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HHSM-500-2014-RFP-QIN-QIO
Amendment 0002 Responses to Solicitation Questions
| No. |
| Section |
| Section Number & Title |
| Question |
| Answer |
| 1 |
| Base Contract, Section B |
| B.3 d and B.3 e. QIN QIO Contract Limitations |
| Can a hospital association-led HEN be a subcontractor or prime contractor on the QIN-QIO proposal? There is language in the RFP that could be interpreted to preclude bidders who have more than 20% of their governing body made of health care facility representatives. But this language could also be interpreted to only mean that no more than 20% of the governing body can be related to a single health care facility entity. |
Can you clarify your intent?
The twenty percent limitation applies to the prime and must be considered in aggregate when determining whether the governing body meets the limitation, regardless of whether governing body members are from a single health care facility or multiple.
| 2 |
| Base Contract, Section B |
| B.3 QIN-QIO Contract Limitations, p. 6 |
| The RFP states that “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 no 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 facilities.” Does the “twenty (20) percent” refer to affiliations with the same entity (e.g., no more than two of 10 Board members can be affiliated with the same hospital) or with any facility (e.g., a Board of 15 could have 2 members affiliated with 2 different hospitals, 1 affiliated with a dialysis facility, and 1 affiliated with a nursing home)? |
| The twenty percent (20%) refers to the aggregate. |
| 3 |
| Base Contract, Section B |
| B.3 QIO Contract Limitation |
| Would a state hospital association whose board is made up of greater than 20% healthcare facilities, be eligible to serve as a subcontractor to the QIN-QIO? |
| The twenty percent only applies to the Prime Contractor. |
| Can Associations and Hospital Engagement Networks or similar entities serve as a partner with another QIO contractor through a subcontractor or consultant relationship given the health care affiliate limitations? |
| Yes, a QIO can enter into a subcontractor or consultant relationship with a HEN or similar entity provided all subcontracting and consultant requirements are met. As noted in the statement of work, CMS encourages effective partnerships that will lead to meaningful improvements in healthcare. |
However, the prime QIO cannot be affiliated – through ownership, management or common control – with any health care facility. According to current law[1], with certain exceptions, the following are not eligible for prime QIO contracts: (1) A health care facility in the QIO area; or (2) A health care facility affiliate; that is, an organization in which more than 20 percent of the members of the governing body are also either a governing body member, officer, partner, five percent or more owner, or managing employee in a health care facility in the QIO area. The representation of all health care facilities is aggregated to determine if this 20% threshold is met.
A subcontracting relationship between the QIO and a health care facility or association of health care facilities is not considered for affiliation for purposes of this prohibition. Social Security Act § 1153(c)(1). Therefore, a QIO can subcontract with or have consultation agreements with a health care facility affiliate as long as they are not conducting case review activities and all other contracting requirements are met.
Lastly, a QIO must not subcontract with a health care facility or affiliate to perform any case review activities except for the review of the quality of care. The term case review refers to those activities listed in the Beneficiary and Family Centered Care (BFCC) SoW.
| The RFP indicates CMS has reserved the right to make a single state award. Please clarify the Multi-State Eligibility Requirements outlined in the RFP with respect to competing fairly for a QIN-QIO contract. |
| As noted in the solicitation; each offeror must propose a minimum of three (3) states and a maximum of six (6) states. If less than 3 states are proposed, then the offeror’s proposal will not be evaluated and will no longer considered for award. If three states are proposed and the offeror meets the go/no go criteria in phase I, then the proposed states will be evaluated separately in phase II by state. |
The technical evaluation will result in overall adjectival ratings for each technical proposal by state. The most highly rated proposals will be determined for each state and an award for a particular state may be made without discussions. CMS will consider the minimum 3 state requirement and it is our intent to make a single contract award and task order award(s) to offerors that have been determined to be the best value to the Government in three or more states. Although our intent is to consolidate and to award no less than three states under a single IDIQ contract, CMS reserves the right to award less than 3 states to one contractor.
| 6 |
| General |
| General |
| Given CMS intent to select strongest state proposal, it seems CMS may reconfigure regions with final awards. Is this a correct assumption? |
| The service areas (regions) will be established based on the states to be awarded under an individual task order. |
| 7 |
| General |
| General |
| Organizations known as Quality Improvement Organizations in the 10SOW will probably subcontract with a QIN-QIO in the 11SOW. Will these organizations no longer be recognized as QIOs but as subcontractors by CMS? Is this correct? |
| Correct. |
| 8 |
| General |
| General Question – Fund Fungibility |
| Is there fungibility across the state (area) task orders or are the funds awarded for each state to be expended only within that state’s (area) task order? Are the funds within the QIN cost center fungible across all QIN tasks? Are the IS and QIN cost center funds fungible? |
| It is our intent to award each state as an individual task order so that the funding may not be fungible among states. Funding between AIMS and tasks except for IS is fungible. |
| 9 |
| General |
| N/A |
| Can the Government provide clarification regarding what will be considered a full-time employee for purposes of the QIN-QIO effort? |
| A FTE is typically based on anywhere from 1640 – 1900 hours/yr., depending on PTO benefits. For example: |
2080 total available work hours (8 hrs/day, 40hrs/wk, 52 wks/yr) 40 less sick leave 120 less 3 wks vacation 40 less indirect effort (training, meetings, etc.)
1880 most commonly used number of hours for a FTE employee
| 10 |
| General |
| Payments - Vouchers |
| Will the budget utilized in FIVS be a non-straight line projection as opposed to a straight line average month to month? |
| CMS will not expect a month to month budget, but rather an annual budget, which will be provided at award. |
| 11 |
| General |
| QIN-QIO |
| Does CMS prefer a prime/subcontractor arrangement to a joint venture arrangement? Or is a joint venture acceptable provided it is a legal entity and meets all other RFP requirements? |
| No, CMS does not have a preference. Yes, a joint venture arrangement is acceptable. |
| 12 |
| General |
| QIN-QIO |
| May an offeror submit a proposal for a state where it currently does not hold a QIO contract, but has the necessary relationships with stakeholders? |
| Yes. |
| Commercial rental space is very expensive. In the interest of efficiencies for the program, can a subcontractor use its physical facilities (property) to perform contractual tasks and charge rental space below the market value saving CMS over 30%? |
| Yes, as long as any IT and security standards required by the contract can be met, and any contract data can be maintained as confidential or proprietary data, the government is emeniable to cost saving initiatives. |
| Neither the BFCC or the QIN RFP defines "QIO" or "QIO-like" status. This is not addressed in the OPPS ruling, either. Can these be defined? |
| Refer to 42 CFR 475 for QIO Definitions. |
| If the "prime vendor A" proposes a region with 4-6 states, and one of the states in the "prime vendor A" proposed region is awarded a BFCC contract, will "prime vendor A" still be considered eligible for their proposed QIN IDIQ award, or will they be eliminated as their original proposed region has changed from 4-6 states to a region of 3-5 states? |
| Review section B.3, QIN-QIO Contract Limitations. A BFCC-QIO cannot be a QIN-QIO, or vice versa. |
| What is the planned release dates for the BFCC NCC, BFCC ORC, QIN NCC RFPs? |
| These dates have yet to be determined. Please continue to monitor www.FBO.gov for these opportunities. |
| Do physicians and nurses need to be licensed in the same states as the quality of care case originated? How does the OPPS impact this requirement? |
| No. The OPPS states that “The organization’s proposed involvement of and access to physicians and practitioners in the QIO area with the appropriate expertise and specialization in the areas of health care concerning the quality improvement initiatives.” |
| If two or more organizations “team” on a proposal whereby the prime contractor intends to subcontract portions of the work to the other “partner(s)”, is/are there limitations regarding the financial structure of the sub-contractual arrangements; i.e., may they be cost-plus fixed fee, cost-only, fixed fee, etc.? |
| There is no limitation on the financial structure of the subcontract arrangements. |
| Is CMS interpreting FAR in such a way that an entity can only submit one proposal? |
| A prime contractor may only submit one proposal but subcontractors can propose under multiple prime contractors. |
| Please confirm that CMS will not disclose the identity of the submitter of any question submitted, as this would have the potential to disclose competitive bid information (i.e., bidding strategy). |
| Yes, CMS will not disclose the identity of the submitter of any question. |
| For the QIN-QIO RFP, can a QIO submit multiple bids encompassing different 3-6 state regions? Either as a prime in both or as a prime in one and a sub in the other? |
| A prime contractor may only submit one proposal but subcontractors can propose under multiple prime contractors. |
| Does the District of Columbia count as a state? |
| Yes |
| What minimum specific training, experience or training will CMS accept for QIN-QIO offerors to demonstrate that they have access to relevant professionals with appropriate QI methodology and practice experience? |
| No minimum expectations are set. You must demonstrate your ability to meet the eligibility requirements as referenced in 42 CFR 475. |
| Can an organization submit more than one proposal to work with different multi-state groups? |
| No, an offeror can only submit one proposal as a prime. |
| Can CMS speak to its expectations at the subcontractor level? Will CMS equipment be provided? Should offeror propose all at prime and distribute upon award? |
| The prime contractor is responsible for identifying and proposing any equipment required to support the work. See Section C.3.2.1 for a guideline. The prime is responsible for coordinating the equipment with its subcontractors. |
| Does the IDIQ contract limit the subcontracting relationships to the prime to no more than 49% of the total work to be completed by the subcontractor within a task order? |
| No. |
| How should a bidder estimate cost (staffing, etc.) for QIA and technical assistance referrals from the BFCC – QIO? Eg. Volume of referrals would not be known |
| Please refer to amendment to include new attachment J.1.G – Confirmed Quality Concerns Report. Reimbursement is based on time spent, not by number of Quality Improvement Initiatives (QIIs); formerly known as QIAs. |
| The Notice line of the December 5, 2013 Solicitation Cover Letter states that this RFP is being issued pending availability of funds. Please clarify what this means and when the Agency intends to notify potential offerors whether funding (and what level of funding) is available for the QIN work. Will draft LOE levels released on December 17 potentially increase once funding for the 11th Statement of Work is finalized? |
| Funds were not available for performance under this contract as of the time of issuance of the solicitation. However, funds will be obligated at the time of contract award. The level of funding will not be disclosed, however, the draft LOE released on December 17 is revised in this solicitation Amendment. |
Regarding an organization that may not have a previously approved accounting system:
1. What is the process for gaining that approval? And,
2. Will CMS assure that the review leading to such approval will be completed in time for contract awards?
Accounting System audits will be scheduled prior to award as the government deems necessary.
| What happens if a contractor (potential) determines they may need an accounting system audit due to potential change in organizational structure? |
| CMS will not audit potential “accounting system” changes. CMS will only audit systems after changes have taken place. |
| The RFP notes task orders cannot be awarded without approved accounting systems. Can CMS award the base without an approved cost accounting system? |
| No. |
| Reference L.17.D. Does this apply to all subcontractors no matter what the level of cost or type of service? |
| Yes. |
| Reference K.11 CAS Notices and Certification. If a QIO is neither subject to Modified or Full CAS coverage, does K.11.C(3)&(4) apply and that a CAS Disclosure Statement is NOT required of submission of the proposal & can be submitted prior to award? |
| All contractors are required to submit a disclosure statement if the award is greater than $50M (for full CAS), or $7.5M (for modified CAS). If the total award is less than $7.5M then no disclosure statement is required. |
| Does the small business accounting system need to be approved for the QIO opportunities? |
| Yes. |
| What are the subcontractor’s expectations for an acceptable/adequate accounting system? |
| The requirements are the same as the Prime contractor. An adequate accounting system is required for a cost-type contract for prime and subcontractors. Subcontractors without an adequate accounting system may have a fixed-price arrangement with the prime. |
| If submitting a Joint Venture with creation of new entity, how soon will CMS conduct an Accounting System Review after bid submitted? Note all members of JV have current approved accounting systems |
| Accounting System audits will be scheduled prior to award as the government deems necessary. |
| If a Joint Venture is created by the combination of established QIOs with individually governmentally approved accounting systems, does the new entity inherit the approved accounting systems of the members? |
| No. |
| If we plan to make changes to our pools and/or allocation structure, do we need to have a government audit prior to receiving an award? |
| No. CMS will not audit potential “accounting system” changes. CMS will only audit systems after changes have taken place. The business proposal (including your indirect rates) should reflect your estimated assumptions to complete the work. |
| What does CMS define as the minimum requirements necessary to be considered an “adequate” accounting system capable of supporting “cost-plus-fixed-fee” and “cost reimbursement” contract types? |
| Refer to the SF-1408. |
| For determining adequate account system: How recent must the DCAA audit be in order to be a valid determination, assuming no changes have been made to the accounting system or methodology? |
| In general, if no changes were made, a term of three (3) to five (5) years. |
| Does the approved accounting system apply to prime and all subcontractors that are not fixed price? |
| Yes. The requirements are the same as the Prime contractor. An adequate accounting system is required for a cost-type contract for prime and subcontractors. No one is exempt from the FAR requirement to be audited. Subcontractors without an adequate accounting system may have a fixed-price arrangement with the prime. |
| Reference G.7, A-133 Audits. This section states each non-profit QIN-QIO shall have an A-133 audit. Should the cost of these A-133 audits be treated as a Direct Cost as a result of this being a requirement of the contract? |
| No. Audits are a requirement of doing business with the Government, not a requirement of the contract. Such costs may never be charged as direct. Also, the costs of the entire company are being audited, not just the costs from an individual contract. Again, the costs are indirect. |
| If I have 1 prime QIO who partners with 2-3 other QIO’s to make a region, one QIO will be the prime and the 2-3 QIO’s will be subcontractors. How do we handle the indirect rates? Are all the QIO indirect rates rolled up to the prime as one rate or do we each submit our own indirect rates as subs? |
| Everyone must use their own rates; the Prime must use their rates and the Subs must their own rates. You may not combine rates or use the rates of another entity. |
| If we add another state to our contract do we need a new indirect rate? |
| Your business proposal (including your indirect rates) should reflect your estimated assumptions to complete the work. Reference L.17.G of the RFP. |
| Reference B.4 Type of Contract. This section states that an adequate accounting system is required. As DCAA is the primary agency that performs these audits and focuses on DOD contractors, if an organization does not or has not had an accounting system review, will CMS have/request DCAA to perform a review or can the QIO obtain the services of an independent CPA firm to perform? |
| The Government will perform the accounting system audits. Accounting System audits will be scheduled prior to award as the government deems necessary. |
| Please provide examples of what constitutes a change in indirect rate structure? |
| Examples are significant changes, such as addition of new pools, new service center allocations, or different allocation base. |
| Do the subcontractors need to prove the same “adequacy” of accounting system? Do the subcontractors need to be audited? What if the subcontractor is a healthcare foundation? Do they need to be audited? |
| Yes, the subcontractors need to prove the same adequacy of accounting system, and need to be audited. No one is exempt from the FAR requirement to be audited, regardless if they are a healthcare foundation. Subcontractors without an adequate accounting system may have a fixed-price arrangement with the prime. |
| Reference L.17.D. Volume IV: Business Proposal. As a potential subcontractor to a prime, how can we obtain an accounting system audit that meets the requirements of this RFP in time to participate in this opportunity? We believe that our accounting system meets the requirements of this RFP but what specific steps should we take to achieve an appropriate accounting review by a government agency? Can we initiate an accounting system audit or does it have to be initiated by a government agency? |
| CMS will not audit potential “accounting system” changes or accounting systems of potential subcontractors. CMS will only audit systems after changes have taken place. There are no steps an offeror can take to initiate an accounting system audit. Audits are initiated only by the Government. |
| Can the Government clarify whether there any salary or fringe caps that we need to account for when building up the cost in the business proposals? |
| Salary must be based on the actual PR data or labor survey data for the employees or labor categories proposed. |
The direct salary cap as required in HHSAR 352.231-70(a) specifically limits an individual's annual compensation that the contractor pays for an individual's direct effort (costs) under the grant. The cap imposed is set to Executive Level II of the Federal Pay Scale ($179,700) and extends to all programs funded through the Departments of Health and Human Services. The cap is applicable to grants and cooperatives agreements.
It should be noted that the guidance referenced regarding the salary cap is applicable to grants only. Under the FAR with regards to contracts, the regulations are extremely different. The difference extends from the significant variance in the compensation cap imposed, as well as how that cap is accounted for. The two most noteworthy differences are the capped amounts and how those capped amounts are applied. Specifically, grant direct salaries are capped at $179,700 of direct salary dollars only, while contract executive compensation is capped at $763,029, and includes salary, bonuses, deferred compensation, and employer contributions to defined contribution pension plans. The grant cap applies to all direct labor, even that of subcontractors and consultants. The contracts cap applies to executive compensation only, which is typically included in the indirect pools.
| 50 |
| Base Contract, Section B |
| B.1 Description of Services |
| What is meant by a “single” IDIQ? |
| Although multiple contracts will be awarded under the single solicitation; the projected task orders are so integrally related to individual states that only a single contractor of that state can reasonably perform the work and will therefore be awarded subsequent task orders . |
| 51 |
| Base Contract, Section B |
| B.2 – QIO Program Structure and Requirements, pages 5-6 |
| The RFP appears to be inconsistent it how it uses the identifiers for the various groups identified. For example, the RFP appears to use the terms “QIN-QIO” and “QIO” interchangeably. Please clarify whether the group identifier terms like “QIN-QIO” and “QIO” relate to specific levels of activities, at the network level or at the state level. |
| QIO refers to the statute and QIN-QIO refers specifically to the statement of work. |
| 52 |
| Base Contract, Section B |
| B.2 – QIO Program Structure and Requirements, pg 5 of the RFP |
| Please provide clarification of CMS’ expectations of the IDIQ contract holder as it relates to contract management. Will the IDIQ contractor submit one cumulative voucher and receive payment on behalf of the multi-state region, or will this still happen at the individual state level? Will deliverables be submitted at the contractor level, or at the individual state level? Please clarify the functions that CMS expects will occur at the contractor (multi-state) level. Additionally, those functions are not explicitly included in the LOE document. Will each individual state included in a region be responsible for funding the contractor management functions at the multi-state level, or will those hours/dollars be negotiated at the multi-state contractor level independent of the state-based level of effort expectations? |
| Vouchers and payments will occur at the individual state (task order) level. Each individual state included in a region will be responsible for funding the contractor management functions at the multi-state level. The corporate level would be responsible for managing the IDIQ multi-state level, which would be considered an indirect cost. |
| 53 |
| Base Contract, Section B |
| B.2 QIO Program Structure and Requirements |
| For a joint venture of multiple QIOs, does the governing board of the IDIQ entity need to have a provider and consumer representative from each of the subcontract QIO states? |
| No. |
| 54 |
| Base Contract, Section B |
| B.2 QIO Program Structure and Requirements (Page 5) |
| Will the contracts listed under B.2.A Program structure, be issued as Task Orders under the QIN-QIO IDIQ, or separate contracts for full and open competition? |
| The contracts listed under B.2.A are separate awards from the QIN-QIO contracts. |
| 55 |
| Base Contract, Section B |
| B.2 QIO Program Structure and Requirements, B. Requirements |
| Section B.2.B.a states, “In accordance with 42 CFR § 475.101(a), throughout the course of the contract, the contractor shall be required to have: i. A governing body that includes at least one individual who is a representative of health care providers and at least one individual who is a representative of consumers.” Is the representative of health care providers required to be a Medicare provider? |
| No |
| 56 |
| Base Contract, Section B |
| B.2 QIO Program Structure and Requirements, B. Requirements |
| Section B.2.B.a states, “In accordance with 42 CFR § 475.101(a), throughout the course of the contract, the contractor shall be required to have: i. A governing body that includes at least one individual who is a representative of health care providers and at least one individual who is a representative of consumers.” Does the representative of health care providers need to be from the state(s) covered by the QIN task order? |
| No. |
| 57 |
| Base Contract, Section B |
| B.2.B QIO Program Structure and Requirements, p. 6 |
| The RFP requires the following with regard to composition of the governing body: “In accordance with 42 CFR § 475.101(a), throughout the course of the contract, the contractor shall be required to have: A governing body that includes at least one individual who is a representative of health care providers and at least one individual who is a representative of consumers.” In the OPPS Final Rule, CMS noted that “The requirement to have at least one consumer and one provider representative on the QIO’s governance board is a statutory requirement from section 1152 of the Act. …However, to ensure that we are not too prescriptive in our governance requirements, we did not propose additional requirements or details beyond the statutory mandate.” While CMS does stipulate certain requirements for consumer board members, are we correct in understanding that the QIO may determine the qualifications for an “individual who is a representative of health care providers?” |
| The QIN-QIO may determine the qualifications, however, all candidates must still meet the requirements of conflict of interest and governance guidelines. |
| 58 |
| Base Contract, Section B |
| B.2A. QIO Program Structure and Requirements |
| The solicitation describes that the QIO contracts will be divided by function, and at the Bidders Conference expected award dates were provided for the eight (8) separate procurement pieces comprising the 11th SOW contract structure. Can the Government provide clarification on the expected release dates for solicitations for the other procurement pieces, specifically, the QIN NCC and VIQRCs? |
| These dates have yet to be determined. Please continue to monitor www.FBO.gov for these opportunities. |
| 59 |
| Base Contract, Section B |
| B.3 |
| Can an organization be a part of multiple QIN-QIO proposals (e.g. Can a contractor prime on region and sub on another region)? |
| Yes. A contractor can prime on one region and sub on another region. |
| 60 |
| Base Contract, Section B |
| B.3 |
| Can a subcontractor focused on Every Diabetic Counts (EDC) provide support to more than one QIO team? |
| Yes, a subcontractor can be a subcontractor for multiple QIN-QIOs as well as across their respective States. |
| 61 |
| Base Contract, Section B |
| B.3 QIN-QIO Contract Limitations |
| Many QIOs (and others) perform Medicaid UR and EQR, which requires that the contractor be a QIO or QIO-like entity for the higher match. The existing definition of a QIO-like entity is based on pre-trade bill statute and regulations. If an existing QIO is no longer a prime contractor – perhaps as a result of a new joint venture -- will it still be considered a QIO-like entity? |
| Any QIO-like entity must meet eligibility requirements specified in 42 CFR 475.101. |
| 62 |
| Base Contract, Section B |
| B.3 QIN-QIO Contract Limitations |
| Is a Medicare Administrative Contractor (MAC) eligible to bid as a subcontractor? |
| They are not excluded; however there is a considerable risk for conflict of interest and a detailed, acceptable mitigation plan must be provided, if necessary. |
| 63 |
| Base Contract, Section B |
| B.3 QIN-QIO Contract Limitations (page 6) |
| We respectfully request CMS to consider the following scenario. An incumbent QIO with multiple subsidiaries submits a BFCC bid, and indicates in its BFCC bid that it will divest its interest in the BFCC entity if awarded a BFCC contract. Will such an incumbent QIO still be eligible to receive a QIN task order award, even if it is awarded a BFCC task order, since it will divest its interest in the entity awarded the BFCC task order? In this scenario, the incumbent QIO would divest the BFCC entity and BFCC contract award prior to the announcement of the QIN bid task order awards, and prior to any BFCC or QIN contract executions. |
| The decision to divest is an organizations’ business decision. If you decide to divest, its s full diversification with no affiliations and the government considers a debt interest to be an ownership interest. Therefore, if you are divesting, a divesture plan should include all sufficient milestones. |
| 64 |
| Base Contract, Section B |
| B.3 QIN-QIO Contract Limitations (pages 6-12) |
| Is Medicaid UR work in conflict with QIN work, given CMS’ stance on Medicare case review being in conflict with QIN work? |
| Only for those that are duel eligible members. |
| 65 |
| Base Contract, Section B |
| B.3 QIN-QIO Contract Limitations (pages 6-12) |
| Is Medicaid quality improvement work in conflict with QIN work? |
| Information should be submitted regarding the contracts that offeror holds or intends to compete for in order for CMS to evaluation. |
| 66 |
| Base Contract, Section B |
| B.3 QIN-QIO Contract Limitations (pages 6-12) |
| Is Medicaid EQR work in conflict with QIN work? |
| Information should be submitted regarding the contracts that offeror holds or intends to compete for in order for CMS to evaluation. |
| 67 |
| Base Contract, Section B |
| B.3 QIN-QIO Contract Limitations and H.3 Conflict of Interest |
| Would an incumbent QIO be conflicted and ineligible to win a QIN award if it divested itself of its QIO Business and staff to another entity that wanted to bid on BFCC-QIO work prior to the end of the 10th Scope of Work, but the QIN-QIO organization was still owed a simple note by the recipient organization that was not contingent on any work but was payable over time after the start of the 11th Scope of Work?” |
| The decision to divest is an organizations’ business decision. If you decide to divest, it’s a full diversification with no affiliations and the government considers a debt interest to be an ownership interest. Therefore, if you are divesting, a divesture plan should include all sufficient milestones. |
| 68 |
| Base Contract, Section B |
| B.3 QIN-QIO CONTRACT LIMITATIONS |
Page #: 6
| Are organizations allowed to participate as subcontractors on multiple QIN bids, including QIN bids that involve one or more overlapping states? |
| Yes. |
| 69 |
| Base Contract, Section B |
| B.3 QIN-QIO CONTRACT LIMITATIONS |
Page #: 6
| If an organization bids as a prime or subcontractor on one or more QIN proposals, does that disqualify them from also submitting a bid for the PCC, or, because the PCC is awarded first, is there an option by which that bidder can exclude themselves from a QIN proposal team at such time as they are awarded the PCC contract? |
| Proposing on a QIN-QIO does not disqualify an organization from proposing on a PCC. Per FAR 15.2, proposals may be withdrawn by written notice at any time before award. |
| 70 |
| Base Contract, Section B |
| B.3 QIN-QIO Contract Limitations, Page 10 |
| Can an offeror hold the VIQRC: Outreach and Education for Inpatient Hospitals, Psychiatric Hospitals, and Cancer Hospitals contract; Ambulatory Surgery Centers and Outpatient Hospitals contract; Monitoring & Evaluation/Analytics contract; and/or Validation Support contract if it does not hold a QIN-QIO contract? |
| Yes. |
| 71 |
| Base Contract, Section B |
| B.3 QIN-QIO Contract Limitations, page 6. |
| With multiple organizations operating under the ID/IQ contract, will the Agency recognize and give “QIO” status to all organizations operating the QIN-QIO? |
| The prime contractor would be recognized as the QIN-QIO and be given QIO status; however subcontractors may be considered QIO-like entities if they meet eligibility requirements specified in 42 CFR 475.101. |
| 72 |
| Base Contract, Section B |
| B.3 QIN-QIO Contract Limitations, pages 6-12 |
| Please confirm that individual state QIOs may participate in more than one QIN proposal at the same time if, for example, a QIO is part of two or more joint ventures that are legally separate entities. |
| A prime contractor may only submit one proposal but subcontractors can propose under multiple prime contractors. |
| 73 |
| Base Contract, Section B |
| B.3.c – Contract Limitations |
| As it relates to QIN QIO, the limitation specifically calls out that contractors awarded under the Value Incentives and Quality Reporting Centers for Appeals are hereby deemed as ineligible for the QIN QIO IDIQ award. Will the government confirm this to be true? |
| Correct. |
| 74 |
| Base Contract, Section B |
| B.3.d and e - QIN-QIO CONTRACT LIMITATIONS , page 67 |
| Company A is a health facility trade association with board members that are health facility board members and employees. Company B’s board members are appointed by Company A, but no board member is a health facility board member or employee. If company B’s board includes employees of company A, is company B eligible to be a QIN-QIO? If company B’s board does not include employees of company A, is company B eligible to be a QIN-QIO or subcontractor to a QIN-QIO? |
| Please submit the Personal Conflict Information in order for CMS to review. Refer to section H.3.C.4 for information regarding affiliates. |
| 75 |
| Base Contract, Section B |
| B.4 |
| If a proposal is structured in such a way that a new joint venture company is the prime contractor, what is the process for a timely review of their accounting system? |
| Accounting System audits will be scheduled prior to award as the government deems necessary. |
| 76 |
| Base Contract, Section B |
| B.4 Note |
| If an organization has a previously approved accounting system and is now running parallel with a new accounting system, what is the process for a timely review of the new accounting system? |
| The audit can take place after the contract award. Parallel systems where the already approved accounting system is still utilized and in place is considered adequate. |
| 77 |
| Base Contract, Section B |
| B.4 Type of Contract, p. 12 |
| This Section does not include Time and Material (T&M) as a pricing arrangement but Section G.3.a.1 (page 78 of 217) mentions Time and Material proposals. May T&M Task Orders be issued? |
| We do not anticipate any time and material task orders and therefore, the mention of time and materials in Subsection G.3(a)(1) in the base IDIQ would not be applicable. The task order in Section J, attachment J.1 will be awarded as a cost-plus-fixed-fee type. |
| 78 |
| Base Contract, Section B |
| B.6 Minimum and Maximum Amounts, p. 12 |
| Will the maximum dollar ceiling be established solely based on the dollar amount of the T001 Task Orders (Excellence in Operations and Quality Improvement) awarded to the QIO? |
| The maximum dollar ceiling will be established based on the dollar amounts of all states awarded as task order(s) for each IDIQ contract. |
| 79 |
| Base Contract, Section B |
| B.7 Travel/Other Direct Costs/ Material (Cost Reimbursement Task Orders) |
| The RFP states, “These items will not be separately priced in this contract….” However, Attachment J.15 specifies requirements for ODC and Travel, stating these costs must be included. Please clarify if ODC/Travel cost must be in costing detail. |
| Yes, ODC and Travel cost must be included on a task order level. |
| 80 |
| Base Contract, Section B |
| B.8 Fixed Fee Payment Schedule (Cost Reimbursement Task Orders) |
| Are subcontractors to include fee? |
| Subcontractor fee is allowable. Please refer to FAR 15.404-4(c)(4)(i) for the fee limitation. |
| 81 |
| Base Contract, Section C |
| C.3.2 Hardware/Software (p. 17-18) |
| Will each QIO acting in a subcontract role propose hardware/software based on the requirements of this section in addition to the Prime? |
| The government's intent is to use GFP to the maximum extent practicable. The prime should propose all hardware/software required to perform the work, including any hardware/software necessary for subcontractors. Prime contractors must coordinate equipment requirements with subcontractors using the hardware/software procurement list provided as a guideline and determine the overall needs of the prime and subs to support the work of the contract. This should take into account the IT connectivity between primes and subs and any other IT needs, not identified on the hardware/software listing. However, the Governments primary intent is to provide GFP equipment to prime contractors before considering subcontractors. For cost realism purposes, the technical proposal shall identify a listing of the hardware/software needs, including the identification of GFP and new purchases (this does not count towards the page limitation). In addition, the prime's business proposal shall include any hardware/software costs that must be procured outside of GFP or the hardware/software listing provided in Section C. The prime contractor is responsible for tracking any equipment, including equipment held by subcontractors and reporting it annually on the 565 Form. |
| 82 |
| Base Contract, Section C |
| C.3.2.1 HARDWARE/SOFTWARE |
| If an incumbent QIO becomes a QIN-QIO subcontractor, will it be permitted to keep its current equipment or will it need to return the equipment and budget for new items, e.g., printers? |
| The determination will be made at contract award. The equipment needed by the prime contractor or subcontractors is stated in Section C.3.2.1. |
| 83 |
| Base Contract, Section C |
| C.3.2.1 Hardware/Software (page 17 & 18) |
| The section states “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/telecom 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.” |
Further on page 18 it states “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.”
Question: With the implementation of QIN-QIO service areas and anticipated greater use of Prime/Subcontractor models, will FTE’s of Subcontractors dedicated to the QIN-QIO program at the level of .5 FTE or greater be provided a workstation and/or laptop? Or does the subcontractor need to include the cost in its proposal?
The government's intent is to use GFP to the maximum extent practicable. The prime should propose all hardware/software required to perform the work, including any hardware/software necessary for subcontractors. Prime contractors must coordinate equipment requirements with subcontractors using the hardware/software procurement list provided as a guideline and determine the overall needs of the prime and subs to support the work of the contract. This should take into account the IT connectivity between primes and subs and any other IT needs, not identified on the hardware/software listing. However, the Governments primary intent is to provide GFP equipment to prime contractors before considering subcontractors. For cost realism purposes, the technical proposal shall identify a listing of the hardware/software needs, including the identification of GFP and new purchases (this does not count towards the page limitation). In addition, the prime's business proposal shall include any hardware/software costs that must be procured outside of GFP or the hardware/software listing provided in Section C. The prime contractor is responsible for tracking any equipment, including equipment held by subcontractors and reporting it annually on the 565 Form. Assume GFP will only be provided for prime and sub personnel that are at least a .5 FTE.
| 84 |
| Base Contract, Section C |
| C.3.2.2 Hardware/Software (p. 17-18) |
| Does the cost of the CMS provided hardware/software get identified and costed into the business proposal? |
| Any hardware/software not identified in the solicitation as government furnished, shall be priced in the business proposal. CMS provided hardware/software does not need to be identified and costed into the business proposal. |
| 85 |
| Base Contract, Section C |
| C.3.3.1.b Information Systems Security Compliance, FISMA Compliance, p. 20 |
| In our 10th SOW business proposal, we budgeted for certain FISMA Compliance purchases; however, have not yet received CMS approval to expend such funds. How does CMS want these mitigation costs reflected in this RFP response? |
| CMS is no longer paying for FISMA compliance on a direct cost basis. If an offeror is not currently compliant, any associated costs to become compliant should be included as an indirect cost. |
The Contractor must be compliant with all security requirements referenced in Section H.6 (CMS Information Security) within 90 days from contract award. If currently non-compliant, the offeror shall demonstrate in their technical proposal, (volume II, separate tab; which will NOT count toward the page limitation) how it will become and remain compliant with the requirements set forth at the CMS Information Security provisions.
| 86 |
| Base Contract, Section C |
| C.3.3.1.b.4 Information Systems Security Requirements - FISMA Compliance |
| Are facility or information system purchases, which have been approved through the HCQIS Remedy Purchase System/Engineering Review Board (ERB) process, required to correct identified weaknesses, findings, gaps, or other deficiencies in the IS program through a CAP (generally the result of a FISMA audit or similar activity) allowable direct expenses to the QIN-QIO contract? |
| Unless the purchases are directly required by the SOW, such costs would generally be considered indirect. IT or facilities standards are a cost of doing business. |
| 87 |
| Base Contract, Section C |
| C.4.2 Confidentiality |
| Are QIN-QIOs covered by the Business Associate Agreement in Section H? |
| Yes |
| 88 |
| Base Contract, Section C |
| C.4.2. Confidentiality |
| Regarding the Business Associate Agreement (BAA), since the QIN-QIO will be a 3-6 state region, please explain the requirements of an entity that subcontracts to do the work for an individual state in the region with regard to the BAA. Would a BAA NOT be required between the QIN-QIO region (primary contractor) and the subcontractor organization performing state-level work since that work does not include health oversight activities? |
| A BAA would be required between the prime contractor and any subcontractors if health data is going to be passed between the entities. |
| 89 |
| Base Contract, Section C |
| C.4.3 – Government Data |
| Will the identified need for the additional data purchases be reimbursed as part of the contract, purchased directly by CMS or determined as needed? And how will the need for additional data be validated? |
| Please refer to amendment noted in Section G.30. |
| 90 |
| Base Contract, Section C |
| C.4.4 Clinical Data Abstraction Center Subcontract, p. 24 |
| Who pays for the clinical data abstraction and records management costs for services outlined in this section? Which costs are the responsibility of CMS (through its contracts with CDACs) and which costs are the responsibility of the Contractor? |
| The CDAC contractor is responsible for paying for the clinical data abstraction and records management costs for services outlined in Section C.4.4. |
| 91 |
| Base Contract, Section C |
| C.4.5 Coordination with Stakeholders Outside the QIO Program |
| The RFP states that coordination with stakeholders outside of the QIO program requires advanced approval of the CO. Is there a defined mechanism in place for applying for and obtaining this approval? How long will the approval process take? Will CMS be providing a list of stakeholders that it considers to be part of the QIO program? |
| Refer to the amendment. |
| 92 |
| Base Contract, Section C |
| C.4.5 Coordination with Stakeholders Outside the QIO Program |
| Does the QIN-QIO need to obtain advanced approval of the CO and COR for each potential stakeholder partnership no matter how large or small? |
| Refer to the amendment. |
| 93 |
| Base Contract, Section C |
| C.4.6.A COMMUNICATIONS- Use of Web Technology/Web Content and Communications |
| Is website maintenance an allowable cost? |
| Yes |
| 94 |
| Base Contract, Section C |
| C.4.7 Emergency Preparedness |
| Based on Section B.3 QIN-QIO Contract Limitations a single organization cannot be awarded nor subcontract for a BFCC-QIO Area. Yet, within the requirements of the Emergency Preparedness Section a QIN-QIO is required to include how it “plans to subcontract with another BFCC-QIO in order to maintain continuity of reviews and appeals during emergency situations…” How can a QIN-QIO do this when it is prohibited? |
| Please refer to amendment. |
| 95 |
| Base Contract, Section C |
| C.4.7 Emergency preparedness |
| Should QIO QINs price proposed emergency preparedness activities or will “just in time” approval of emergency preparedness activities include additional funding? |
| QIOs shall allocate resources in their proposal to assist CMS’ in the event of a public health emergency or some other national incident as directed by CMS. |
| 96 |
| Base Contract, Section C |
| C.6.1.1 QIN-QIO Comprehensive Strategic Plan |
| Does the offeror provide the Comprehensive Strategic Plan at the IDIQ Umbrella Contract level or only at the individual state task order contract level? |
| After award, the contractor will provide a comprehensive strategic plan at the State (task order) level, which will encompass a multi-state approach. |
| 97 |
| Base Contract, Section C |
| C.6.1.1. QIN-QIO COMPREHENSIVE STRATEGIC PLAN, Page 34 |
| Is the CSP to be created for a QIN’s services area, i.e., an overarching CSP across all of the states in its proposed service area? |
| After award, the contractor will provide a comprehensive strategic plan at the State (task order) level, which will encompass a multi-state approach. |
| 98 |
| Base Contract, Section C |
| C.6.2.1.3 Successful Interventions: Effective Dissemination of Successful Interventions That Lead to System-Level Improvement and Sustainability of Efforts |
| Paragraph c.8) lists provision of continuing education credits as an example of a learning session design strategy. Are costs and work effort related to obtaining and maintaining accreditation as a continuing education granting organization allowable as a direct cost? |
| The government is paying a labor rate for an employee of specific accreditations. It is assumed that a higher labor rate is warranted for a more senior/qualified individual. In order to charge the higher labor rates for such accreditations, it is the company’s responsibility, not the governments’ directly, to pay to maintain the quality of employee that is warranted and proposed on a contract. Qualifications and the maintenance of such qualifications are the contractor’s responsibility. Customers are paying for varying degrees and levels of experience through the DlL rate – it is not reasonable to also direct charge such training. |
| 99 |
| Base Contract, Section C |
| C.6.3.1 Designation of Key Personnel; HHSAR 352.242-70 Key Personnel; Key Personnel and Other Recommended Staff |
| Please clarify the expectations for Project Managers at the IDIQ level. |
| The Project Manager (renamed to IDIQ Director) would be responsible for managing the IDIQ multi-state level, which would be considered an indirect cost. |
| 100 |
| Base Contract, Section C |
| C.6.3.1 Statement of Work: Personnel Core requirements: Designation of Key Personnel and HHSAR 352.242-70 Key Personnel |
| Is the Program Director for the IDIQ expected to be one FTE or part time? |
| Please refer to amendment. One FTE is estimated per each State Program Director. The FTE for the key personnel for the IDIQ Program Director (to be renamed IDIQ Director) will no longer be specific to an FTE because any work would be based on the activity for the service area. |
| 101 |
| Base Contract, Section C |
| C.6.3.3 Other Recommended Personnel, p. 55 |
| Please clarify the meaning of Task Lead (one FTE per Task with 100% commitment). Does CMS define the Task as B.1? Or all of B? Is this one FTE with 100% commitment per region, or per state? |
| The task order would be divided into three AIMs. Within each AIM, there are one or more tasks. CMS defines three AIMs, which includes B (except B.3), C, and D. Within each AIM, there are one or more tasks. Eg. There are three tasks (C.1, C.2, and C.3) under AIM C. The QIN-QIO may assign a task lead to any task under one or more AIMs. Task Lead, means a lead for one or more specific tasks in the task order. |
| 102 |
| Base Contract, Section C |
| C.6.4.1., pg. 58, Task Order |
| Do all Task Orders go through the organization that holds the IDIQ contract or can Task Orders be issued directly to the state based subcontractors? |
| Task Orders will be issued to the prime contractor. |
| 103 |
| Base Contract, Section C |
| C.6.4.1.c.3 and G.15 Task Order Work Plan (pg.58) and Consultant Services Approval (pg. 92) |
| Please clarify the conflict in the language provided in the Task Order Work Plan which indicates “Consultants may be utilized only upon receiving permission from the COR and Contracting Officer” as compared to the G.15 which provides prior written consent is from the Contracting Officer is required if the fully loaded hourly rate exceeds $150/hour. |
| The reference to consultants in the Task Order Work Plan refer to any consultants that meet the thresholds in Section G.15. |
| 104 |
| Base Contract, Section C |
| C.6.4.5 Partners and Stakeholder Recruitment and Collaboration |
| Can the QIN-QIO subcontract a portion of the task work; if so what entities are eligible. |
| Yes, as long as the contract limitations and OCI are adhered to. |
| 105 |
| Base Contract, Section C |
| C.6.4.7 Monitoring and Reporting Requirements |
| Paragraph c, Ad-Hoc Analyses, states that QIN QIOs shall provide up to twenty-five (25) written ad-hoc analyses, if applicable. Should this be allocated and priced across all task order proposals submitted? |
| The QIN-QIO contractor may determine the appropriate cost allocation for these services across Tasks as deemed necessary. |
| 106 |
| Base Contract, Section F |
| Deliverables or Performance |
| I do not see finance deliverables listed in QIN RFP or BFCC RFP. |
| We do not request finance deliverables as the deliverables will be provided in FIVs. |
| 107 |
| Base Contract, Section G |
| G.14 |
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