the section, and incorporate Subsections:

C.4.6. COMMUNICATIONS

This section pertains to the general requirements and policies surrounding the applicability of federal and agency policies to QIN-QIO communication. More specific information about the ways QIOs conduct communications in accordance with the tasks of this contract is provided in Section C.6. 1.2.

The QIO is required to engage in education, outreach and communication activities to inform Medicare beneficiaries and providers about the purpose of the QIO program, beneficiary rights under Medicare and how such rights may be exercised, and to otherwise meet the requirements of Sections 1154(a)(9)(B) and 1156(c) of the Act.

The QIN-QIO shall manage its resources as efficiently and effectively as possible. In this regard, CMS recognizes three major sources from which the QIO can obtain marketing materials and resources: (1) other CMS contractors; (2) the ESRD Networks; and (3) other external sources that provide non-copyrighted materials and resources. In addition, the QIN-QIO may develop its own communications materials.

At any time, a COR/GTL may request a copy of any piece of material used to communicate internally or externally about any provision under this SOW and its Task Orders. When such a request is made, the QIO shall furnish the item within 5 business days of the request. (When a request for hard-copy items is made, the mailing shall be postmarked within 5 business days of the request.) QIOs shall not submit unsolicited materials to the COR/GTL; however, the QIO is encouraged to share communications materials and best practices with other QIOs per Section C.4.6.3 of this SOW.

C.4.6.1 APPLICABILITY OF COMMUNICATIONS POLICIES TO QIN-QIO ACTIVITIES

For communications activities, the QIO shall adhere to the requirements delineated in Chapter 12 of the QIO Manual as well as the most recent version of the QIO Communications Handbook, provided for reference at Section J, Attachment J.7, as well as the QIO Program Brand Guidelines Manual (Section J, Attachment J.7(a)). The most recent version of either the Handbook or the Guidelines Manual shall be applicable, based on the date a communique was or will be disseminated.

All material, regardless of format, must follow the Department of Justice’s “Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition against National Origin Discrimination Affecting Limited English Proficient Persons,” promulgated on June 12, 2002. HHS offers further guidance on adhering to these standards on its website at http://www.hhs.gov/ocr/civilrights/resources/laws/revisedlep.html. Following these requirements ensures that the QIN-QIO is meeting the communications needs of individuals who do not speak English as their primary language (that is, are limited English proficient) or who are deaf or hard of hearing. The communication product must be developed using plain language that is easily understood by persons with a range of educational backgrounds.

C.4.6.2 SPECIFIC REQUIREMENTS FOR COMMUNICATING ELECTRONICALLY

In addition to these general requirements for communication activities by the QIN-QIO, the QIN-QIO must comply with the following standards in connection with any material communicated electronically.

1) Follow the CMS Contractor Website Guidelines as specified in, http://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/Section508/index.html. The QIN-QIO shall refer to this website at least every 90 days for the current standards and guidelines.

2) Follow the accessibility requirements of Section 504 and 508 of the Rehabilitation Act of 1973.

3) Follow the Department of Justice guidance titled, “Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition against National Origin Discrimination Affecting Limited English Proficient Persons,” promulgated on June 12, 2002.

4) Adhere to the following HHS guidelines: (1) Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons, promulgated on August 4, 2003 http://www.hhs.gov/ocr/civilrights/resources/laws/revisedlep.html; (2) Language Access Plan, released in February 2013 http://ohr.dc.gov/release/languageaccess2012/english; and (3) National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the National CLAS Standards), updated in April 2013 https://www.thinkculturalhealth.hhs.gov/Content/clas.asp.

5) Only use electronic materials for informational purposes and not for any application (software) design/usage unless approved in writing by CMS ISSO;

6) Follow branding guidelines as enumerated in the QIO Program Brand Guidelines Manual, based upon the most recent revision date at the time of web posting.

All electronic materials produced, including text, audio or video must conform to applicable Section 508 standards to allow persons with disabilities to access information. That information and its availability shall be comparable to that provided to persons without disabilities.

All contractors (including subcontractors) or consultants responsible for preparing or posting content must comply with applicable Section 508 accessibility standards, and where applicable, those set forth in the referenced policy or standards documents (above/below). Remediation of any materials that do not comply with the applicable provisions of 36 CFR Part 1194 as incorporated into this SOW, shall be the responsibility of the contractor or consultant. The following Section 508 provisions apply to the content or communications material identified in this SOW:

C.4.6.3 SHARING COMMUNICATIONS MATERIALS WITH OTHER QIOs:

The QIN-QIO shall periodically make available to other QIOs via the HealthCareCommunities.org portal (or other tool in accordance with Section C.4.8 of this SOW): (1) new materials developed by the QIN-QIO and approved in writing by CMS for distribution; and (2) substantial adaptations by the QIN-QIO of materials developed by CMS or contractors of CMS which have been approved in writing by CMS after the revision and prior to distribution. This requirement does not compel the QIN-QIO to share every piece of communication; however, the QIN-QIO shall select materials for peer sharing that demonstrate a particularly successful effort or that yields a lesson-learned for sharing with the QIN-QIO community at large.

C.4.6.4 PUBLICATION MATERIAL REQUIRING CMS APPROVAL:

Note that some communication materials require CMS approval before being published. The QIN-QIO shall adhere to review requirements outlined in the QIO Manual and the QIO Communications Handbook with regard to media activities and/or materials supporting high-profile events and national initiatives. Once a submitted document has been approved by the CMS communications lead identified in the contract, the QIN-QIO shall provide a copy of the final version to the COR and CMS communications lead in a file format specified by CMS to the COR.

C.4.6.5 MEASURING COMMUNICATION EFFECTIVENESS:

To the maximum extent practicable, the QIN-QIO shall measure and evaluate the effectiveness of its communications and outreach work. That is, the QIN-QIO shall use systematic, communications-industry-standard methods to assess how well communications activities meet their intended objectives and how these communications objectives ultimately help the QIN-QIO meet its contractual objectives. CMS will not assess QIN-QIO performance on the success or failure of particular communications tactics; however, the QIN-QIO shall ensure that it uses the information gathered from communications evaluates to determine whether certain communications techniques are effective and worth repeating or sharing with other QIOs.

The QIN-QIO shall not use contract resources to repeat communications activities/tactics/techniques that the QIN-QIO finds unsuccessful, unless the QIN-QIO tweaks its approach for communications through a “test of change” as part of the Plan-Do-Study-Act cycle. (That is, the QIN-QIO shall not repeat its known mistakes and errors; rather, the QIN-QIO shall learn from mistakes and errors and change its approaches to avoid them in the future.)

d. Subsection C.4.7 EMERGENCY PREPAREDNESS, is REVISED to DELETE the last two bullet items in this section that read as follows:

· How the QIN-QIO shall receive referrals from CMS, MACs, providers/practitioners, or beneficiaries if the COOP Plan or CP Plan is activated.

· How the QIN-QIO plans to include subcontracts with another BFCC-QIO in order to maintain continuity of reviews and appeals during emergency situations, if the QIN-QIO so chooses.

e. Under Subsection C.6.1.2 QIN-QIO INTEGRATED COMMUNICATIONS PLAN, the first sentence that reads, “For communication activities, the QIN-QIO shall adhere to the requirements delineated in Chapter 12 of the QIO Manual and the QIO Communications Handbook.” is hereby DELETED.

f. Under Subsection C.6.1.2.1 BUILDING AND MAINTAINING PROGRAM AWARENESS, this section is DELETED and REPLACED in its entirety in order to remove some language and incorporate new language:

C.6.1.2.1. BUILDING AND MAINTAINING PROGRAM AWARENESS

The QIO’s communication plan shall articulate how the QIN-QIO will use a variety of communications tools and tactics to spread information about the QIO’s work within its service area. Some of the particular tools, tactics and requirements to which QIOs must adhere are outlined below.

The QIN-QIO shall serve as a resource for providers, practitioners, beneficiaries and other public stakeholders for communiqués, tools and materials that drive health improvement efforts such as templates, checklists, LISTSERV blasts, change packages (see Section J, Attachment Section J, Attachment J.8, Glossary of Terms and Acronyms), vignettes/success stories, and health interventions. The QIN-QIO shall curate, evaluate, and disseminate pre-existing items whenever possible and develop and disseminate new items as needed.

For paper and hard-copy materials, the QIN-QIO shall follow all applicable policies and requirements outlined in Section C.4.6 of this SOW.

The QIO’s focus on building and maintaining program awareness shall include special emphasis with respect to beneficiary support systems. These are the family members, caregivers, advocates, or representatives involved in critical decisions and management of the health and/or overall living of older independent beneficiaries. Outreach initiatives shall consider that such family members, caregivers, advocates, or representatives may not be Medicare eligible and are unaware of QIOs, Medicare policies, benefits, and patient support programs. In order for beneficiary families and representatives to be successful advocates to the patient, they must be equipped with the knowledge and tools to assist in beneficiary support and care. Providers and practitioners should be encouraged to implement strategies and processes to effectively engage the beneficiary support system as part of their standard practice with older beneficiaries. The beneficiary’s support system may be the provider/practitioner’s primary resource to ensure that medication and other medical instruction to the beneficiary are consistently followed.

Raising program awareness is the first step to maintaining program awareness. Assumptions cannot be made on the awareness, level of knowledge, or the ability to use the knowledge and support programs of Medicare by beneficiaries, their support systems, providers, and practitioners. The circumstances affecting awareness must be addressed at all levels. Effective dissemination of information on QIN-QIO existence and work to the communities, providers and practitioners within the QIO’s service area is the foundation to effecting widespread change in the healthcare system by involving all responsible parties.

g. Under Subsection C.6.1.2.2 WEB PRESENCE, this section is DELETED and REPLACED in its entirety in order to remove some language and incorporate new language:

C.6.1.2.2. WEB PRESENCE

The QIN-QIO’s communication plan shall include a website. The QIN-QIO shall create a new website or maintain an existing website(s) on which communications pursuant to the QIO's Medicare contract activities appear. The QIN-QIO shall adhere to the requirements for electronic communications articulated in C.4.6 of this SOW, as well as the following elements in presenting its Medicare contract-related communications on its QIN-QIO website(s):

a. Only use the website for informational purposes and not include any application design usage unless approved in writing by CMS Information System Security Officer (ISSO).

b. Use a single web domain for its corporate and its QIN-QIO web presence, or bifurcate these presences into separate websites (with different web domains). If a QIN-QIO chooses to house its QIN-QIO web presence on its corporate website, the QIN-QIO shall compartmentalize its presence so that users of the website clearly understand which pieces of the website are applicable to the QIN-QIO contract (and thus funded by QIN-QIO dollars).

c. At a minimum, include the following on the website(s):

1) Provide a means for the website to be continually informed by audience analysis and situational analysis performed as part of the QIN-QIO’s strategic plan.

2) Host content syndicated from a centralized CMS QIO Program web presence, as required by guidance from CMS and its coordinating center contractors.

3) Include Really Simple Syndication (RSS) feeds (or other applicable technologies, per the COR’s discretion) that alert web users to recent updates from the QIO, including RSS feeds as applicable from CMS’ own website, Medicare.gov, and other partner websites.

4) Conform to QIO national program branding guidelines as articulated by CMS and its national coordinating center contractors (e.g., QIN NCC).

5) Promote national-level QIO program communications vehicles consistent with guidance from CMS and its coordinating center contractors (e.g., newsletters, advertisements for nationally available conferences and learning opportunities).

6) Post matters of national importance as directed by CMS or the Department of Health and Human Services.

h. Under Subsection C.6.3.1 DESIGNATION OF KEY PERSONNEL, this section is DELETED and REPLACED in its entirety with the following in order to clarify the key personnel at the IDIQ and State Task Order level:

C.6.3.1. DESIGNATION OF KEY PERSONNEL

Certain positions may be designated as “Key Personnel”, within the meaning of Health and Human Services Acquisition Regulation 352.270-5. For the overall contract and each Task Order/Task, unless otherwise specified, the following position(s) are determined as Key Personnel:

· IDIQ Director – Required for the overall contract

· QIN-QIO State Program Director – Required for each State Task Order awarded the overall contract (1 FTE with 100% commitment)

i. Under Subsection C.6.3.2 KEY PERSONNEL QUALIFICATIONS, this section is DELETED and REPLACED in its entirety with the following in order to clarify the requirements of the key personnel identified in Subsection C.6.3.1.:

C.6.3.2. KEY PERSONNEL QUALIFICATIONS

1. IDIQ Director

0. Proven ability to manage the contract at a strategic level including managing and navigating internal and external customer relationships.

0. Demonstrated experience with having authority and accountability for meeting all contract deliverables and requirements within budget and the use of appropriate tools to track project deliverables such as project plans, and timelines.

0. Demonstrated experience and skills in excellent oral and written communication spanning executives to the general public.

0. Proven skill and experience in innovative continuous learning approaches to drive delivery system transformation.

0. Proven skill and experience in innovative continuous learning approaches to drive delivery system transformation.

1. QIN-QIO State Program Director (Minimum Recommended Requirements)

1. Demonstrated experience in healthcare QI tools that lead to large scale change and improvement including healthcare QI processes to reduce waste and promote value in healthcare expenditures.

1. Proven ability to manage the contract at a strategic level including managing and navigating internal and external customer relationships.

1. Demonstrated experience with having authority and accountability for meeting all contract deliverables and requirements within budget and the use of appropriate tools to track project deliverables such as project plans, and timelines.

1. Demonstrated experience in project management that includes strategic planning, risk management, change management, data analyses, project management techniques and tools, defining project tasks and resource requirements, assembling and coordinating project staff, managing resource allocation, providing direction and support to a project team, coordination, implementation, execution, control and successful completion of projects.

1. Demonstrated experience in the implementation and management of project changes, interventions to achieve project outputs, constant monitoring and report of project progress, and development of constructive reports defining project progress, problems and solutions.

1. Demonstrated experience and skills in excellent oral and written communication spanning executives to the general public.

1. Proven skill and experience in innovative continuous learning approaches to drive delivery system transformation.

1. Demonstrated experience in performance measures, quality assurance, project evaluations, and analysis of results.

j. Under Subsection C.6.3.3 OTHER RECOMMENDED PERSONNEL, the language in section a. Task Lead that reads, “(One FTE per Task with 100% commitment)” is hereby DELETED.

k. Under Subsection C.6.4.1 TASK ORDER WORK PLAN, the reference in paragraph c.3 to “marketing strategy” is DELETED and REPLACED with “integrated communication plan”.

l. Under Subsection C.6.4.8 MEASUREMENT AND INTERVENTIONS, paragraph c is REVISED as follows to incorporate “stakeholders”:

c. Improvement in the coordination of health prevention efforts and managing population health such as by using immunization information systems as well as the meaningful use of health information technology in collaboration with stakeholders (e.g., Regional Health Extension centers (RECs)) and supporting physician and other clinician practices that are attempting to improve care and outcomes for their population of patients);

3. Under SECTION G – CONTRACT ADMINISTRATION DATA, the following changes shall be made:

a. Under Subsection G.3 TASK ORDER PROPOSALS, DELETE the reference to “computer time” in section G.3.a. Business Proposal. In section G.3.a.1. Direct Labor, DELETE the reference to “each month”, and DELETE the final sentence that reads “Time and Material proposals shall apply the fully burdened labor rates as applicable.”

b. Under Subsection G.10 GOVERNMENT TASK LEADER (GTL), the Subsection is DELTED in its entirety and replaced with the following, in order to remove item number 1 from the responsibilities, and edit item number 2:

G.10 GOVERNMENT TASK LEADER (GTL)

A. Designation

The GTLs will be determined at the task order level.

B. Government Task Leader Responsibilities

1. The GTL will be the person representing CMS for the purpose of providing program content and clarification.

2. It is the responsibility of the GTL to participate with the COR in monitoring the contractor's progress against the QIN-QIO’s contract management plan.

3. It is the responsibility of the GTL to provide information to the Contractor which assists in the interpretation of the work and services to be furnished within their task area.

4. The GTL may provide advice and consultation on a Contractor’s implementation of the Statement of Work and deliverables and services to be furnished under the provisions of the contract. The GTL, however, may not provide technical direction to the Contractor as distinguished from advice and consultation in Section G.9.

5. Any and all advice and consultation must be within the general scope of the contract. The GTL does not have the authority to and shall not issue any advice which:

· constitutes an assignment of additional work outside the scope of the contract;

· constitutes a change as defined in the contract clause at FAR 52.243-2, Alt I or FAR 52.243-1;

· in any manner, causes an increase or decrease in the total estimated contract cost; and,

· changes any of the expressed terms, conditions, or specifications of the contract.

c. Under Subsection G.12 CONTRACTING OFFICER RESPONSIBILITY, REVISE the reference from “FAR 52.202-1 Definitions (JAN 2012)” to “FAR 52.202-1 Definitions (NOV 2013)”.

d. Under Subsection G.28 FOOD COSTS, DELETE and REPLACE in its entirety with the following in order to revise the dates of recent memorandums:

G.28 FOOD COSTS

On January 3, 2012, Health and Human Services (HHS) issued a follow-up memorandum to Operating Division Heads articulating the Department’s policy on the purchase of food with appropriated funds. The general principle stated in the memoranda of June 17, 2007, July 26, 2005 and October 12, 2004 remains unchanged; that is, food cannot be purchased with appropriated funds.

For the purposes of this contract, Food Expense either incurred as a direct or indirect expense will be considered an unallowable cost.

Note: This contract clause does not pertain to the meals portion of allowable costs incurred as a part of the per diem expense allowed under the Federal Travel Regulations (FTRs). However, Contractor employees must remove the cost of the meal(s) from their allowable per diem reimbursement when attending a conference where meals are included in the cost of the conference.

e. Under Subsection G.30 DATA DE-IDENTIFICATION PROCESS, DELETE and REPLACE in its entirety with the following, in order to DELETE items 2 and 3, and to DELETE the language, “of receipt of payment by the HCQIS Contractor” from item 4, and DELETE the language, “when the HCQIS Contractor provides the QIN-QIO with the budget.” from item 5:

G.30 DATA DE-IDENTIFICATION PROCESS

A. The HCQIS Contractor shall be responsible for de-identifying, duplicating and maintaining duplicate data requests received from QIN-QIOs on behalf of entities engaging in Data Use Agreements with the QIN-QIOs.

B. For all data requests under this contract and task orders, the QIN-QIO shall follow the procedures identified below:

1. The QIN-QIO shall submit a written request for de-identified data to the HCQIS Help Desk.

2. Within ten (10) working days the data de-identification request shall be completed and returned to the QIN-QIO for distribution to the requesting entity.

3. In the event that the size of the data request is too large to be completed within the above timeframe, the HCQIS Contractor will notify the QIN-QIO. The HCQIS Contractor and the QIN-QIO shall reach agreement on a reasonable timeframe for processing the data request.

f. Under Subsection G.33 SECURITY CLAUSE – BACKGROUND INVESTIGATIONS FOR CONTRACTOR PERSONNEL, DELETE and REPLACE in its entirety with the following, in order to incorporate the correct clause, and to identify the reference for sensitivity level as “Moderate Risk”:

G.33 SECURITY CLAUSE – BACKGROUND INVESTIGATIONS FOR CONTRACTOR PERSONNEL

If applicable, Contractor personnel performing services for CMS under this contract, task order or delivery order shall be required to undergo a background investigation. CMS will initiate and pay for any required background investigation(s).

After contract award, the CMS Project Officer (PO) and the Security and Emergency Management Group (SEMG), with the assistance of the Contractor, shall perform a position-sensitivity analysis based on the duties contractor personnel shall perform on the contract, task order or delivery order. The results of the position-sensitivity analysis will determine first, whether the provisions of this clause are applicable to the contract and second, if applicable, determine each position’s sensitivity level (i.e., high risk, moderate risk or low risk) and dictate the appropriate level of background investigation to be processed. Investigative packages may contain the following forms:

1. SF-85, Questionnaire for Non-Sensitive Positions, 09/1995

1. SF-85P, Questionnaire for Public Trust Positions, 09/1995

1. OF-612, Optional Application for Federal Employment, 12/2002

1. OF-306, Declaration for Federal Employment, 10/2011

1. Credit Report Release Form

1. FD-258, Fingerprint Card, 12/2007, and

1. CMS-730A, Request for Physical Access to CMS Facilities (NON-CMS ONLY), 11/2003.

The Contractor personnel shall be required to undergo a background investigation commensurate with one of these position-sensitivity levels:

1) High Risk (Level 6) Public Trust positions that would have a potential for exceptionally serious impact on the integrity and efficiency of the service. This would include computer security of a major automated information system (AIS). This includes positions in which the incumbent’s actions or inaction could diminish public confidence in the integrity, efficiency, or effectiveness of assigned government activities, whether or not actual damage occurs, particularly if duties are especially critical to the agency or program mission with a broad scope of responsibility and authority.

Major responsibilities that would require this level include:

1. development and administration of CMS computer security programs, including direction and control of risk analysis and/or threat assessment;

1. significant involvement in mission-critical systems;

1. preparation or approval of data for input into a system which does not necessarily involve personal access to the system but with relatively high risk of causing grave damage or realizing significant personal gain;

1. other responsibilities that involve relatively high risk of causing damage or realizing personal gain;

1. policy implementation;

1. higher level management duties/assignments or major program responsibility; or

1. independent spokespersons or non-management position with authority for independent action.

Approximate cost of each investigation: $2,900

2) Moderate Risk (Level 5)** [Offerors are to assume a Moderate Risk for this Solicitation] Level 5 Public Trust positions include those involving policymaking, major program responsibility, and law enforcement duties that are associated with a “Moderate Risk.” Also included are those positions involving access to or control of unclassified sensitive, proprietary information, or financial records, and those with similar duties through which the incumbent can realize a significant personal gain or cause serious damage to the program or Department.

Responsibilities that would require this level include:

1. the direction, planning, design, operation, or maintenance of a computer system and whose work is technically reviewed by a higher authority at the High Risk level to ensure the integrity of the system;

1. systems design, operation, testing, maintenance, and/or monitoring that are carried out under the technical review of a higher authority at the High Risk level;

1. access to and/or processing of information requiring protection under the Privacy Act of 1974;

1. assists in policy development and implementation;

1. mid-level management duties/assignments;

1. any position with responsibility for independent or semi-independent action; or

1. delivery of service positions that demand public confidence or trust.

Approximate cost of each investigation: $2,400

3) Low Risk (Level 1) Positions having the potential for limited interaction with the agency or program mission, so the potential for impact on the integrity and efficiency of the service is small. This includes computer security impact on AIS.

Approximate cost of each investigation: $550

The Contractor shall submit the investigative package(s) to SEMG within three (3) days after being advised by the SEMG of the need to submit packages. Investigative packages shall be submitted to the following address:

Centers for Medicare & Medicaid Services Office of Operations Management Security and Emergency Management Group Mail Stop SL-13-15 7500 Security Boulevard Baltimore, Maryland 21244-1850

The Contractor shall submit a copy of the transmittal letter to the Contracting Officer (CO).

Contractor personnel shall submit a CMS-730A (Request for Badge) to the SEMG (see attachment in Section J). The Contractor and the PO shall obtain all necessary signatures on the CMS-730A prior to any Contractor employee arriving for fingerprinting and badge processing.

The Contractor must appoint a Security Investigation Liaison as a point of contact to resolve any issues of inaccurate or incomplete form(s). Where personal information is involved, SEMG may need to contact the contractor employee directly. The Security Investigation Liaison may be required to facilitate such contact.

SEMG will fingerprint contractor personnel and send their completed investigative package to the Office of Personnel Management (OPM). OPM will conduct the background investigation. Badges will not be provided by SEMG until acceptable finger print results are received; until then the contractor employee will be considered an escorted visitor. The Contractor remains fully responsible for ensuring contract, task order or delivery order performance pending completion of background investigations of contractor personnel.

SEMG shall provide written notification to the CO with a copy to the PO of all suitability decisions. The PO shall then notify the Contractor in writing of the approval of the Contractor’s employee(s), at that time the Contractor’s employee(s) will receive a permanent identification badge. Contractor personnel who the SEMG determines to be ineligible may be required to cease working on the contract immediately.

The Contractor shall report immediately in writing to SEMG with copies to the CO and the PO, any adverse information regarding any of its employees that may impact their ability to perform under this contract, task order or delivery order. Reports should be based on reliable and substantiated information, not on rumor or innuendo. The report shall include the contractor employee’s name and social security number, along with the adverse information being reported.

Contractor personnel shall be provided an opportunity to explain or refute unfavorable information found in an investigation to SEMG before an adverse adjudication is made. Contractor personnel may request, in writing, a copy of their own investigative results by contacting:

Office of Personnel Management Freedom of Information Federal Investigations Processing Center PO Box 618 Boyers, PA 16018-0618.

At the Agency’s discretion, if an investigated contractor employee leaves the employment of the contractor, or otherwise is no longer associated with the contract, task order, or delivery order within one (1) year from the date the background investigation was initiated by CMS, then the Contractor may be required to reimburse CMS for the full cost of the investigation. Depending upon the type of background investigation conducted, the cost could be approximately $550 to $2,900. The amount to be paid by the Contractor shall be due and payable when the CO submits a written letter notifying the Contractor as to the cost of the investigation. The Contractor shall pay the amount due within thirty (30) days of the date of the CO’s letter by check made payable to the “United States Treasury.” The Contractor shall provide a copy of the CO’s letter as an attachment to the check and submit both to the Office of Financial Management at the following address:

Centers for Medicare & Medicaid Services PO Box 7520 Baltimore, Maryland 21207

The Contractor must immediately provide written notification to SEMG (with copies to the CO and the PO) of all terminations or resignations of Contractor personnel working on this contract, task order or delivery order. The Contractor must also notify SEMG (with copies to the CO and the PO) when a Contractor’s employee is no longer working on this contract, task order or delivery order.

At the conclusion of the contract, task order or delivery order and at the time when a contractor employee is no longer working on the contract, task order or delivery order due to termination or resignation, all CMS-issued parking permits, identification badges, access cards, and/or keys must be promptly returned to SEMG. Contractor personnel who do not return their government-issued parking permits, identification badges, access cards, and/or keys within 48 hours of the last day of authorized access shall be permanently barred from the CMS complex and subject to fines and penalties authorized by applicable federal and State laws.

Work Performed Outside the United States and its Territories

The contractor, and its subcontractors, shall not perform any activities under this contract at a location outside of the United States, including the transmission of data or other information outside the United States, without the prior written approval of the Contracting Officer. The factors that the Contracting Officer will consider in making a decision to authorize the performance of work outside the United States include, but are not limited to the following:

0. All contract terms regarding system security

0. All contract terms regarding the confidentiality and privacy requirements for information and data protection

0. All contract terms that are otherwise relevant, including the provisions of the statement of work

0. Corporate compliance

0. All laws and regulations applicable to the performance of work outside the United States

0. The best interest of the United States

In requesting the Contracting Officer’s authorization to perform work outside the United States, the contractor must demonstrate that the performance of the work outside the United States satisfies all of the above factors. If, in the Contracting Officer’s judgment, the above factors are not fully satisfied, the performance of work outside the United States will not be authorized. Any approval to employ or outsource work outside of the United States must have the concurrence of the CMS SEMG Director or designee.

4. Under SECTION H – SPECIAL CONTRACT REQUIREMENTS, the following changes shall be made:

a. Under Subsection H.2 HHSAR 352.242-70 KEY PERSONNEL (JAN 2006), REVISE the labor category under the IDIQ Contract from “Program Director” to “IDIQ Director”; and the labor category under the Task Order 001 from “Program Director” to “QIN-QIO State Program Director”.

b. Under Subsection H.3 CONFLICT OF INTEREST, section H.3.D.5(a) is updated to DELETE the first bullet item. Therefore, paragraph (a) is DELTED and REPLACED with the following:

“a) In addition to the conflict identified in this section regardless of when such conflict may arise, the Contracting Officer considers that a conflict of interest has occurred if during the term of the contract –

· The Contracting Officer determines that the Contractor’s activities are creating a conflict of interest.”

c. Under Subsection H.12 COSTS FOR CONFERENCES, MEETING AND RELATED TRAVEL, DELETE the reference that reads: “and the costs of teleconferences.” Also, REVISE the date of the referenced memorandum in the final sentence to read “December 16, 2013” versus “June 7, 2012”. A copy of this memorandum is provided with this Amendment 0003 as Attachment J.18.

d. Under Subsection H.14 CMS-DIRECTED SUBCONTRACTS/SPECIAL PROJECT LEAD QIN-QIOS, Part A – Coordination, DELETE the reference to “Strategic Innovation Engine”.

e. Under Subsection H.21 CONTRACTOR COMPLIANCE OFFICER RESPONSIBILITY, DELETE and REPLACE in its entirety with the following in order to CORRECT some of the references made to Sections F and H, and Deliverables:

H.21 CONTRACTOR COMPLIANCE OFFICER RESPONSIBILITY

It is the Contractor’s Compliance Officer’s responsibility to fully review, mitigate (if necessary) and fully document organizational conflicts of interest (OCI’s). If the QIO Compliance Officer is unsure what constitutes an acceptable mitigation strategy, they shall contact their designated CMS Contracting Officer.

Upon identification of a change in the Conflict of Interest Certificate, the QIO shall:

(1) Provide the proposed change and associated documentation to the QIO Compliance Officer for review, analysis and determination. It is the responsibility of the contractor’s Compliance Officer to fully document and mitigate potential and actual OCIs;

(2) Upon completion of the Compliance Officer’s review, including approval of a mitigation plan for any identified conflict of interest, the QIO shall provide written notification of the change to the Government;

(3) The Government reserves the right to review and approve the information provided in item 2 above, if specifically requested by the Contracting Officer, on a case by case basis. One example of where this may occur would be with new types of programs where CMS determines it should review all contracts/subcontracts related to that effort.

The OCI notification requirements apply to the following four key areas:

(a) Governing Body and Organization Executives

(b) Key Personnel

(c) Contracts/Business Arrangement Outside of the QIO contract

(d) QIO Subcontracts

It is the Contractor’s Compliance Officer’s responsibility to:

• Submit…