Attachment_JA_DME_RFP_Amend_000002_replacement_pages_116-118.pdf

HHSM-500-2015-RFP-0102 (Amendment 0002) DME MAC Jurisdiction A

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TECHNICAL APPROACH EVALUATION FACTOR

INNOVATIONS ELEMENT

Section M.5, Evaluation Criteria The Government will evaluate the extent to which the Offeror’s proposed innovation(s) is a well-thought-out and achievable contractual promise(s) reasonably expected to result in qualitative (i.e. measureable program efficiencies such as improved customer service and reductions to improper payments) and/or quantitative (i.e. measurable cost reductions) value and benefit to the Government. The Government’s evaluation will also consider the extent that the Offeror’s plans for implementing each proposed innovation considers and mitigates risks (i.e. likelihood of Government approvals, Statement of Work requirement changes, etc.) to delivering the promised performance outcomes. Offerors are cautioned that any proposed cost savings and price reductions associated with an unattainable, unsupported or unviable innovations and/or inadequate implementation plans, in whole or in part, will likely result in an associated cost realism adjustment to the Offeror’s proposed cost pursuant to FAR 15.404-1(d).

MISSION-ESSENTIAL FUNCTIONS ELEMENT

Section L.14.5, Written Technical Proposal Instructions

Volume III, TAB G, (included in the 55-page limit) The Offeror shall address the following Mission-Essential Functions:

Medical Review

Strategy and approach to handling the proposed medical review workload volumes for this contract to include:

o the workload category as defined in the RFP (complex pre-pay reviews, complex probe reviews, etc.);

o the identification of the types of claims that the Offeror will focus on for review (e.g., Power

Mobility Devices, Oxygen, Urological Supplies etc.); and o the categorization of the reviews as either supplier-specific or service-specific.

Describe how the Offeror’s understanding of the jurisdiction-specific risk points for this contract resulted in the Offeror’s anticipated claim-type reviews (and volume per claim type) and the expected benefits to the Medicare Program and/or return on investment the Offeror anticipates by focusing on these claim types;

Indicate the level of experienced staff proposed for each of the prioritized problem list items of the

Offeror’s proposed strategy;

Process for ensuring varied and quality medical reviews are conducted throughout the year. Include in this discussion the approach to conduct data analysis for the jurisdiction and how this proposed data analysis impacts the proposed focus of the claim reviews. Describe the corrective actions employed with suppliers, the one-on-one education planned for suppliers, and the plan to ensure follow through on education given to suppliers;

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Approach to using automated reviews to support the Offeror’s overall strategy; provide a projected number of automated reviews and savings (denied dollars-reversals) expected given the Offeror’s approach;

Approach to ensuring maximum participation in ALJ hearings;

Definition of the role CMDs play relative to the medical review strategy, as well as the role of the medical review managers; and

Plan to collaborate with other contractors doing medical review.

TECHNICAL APPROACH EVALUATION FACTOR

MISSION-ESSENTIAL FUNCTIONS ELEMENT

Section L.14.5, Oral Presentation (Substitute) Instructions The Offeror shall address the following topics relative to each of these mission-essential SOW functional areas. In doing so, the Offeror shall fully describe its:

1. Implementation:

Proposed approach to address, mitigate, and resolve problems that may arise during the implementation. Provide one example of a significant problem/risk that may occur during the implementation, and walk through how the Offeror’s problem resolution process would handle the situation in detail;

Proposed approach to conflict resolution as it relates to the outgoing contractor. Discuss any steps in the Offeror’s plans to anticipate issues and that will minimize the need for unnecessary CMS intervention; and

Outreach plan as it relates to the Offeror’s communication approach to the Durable Medical

Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) supplier community and other key stakeholders to ensure that contract transitions are not disruptive and are seamless. Explain how communications to DMEPOS suppliers and stakeholders will be handled when the technology offered may be different than what was offered by the outgoing contractor.

2. Provider Customer Service Program (PCSP)

Approach to handling all types of DMEPOS supplier telephone inquiries, specifically General

Inquiries, Appeals, and Medical Review to ensure quality service to DMEPOS suppliers while meeting the performance and quality standards for the Provider Contact Center;

Approach to using technology to enhance the Offeror’s PCSP, including a description of the self-service technologies it will make available to the DMEPOS supplier community, the information available and the rationale for offering each, as well as how the use of any self-service options will be promoted. Include the total proposed self-service rate, as well as the individual self-service rate for each self-service technology proposed;

Approach to achieve a comprehensive, coordinated and integrated PCSP and how the PCSP will be integrated both internally within the organization and externally with stakeholders; and

Approach to assessing the unique educational needs of the DMEPOS suppliers in the solicited

Jurisdiction, as well as the approach for disseminating timely, accurate, and relevant information.

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CONTINUED

Section L.14.5, Oral Presentation (Substitute) Instructions

3. Bill/Claims Payment

Process to monitor bills/claims payment activities to quickly identify when bills/claims payment issues are occurring, including any system that monitors volumes, counts, IURs processed, dollars paid out, etc.

4. Appeals

Approach to ensure efficient, effective solutions in handling the processing of reopenings and redeterminations;

Approach to the successful, timely transfer of case files to the Qualified Independent Contractor

(QIC), under a scenario where the Medicare Appeals System (MAS) is not available; and

Identify the potential causes of workload spikes and plan to mitigate or minimize the impact of increase appeals volumes, as well as your approach to handle significant workload increases that cannot be mitigated.

CONTINUED

Section L.14.5, Oral Presentation (Augment) Instructions

5. Medical Review Strategy and approach to handling the proposed medical review workload volumes for this contract to include:

o the workload category as defined in the RFP (complex pre-pay reviews, complex probe reviews, etc.);

o the identification of the types of claims that the Offeror will focus on for review (e.g., Power

Mobility Devices, Oxygen, Urological Supplies etc.); and o the categorization of the reviews as either supplier-specific or service-specific.

Describe how the Offeror’s understanding of the jurisdiction-specific risk points for this contract resulted in the Offeror’s anticipated claim-type reviews (and volume per claim type) and the expected benefits to the Medicare Program and/or return on investment the Offeror anticipates by focusing on these claim types;

Indicate the level of experienced staff proposed for each of the prioritized problem list items of the

Offeror’s proposed strategy.