JD-J.19 Assumptions 12232014 redline.docx

GOVERNMENT PROVIDED PROPOSAL ASSUMPTIONS

See RFP Section L.13-3

1. CONTRACT AWARD DATE

CMS anticipates awarding the Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) contract for Jurisdiction D on or about August 28, 2015, with a contract effective date of September 1, 2015.

2. IMPLEMENTATION CUTOVER DATE

a. Implementation Cutover Date

The Offeror shall use the Implementation cutover dates developed by CMS (see table below) when developing its proposed CLIN 0001 costs associated with its Jurisdiction Implementation Project Plan. Completion of the movement of the Jurisdiction to the incoming MAC shall occur within six (6) months of award.

At the implementation cutover date the outgoing MAC ceases Medicare operations and the incoming MAC begins to perform Medicare business functions for that jurisdiction. The following table considers each individual Customer Information Control System (CICS) region as an individual “segment”. (Table excludes VA MRA DMEPOS project)

b. HIGLAS

For proposal purposes, Offerors should assume that DME MACs will not utilize HIGLAS for the duration of the Jurisdiction D contract, and (accordingly) Offerors shall include costs in their proposal associated with providing their own solution to the DME MAC SOW requirements relating to CFO reporting.

c. Joint Operating Agreements (JOAs)

Joint Operating Agreements (JOAs) between functional contractors impacting the new MACs shall be executed prior to the operational start date. (See the Statement of Work section F.1.1 for more information on required JOAs.) The operational start date is defined as the date that the MAC assumes all Medicare functions from an outgoing contract and is capable of processing Medicare claims for that jurisdiction. Please refer to the implementation cutover dates in the chart above for the operational start date. The dates are depicted in the timeline below:

Implementation and Base Periods – 9/1/2015 – 8/31/2016 [Excludes VA MRA DMEPOS Project]

9/01/2015 2/14/2016 8/31/2016 Cutover

End of Base Year Contract Award - Implementation Start

Implementation and Base Periods are shown below:

[Excludes VA MRA DMEPOS Project]

CLIN 0001 - Implementation

2/14/2016 Cutover End of CLIN 0001 9/1/2015 Start of CLIN 0001

CLIN 0002 – Base Period

2/15/2016 Start of Base Period 8/31/2016 End of CLIN 0002

TABLE OF ESTIMATED DATES FOR CLINs 0001 – 0007 (Excludes VA MRA Project)

3. JURISDICTION D - PM & MIP PROVIDER CUSTOMER SERVICE, PROVIDER OUTREACH AND EDUCATION (SOW D.5.1 and E.4.6) For PM & MIP Provider Customer Service, Provider Outreach and Education activities, the DMEPOS supplier populations by State for this jurisdiction, DME MAC Jurisdiction D, are provided below. The Offeror should use these volumes when proposing hours and costs for its provider education and outreach activities for Jurisdiction D, when completing the Basis of Estimate (BOE) and the Business Proposal. There are no CMS-specified staffing or workload requirements, so the Offeror must develop their own strategy for how they can best service the DMEPOS supplier populations identified. The Offeror shall enter its workloads and supporting direct labor resources into the BOE. Any assumptions or narrative explanations should be included in the BOE (Column N), and additional explanation may be provided in keeping with the BOE instructions in Proposal Volume II, TAB C, Offeror Proposal Assumptions. NOTE: The DME MAC has jurisdiction for DMEPOS claims based on a “beneficiary residence” rule, so the DME MAC will also interact with some DMEPOS suppliers from outside these states.

PM and MIP Supplier Counts

Base Year – 6 months

Option Year 1

Option Year 2

Option Year 3

Option Year 4

4. CHANGE REQUESTS

CMS issues approximately 500 draft change requests (CRs) annually to Medicare Contractors, Shared System Maintainers (SSMs), and the Common Working File (CWF) Maintenance Contractor for review and comment. (This is otherwise known as the Point of Contact (POC) Review period, which is described in detail in section C.4.1, Participation in Change Management Process, of the SOW.) On an annual basis, approximately 146 of these draft CRs impact the Medicare DMEPOS benefit and are issued in final for implementation. Annually, approximately 102 of those issued CRs resulted in DMEPOS claims processing changes to the VMS System and the Common Working File. See the Basis of Estimate (BOE), Attachment J.18 for specific workload assumptions.

5. REFERENCES TO MANUALS IN THE SOW

The Offeror shall prepare their proposal based upon the version of the Manuals (both the Internet-Only Manuals and Paper-Based Manuals) as of the date of the RFP release. The Statement of Work (Attachment J.01) has precedence over the Internet-Only Manuals, which in turn has precedence over the Paper-Based Manuals. The Offeror shall not respond to Manual changes issued after the RFP release date unless otherwise instructed by CMS.

6. RECORDS RETENTION ASSUMPTIONS

For DME MAC Jurisdiction D, the Offeror shall assume a total of 41,640551,659 boxes of hard copy Medicare records. All 41,640551,649 boxes of Medicare records are currently stored in a National Archives and Records Administration (NARA) compliant facilities shown belowy located in Scranton, Pennsylvania (PA). During the operational period of the new DME MAC DB contract, all of these boxes, as well as new hard-copy records pertaining to DME MAC Jurisdiction D, must continue to be stored in a NARA compliant facility that is certified by CMS and approved by NARA. For proposal purposes, Offerors shall assume that these records will continue to be housed in the current facilitiesy for the duration of the DME MAC Jurisdiction D contract (i.e., Offerors do not need to include retrieval, permanent withdrawal, and handling costs in the CLIN 0001 and CLIN 0007 cost estimates).

The Offeror shall include in their proposal (CLINs 0002-0006) the ongoing costs of storing the 41,640551,649 boxes that are currently in the Scranton, PA -based NARA compliant facilitiesy. In addition, the Offeror shall estimate and include additional ongoing storage cost for additional boxes of hard-copy Medicare documents that may be created during the execution of the DME MAC D contract.

TOTAL:

41,640551,648.22

7. MANAGEMENT PAPER BILLS/CLAIMS

In the management of paper bills and claims addressed in section D.1.1.2.1 of the Statement of work (Attachment J.01), the images from the outgoing contractor will be transferred to the incoming contractor. For proposal purposes, the Offeror shall assume that the formats of these images are compatible with their systems. Additional information regarding the images from the outgoing contractor will be provided after contract award and during the implementation period.

8. ELECTRONIC DOCUMENT AND DATA RETRIEVAL

For obtaining, reading and storing historical electronic files addressed in section C.2.2.3 of the Statement of work (Attachment J.01), for proposal purposes, Offerors shall assume that historical electronic file formats are compatible with their systems. Additional information will be provided after contract award and during the implementation period.

9. DME COORDINATION MEETINGS

Section E.4.8. of the Statement of Work (Attachment J.01), addresses DME Coordination Meetings (DCMs). For proposal purposes, Offerors need to include the cost of scheduling, coordinating, and facilitating two DCM meetings per year.

10. PARTICIPATION IN CONFERENCES

In accordance with Section C.3.5.1 of the Statement of Work (Attachment J.01), the contractor shall participate in conferences. For proposal purposes, Offerors should plan for 12 conferences annually (6 in Baltimore, Maryland and 6 in Denver, Colorado), 4 attendees at each conference, and 2 overnights at each conference.

In addition to the 12 conferences, the Offeror should plan to attend two (2) Security Best Practices conferences annually (1 in Baltimore, Maryland and 1 in Denver, Colorado), with 3 overnights at each conference.

Additionally, the Offeror should propose to the following conferences and workgroups in the Provider Customer Service (PCSP) functional area: (a) Provider Customer Service Program Conference once every two years. Up to 5 contractor staff may attend; attendees will typically include representatives from provider outreach and education, provider inquiries, webmaster, customer service representative, etc., (b) Monthly Provider Customer Service Program User Group teleconference. Provider inquiry and provider outreach and education representatives from the contractors attend, and (c) Periodic workgroups (about two per year) with contractor representatives to address PCSP issues. The workgroups always meet by teleconference, usually on a weekly or monthly basis.

In addition to the proposal assumptions provided above for section C.3.5.1, Offerors shall propose any travel required to perform other requirements in the statement of work. Additional travel may include, but is not limited to, the following sections of the SOW:

C.1.1.6

Kick-off Meeting

11. PROVIDER OUTREACH AND EDUCATION – DIRECT MAILINGS

For proposal purposes, Offerors should plan for two (2) direct mailings a year to the 7,566 DMEPOS suppliers located within the Jurisdiction D MAC states (see Table above at 3) in accordance IOM Pub 100-9, Chapter 6.

12. BANKING

CMS provides banking services to MACs through standard commercial banking contracts between the commercial bank and CMS. The banking contracts were recently recompeted and the Jurisdiction D DME MAC workload will be assigned to US Bank for their MAC Medicare Bank Account. The current Jurisdiction D DME MAC workload will be transitioned to US Bank by December of 2014.

Effective February 2012, CMS no longer provides lockbox services as part of these standard commercial banking contracts. Therefore, Offerors shall include in their proposals any costs associated with creating their own subcontract for lockbox services, or switching their banking procedures such that lockboxes are no longer needed for DME MAC functions.

13. FREEDOM OF INFORMATION (FOIA) REQUESTS

Offerors should note that FOIA workload has been included in the Basis of Estimate.

14. STATEMENT OF STANDARDS FOR ATTESTATION ENGAGEMENTS (SSAE)16 , REPORTING ON CONTROLS AT A SERVICE ORGANIZATION

Offerors are advised that all MACs will be required to follow the SSAE No. 16 auditing procedures as described in the Statement of Work (SOW), Attachment J.01, section C.3.1. Formerly, MACs were required to follow the SAS 70 procedures. As part of the requirement, the Contractor shall update the information that is shown in Section II of the SSAE 16 report, Description of Internal Control Structure Control Environment and Applications. With the new SSAE 16 procedures, the Contractor shall prepare a written assertion attesting to the fair presentation and design of controls. Under SAS 70, it was the auditors who reported directly on the controls. Contractors will also be required to internally track and correct Section III findings. Contractors are required to prepare and maintain documentation to support the status and corrective actions taken on Section III findings.

15. Medicare Pilot Project for Asbestos Related Disease (MPPARD) (aka Libby Project) (SOW D.1.8) The Offeror shall prepare their proposal based on the workload assumptions provided in the workload table below and the Basis of Estimate (BOE) (Attachment J.18).

Table 1 - Estimated Annual MPPARD Workload Metrics

Est. Total Claims Processed (Included in BOE claims) 5,400

Est. Total Appeals (included in BOE appeals)

Est. Total Care Coordination Activities Face to Face Visits Telephone Visits 1,200

Est. Telephone Inquiries Beneficiary Provider

1,300

16. Medicare Remittance Advice (MRA) for Veterans Administration (VA) Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Claims (SOW C.7.1) (Attachment J.01.G)

The Offeror should refer to Attachment J.01.G for requirements and assumptions regarding the MRA VA DMEPOS project.

The (CICS) production region developed to support this project will mirror the MAC’s claims processing region. The payment floor will remain. When the claims finalize, the MRA will be released when the payment floor expires.

Table 2 - Estimated Claim Workload Metrics and Call Center Volume (Also included in Attachment J.01.G)

(CLIN 0003)

OY 2 - 4

(totals per contract year) (CLINs 0004-0006)

*Based on current Part B VA workloads and Total Expected DME VA Claims Volume + Includes claims with dates of service of up to one year prior to January 2017 – the projected start date for claim submission based on the projected release schedule in Table 1.

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