Amendment 000002 E.9 UPIC Questions and Responses.xlsx
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- Unified Program Integrity Contract (UPIC) Federal contract opportunity
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- HHSM-500-2015-RFP-0122
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E.9 Responses to UPIC Questions Amendment 000002
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Responses to UPIC Questions
| Type of Question | Attachment and Title | Page # | Section | Question | CMS Response | ||
| 1 | Business | E.2.A - E.2.E Business Proposal Spreadsheet Task Order SOW | 6 | Medicaid and Medi-Medi | The Task Order SOW is requiring the contractors to report expenditures by state for Medicaid and Medi-Medi. The templates E.2.A through E.2.E do not provide for expenditures by state. Please clarify | Offerors are not required to propose costs by state but are expected to report state expenditures in the monthly cost report. | |
| 2 | Business | E.2.A - E.2.E Business Proposal Spreadsheet | ODC & Travel Tab | The template provided for the ODC & Travel costs does not provide a place for the allocation of costs to the individual task activities within MIP, DRA, Medi Medi. In order to bring the ODC and Travel costs back to these worksheets we would need to break the costs out to one or more of the following activities ((Vulnerabilities, Investigations, Lead Management, Data Analysis, Support to Law Enforcement, Support to CMS, Quality Assurance, Appeals to Support, and Information Technology). Please clarify the current template does not provide for this breakout. | This is correct. | ||
| 3 | Business | E.2.A UPIC J1 Business Proposal Spreadsheet CLIN 0001 | When in Year 2 should contractors assume that the two additional Medi Medi states will become operational? | Offerors should assume the additional states will become operational at the beginning of option year one. | |||
| 4 | Technical | HHSM-500-2015-RFP-122 | |||||
| UPIC Solicitation | 88 | Assumptions | "Assumptions: The Offerors shall assume the following in the preparation of proposals: |
1. Four states will participate in Medi-Medi in the base year: Ohio, Iowa, Nebraska, and Missouri;
2. Two additional Medi-Medi states will be added in Option Year one: Kentucky and Indiana;
3. No additional Medi-Medi states are expected to be added in Option Years two, three and four."
| For Medicaid-only work, does CMS anticipate the UPIC collaborating with each of the eleven states in Jurisdiction 1? | Yes CMS anticipates that the UPIC will collaborate with each of the eleven states. | ||||||
| 5 | Business | HHSM-500-2015-RFP-122 | |||||
| UPIC Solicitation | Page 88 | Section L-12 General Proposa Instructions | Under Assumptions, CMS indicates that four states will participate in Medi Medi in the base year, two additional states will be added in Option Year 1 and no states are expected to be added in the remaining option years. Does CMS expect that UPIC services will be provided for the other five states under this contract? Please clarify. | That assumption pertains to the Medi-Medi only workload for the identified states. | |||
| 6 | Other | General | In what locations does the incumbent currently process workload? This will help guide travel estimates. | Offerors shall adhere to the location requirements outlined in the UPIC SOW. | |||
| ERROR:#REF! | Business | HHSM-500-2015-RFP-122 | |||||
| UPIC Solicitation | 88 | Part II - The Schedule, L.12.2.5 | Clarify that offerors assume $35,000 in file transfer/storage costs in the first year of transition and fully operational. Wouldn't it be appropriate to factor in an increase for increases in volumes and inflation? Also does this include electronic storage and hard copy storage? | Yes, this assumes costs associated with file transfer/storage in the first year of transition/fully operational. This includes transfer and storage of hardcopy records from the existing contractor. | |||
| ERROR:#REF! | Business | HHSM-500-2015-RFP-122 | |||||
| UPIC Solicitation | 90 | L.13.I.D.2 Executive Summary | In order to determine a bid strategy for the other UPIC Jurisdictions, we request a better understanding of the timing and order of the bids. Can CMS provide an estimated schedule for the release of the future UPIC Jurisdictions? | ||||
| CMS anticipates that two additional jurisdictions will be awarded by the end of FY16 and two jurisdictions will be awarded in FY17. This is an estimated schedule and may be subject to change. | |||||||
| ERROR:#REF! | Technical | HHSM-500-2015-RFP-122 | |||||
| UPIC Solicitation | 104 | L.14 | Technical Proposal Volume II instructions, Section F, item 1 Key Personnel | ||||
| In addition to the 3 pages allowed to summarize the required 9 key personnel (along with a number of other factors), we recommend CMS require resumes for each key person with a 2-page maximum page count for each resume. The value of this is that it will enable evaluators to review additional detail about the qualifications and experience of the key personnel bid. Will CMS require and allow submission of a 2-page resume for each key person proposed? | Section F has been revised to allow for 2-page resumes that will not be counted in the overall page count to be submitted for Key Personnel and to increase the overall page limit from 3 to 6. | ||||||
| ERROR:#REF! | Technical | HHSM-500-2015-RFP-122 | |||||
| UPIC Solicitation | 102 | L.14.C.3.d | "Are there any other contract or technical performance related risks that you have identified? If so, what do you recommend that your organization and/or CMS do in order to mitigate and minimize these risks?" How do "technical performance related risks" requested here differ from risks requested in L.14.C.3.c or L.14.C.1.ii? | Item C references performance objectives submitted by offerors. Item D relates to risks associated with technical requirements identified in the SOW. | |||
| ERROR:#REF! | Technical | HHSM-500-2015-RFP-122 | |||||
| UPIC Solicitation | 88 | L.12.2 | Assumptions: #12.c "The draft PIM documents are provided for proposal preparation purposes only." Does this mean that the draft PIM Chapters 4, 8 and 16 (E.6, E.7 and E.8) are to be used when providing responses to the Technical Evaluation Scenarios and not current PIM chapters? | Yes, the draft PIM chapters included in the solicitation should be used for proposal purposes. | |||
| ERROR:#REF! | Technical | HHSM-500-2015-RFP-122 | |||||
| UPIC Solicitation | 101 | L.14 C.1.ii | Should the requirement "Education of providers, states, and other stakeholders on the role of the UPIC" be a separate requirement? It is now combined with C.1.14 Anticipated Risks and Mitigation | Yes, Education of providers, states and other stakeholders on the role of the UPIC has been made a separate bullet. | |||
| ERROR:#REF! | Business | HHSM-500-2015-RFP-122 | |||||
| UPIC Solicitation | 88 | L.12.2 | Assumptions, #10: "At the maximum, all contractor staff that will use OnePI will travel to Baltimore, Maryland for up to three (3) two-day training sessions." | ||||
| Travel is required for all personnel attending UCM and IDR training. Can we use the "Train-the-trainer" approach, wherein some of our users could train other users on the systems? | Assumption #10 is specific to One PI. The "train the trainer" approach is not available for OnePI at this time. | ||||||
| ERROR:#REF! | Technical | HHSM-500-2015-RFP-122 | |||||
| UPIC Solicitation | 102 | L.14 Technical Proposal Instructions | In Section C.4 Approach to Meeting Information Technology and Security Requirements, offerors are required to provide a list of "relevant levels of revisions or patches that the offeror will be using to complete UPIC work" as it relates to hardware and software. Exposing this level of detail in a response could present a security risk. Will CMS please consider removing the requirement to include the levels of revisions or patches from submission in the Technical Proposal response? | This poses no risk to offerors as this information will remain proprietary. | |||
| ERROR:#REF! | Other | J.1 Unified Program Integrity Contract USOW | 8 | Section 1.3 | Section 1.3 UPIC Jurisdictions states that: The UPIC shall operate in CMS defined geographic areas, or jurisdictions, as found in the map in Appendix B. At a minimum, the UPIC shall have the majority of its offices and staff located in the jurisdiction. See Section 8.3 on Key Personnel for additional requirements. Section 8.3 is incorrect - Confirm that the reference should be to Section 7.3. | Yes, 7.3 is the correct reference. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 15 | 4.1 | Do the ZPIC, PSC, and MIC contracts all contain provisions for them to assist with a smooth transition to incoming contractors? | Transition language is currently included in ZPIC, PSC, and MIC contracts. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 16 | 4.1.1 a | Will CMS provide workload assumptions for work by the outgoing contractors that will need to be incorporated by the incoming contractor? This information will ensure the incumbent is not at an advantage over other offerors. | It is anticipated that approximately 135 Medicare and Medicaid investigations will be transitioned from the outgoing contractor. | |
| ERROR:#REF! | Business | J.1 Unified Program Integrity Contract USOW | 16 | 4.1.2 | Can CMS provide the current contractors (ZPICs, PSCs, and MICs) for Jurisdiction 1 and the estimated volume of work that will be transferred from each contractor upon award of Jurisdiction 1? | It is anticipated that approximately 135 Medicare and Medicaid investigations will be transitioned from the outgoing contractor | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 16 | 4.1.2 | What is a "recalcitrant provider?" | Please refer to 100-08 Chapter 4. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 19 | 4.3.1 | The "Workload closeout Project Plan" identifed in section 4.3.1 of the USOW is missing from Appendix A Deliverables list. There is a "Workload Closeout Risk Management Plan'" in Appendix A. Are these referring to the same Plan and if so, please clarify the title? | The workload closeout risk management plan and the Workload closeout project plan are separate documents. CMS will amend Appendix A to include the Workload closeout project plan. | |
| ERROR:#REF! | Business | J.1 Unified Program Integrity Contract USOW | 20 | 5.1 | The UPIC shall submit identified program vulnerabilities at CPIVulnerabilityIntake@cms.hhs.gov - Is there a specific format for these vulnerabilities or are they just free form text? | CMS will provide the format upon contract award. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 21 | 5.1.1 | UPIC required to form Steering Committee with program partners, serve as organizer, etc. This type of committee already exists in many states. Most states would see no need for another committee. Is UPIC still required to form such a group or does it simply integrate into existing entity? | The UPIC will support CMS and State program integrity efforts. Existing steering committee meetings will be leveraged to the extent possible with the overall goal of maximizing state collaboration. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 22 | 5.1.2 | Annual conference. Where will the referenced annual conference be held and how many staff from each UPIC will be expected to attend? | The Annual PI Mission will be held in the Baltimore command center. Offerors should assume 3 days for the conference with a maximum of 3 attendees. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 22 | 5.1.2 | The success of the Annual Program Integrity Mission is dependent upon the sharing of information among UPICs. Historically, sharing information among competitors or future competitors has presented some reticence on the part of participants. What will CMS do to facilitate and encourage the sharing of information? | Contractors are expected to actively participate in these missions. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 22 | 5.2.1 | Regarding "During the Implementation Phase, the UPIC shall participate in meetings with outgoing contractors and CMS regarding the transfer of data and information." - For planning purposes, can CMS share the Medi-Medi data dictionary for each of the four Medi-Medi states (Ohio, Iowa, Nebraska, and Missouri)? | No | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 22 | 5.2.1 | Is there a look back period the UPIC should keep in mind when performing comprehensive research and data analysis? | The UPIC will adhere to Medicare and Medicaid state guidelines in regard to the look back period. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 23 | 5.2.1 | Regarding "For more information on implementation activities, please Section 5, Implementation Requirements" - Can CMS confirm that the referenced Section 5 is the same as Section 4. TRANSITION AND IMPLEMENTATION REQUIREMENTS which begins on page 15 of the USOW? | Correct-the transition and implementation requirements can be referenced in section 4 of the UPIC USOW. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 23 | 5.2.2.b) | This section refers to the "vision of the IDR is that of a national level respository." Is the IDR currently fully functional with Medicaare Parts A-D and Medicaid data? If not, when is it anticipated to be fully functional? | The IDR currently houses Medicare Parts A-D data. CMS will work with each UPIC jurisdiction to determine the sequence and timeframes for implementing state Medicaid data into the IDR. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 24 | 5.2.3 | Will CMS facilitate initial communications between States and the UPIC? | Yes | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 24 | 5.2.3 | The SOW directs the UPIC to "collaborate with the states in their jurisdiction to develop a comprehensive strategy for data analysis involving Medicaid data." Does CMS expect this collaboration to take place on a state by state basis within the jurisdiction or can there also be an additional collective collaboration among all the states in the jurisdiction? | The offeror shall propose their best approach to collaborating with states on an individual and jurisdictional level. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 24 | 5.2.4 | This section requires the UPIC to perform activities related to the Fraud Prevention System, as directed by the Contracting Officer Representative. The FPS 2.0 procurement is now underway. Are there prohibitions from the FPS 2.0 awardee from also being a UPIC? | There are no prohibitions from the FPS 2.0 awardee being a UPIC | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 24 | 5.2.4 | In section 5.2.4 and other sections, the USOW includes the statement "Note: CMS reserves the right to perform this requirement, or any portion thereof, in order to streamline data matching on a local, regional, or national scale". Is it known yet whether CMS will provide any data matching software or algorithms for the initial Medi-Medi implementation in Jurisdiction 1? | No-please refer to the SOW. | |
| ERROR:#REF! | Business | J.1 Unified Program Integrity Contract USOW | 25 | 5.2.4 | The RFP states "The Medi-Medi data dictionary shall be submitted to CMS in accordance with Appendix A, Deliverables.....In some cases, data dictionaries may alreadyexist; however, when data dictionaries do not exist or are not adequate for Medi-Medi purposes, they must be developed or modified. This deliverable is not listed in Appendix A. Please provide guidance on the frequency of this deliverable. | CMS expects that data dictionaries shall be made available upon request. However, the contractor is not required to submit data dictionaries as a deliverable. CMS will amend the language to reflect this. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 25 | 5.2.4 (b) | Section b. of 5.2.4 pertains to Medi-Medi Activities & Data Dictionary and states, "The UPIC shall provide data dictionaries to the OnePI and IDR contractors and support the loading of data in the system." | ||
| Will the UPIC also be responsible for creating/providing data dictionaries to the One PI and IDR contractors for Medicaid states who are in the jurisdiction, but not a Medi-Medi? | The UPIC shall collaborate with CMS regarding the details surrounding data from the states - including the creation/provision of data dictionaries. | ||||||
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 29 | 5.3 | Under Lead Management, it states that the UPIC shall partner with CMS to identify and prioritize leads for investigation. How does this partnership differ from partnerships with MACs or States or Stakeholders in order to move forward on findings? Must all Stakeholder Identified Leads (See 5.3.1.b) be prioritized and then approved by CMS for further action? | The UPIC is expected to work in collaboration with CMS to prioritize leads for further action. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 29 | 5.2.5.b | Analytics Finding Report: Is this a manual or automated delivery process for submitting report to CMS , Law Enforcement, State Medicaid Agencies, and other entities. | Please see UPIC USOW 5.2.5 b. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 30 | 5.3.1.b) | Contractor developed data models: does the current contractor provide all data models related documentation / information during Transition? Is there a checklist / process to validate the data shared by the current contractor? | CMS expects the offeror to propose the most efficient approach to validate the data. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 30 | 5.3.2 | Leads: Do we receive leads via Phone / email / paper / fax? Or the expectation for leads is through listed out System(s) only. Also is there an anticipated volume of leads that the UPIC can assume will be received annually? | The contractor shall be prepared to receive leads from multiple sources. The volume of leads should be based on the demographics provided in the solicitation. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 33 | 5.4 | Does CMS have metrics related to the number of investigations it expects the UPIC to conduct on a quarterly or annual basis for Jurisdiction 1? | No | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 33 | 5.3.5 | What is the process for gaining access to the UCM? What are the various levels of role based access that the UPIC can have or will the UPIC need a separate workflow management system to monitor workload of its workers? | Please refer to the UCM functional requirements document. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 34 | 5.4 | "Note: The Medicaid Integrity Contractors (MICs) previously conducted “audits” of providers/suppliers to identify overpayments. For the purposes of this contract, the term investigation shall include audit activities previously performed by Audit MICs for the review of providers/suppliers or suppliers furnishing items or services under the Medicaid program." | ||
| Please confirm that the UPIC is required to perform Audit MIC desk review and field review functions, i.e., these are not referred to any other entities to perform these Medicaid claim reviews and audits, unlike what is required for Medicare claims. | The offeror shall propose their best approach to meeting requirements identified in the SOW. | ||||||
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 34 | 5.4 | The SOW directs the UPIC to "notify the COR when the state requests specific assistance to support ongoing investigations." Can the UPIC provide that specific assistance unless and until the COR directs otherwise? In other words, does the UPIC have to wait for the COR to respond to such a notification? | The contractor shall work in coordination with CMS to support ongoing investigations. | |
| ERROR:#REF! | Other | J.1 Unified Program Integrity Contract USOW | 36 | 5.5 | The audits shall be conducted in accordance with Generally Accepted Government Auditing Standards (GAGAS). Will the Government please confirm if the audits, reviews, and examinations requested require adherence to GAGAS, which requires adherence to specific standards and requirements issued by the AICPA and GAO that instill confidence that attestation services meet the utmost quality and soundness only provided by a CPA firm in good standing? These requirements include adherence to certain standards and peer reviews as well as filing with the State boards of accountancy to issue reports. | The offeror shall ensure all applicable work outlined in the SOW is in accordance with GAGAS requirements. | |
| ERROR:#REF! | Other | J.1 Unified Program Integrity Contract USOW | 36 | 5.5 | The audits shall be conducted in accordance with Generally Accepted Government Auditing Standards (GAGAS). In order for GAGAS requirements to be met, the organization must comply with the Quality Control Program required by AICPA Statement on Quality Control Standard (SQCS) No. 8, and undergo a peer review every three years to comply with SQCS No. 8, which only individual CPAs, CPA Firms, and Government organizations (e.g., OIG) comply with who provide attestation services. Will the Government please confirm that ALL bidders are required to meet these minimum standards to perform work under this SOW? | The offeror shall ensure all applicable work outlined in the SOW is in accordance with GAGAS requirements. | |
| ERROR:#REF! | Other | J.1 Unified Program Integrity Contract USOW | 36 | 5.5 | The CPA industry is a highly regulated industry governed by State Boards that must adhere to AICPA requirements. As such, non-CPA firms that perform and issue audit, examination, and attestation reports are subject to State laws and regulations. To ensure that the CPA/CPA firm is in good standing, please have the CPA/CPA firm provide evidence of licensing for being a CPA firm and as a firm to conduct audits, examinations, and attestation engagements. | The offeror shall ensure all applicable work outlined in the SOW is in accordance with GAGAS requirements. | |
| ERROR:#REF! | Other | J.1 Unified Program Integrity Contract USOW | 36 | 5.5 | Being merely a CPA does not enable that individual to perform and issue audit, examination, and/or attestation reports. State Boards as well as laws and regulations have different requirements to be a licensed CPA and one that is in the practice of performing audits, examinations, and attestations engagements. Please require that the CPA/CPA firm is both licensed as a CPA and is licensed to perform audits, examinations, and attestation engagements, as there is a difference. | The offeror shall ensure all applicable work outlined in the SOW is in accordance with GAGAS requirements. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 36 | 5.4.4 | What is the nature of the appeals support work? | Please refer to SOW and TO documents for information. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 38 | 5.6 | Will the UPIC document the results of Medical Reviews in the UCM? | It is anticipated that MR review results will be documented in the UCM. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 38 | 5.6 | The RFP indicates "The UPIC shall send a review results letter to the Medicare provier/supplier or appropriate medicaid State Agency contact". The draft UCM requirements provided in Appendix K in section 4.4.7 lists form letters as optional functionality. Please confirm whether UCM provides functionality to generate review results letters. | The UPIC shall follow the SOW in generating review results letters. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 38 | 5.6 | Medical Review Requirements - "The UPIC shall conduct Medicaid MR by request of the state in accordance with existing state policy rules and relevant guidance." Is this the only way the UPIC can conduct Medicaid MR, i.e., if state formally requests it? | It is generally anticipated that Medicaid medical review will be conducted in collaboration with the state. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 38 | 5.6 | "The UPIC shall perform: |
a. Prepayment MR
b. Post-payment MR
c. MR in support of other Program Integrity (e.g., State Medicaid Agency requests)
d. Provider Notification and Feedback in support of Medicare MR findings."
| For Option Year 1, does CMS anticipate that all medical review functions will be carried out within the UCM exclusively? | It is anticipated that MR funcitions will be carried within UCM in OY1. | ||||||
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 38 | 5.7 | Does the licensed practitioner (MD,DO, etc) denying the medical necessity of a medical review need to be of the same specialty as the practitioner rendering the services? | The UPIC must adhere to state Medicaid MR policies. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 38 | 5.7 | Will the contractor RNs be required to utilize some form of recognized clinical screening tool such as InterQual to determine coverage/medical necessity determinations in medical review or can they rely on their clinical expertise? | The RN reviewer must adhere to Medicare/Medicaid policies. Use of a recognized screening tool is recommended. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 39 | 5.7.2 | Will the adjudication of claim review decisions be added to list of tasks for Shared Systems to section 5.7.2 as listed in section 7.5.1.4 e) on page 58? | No, the UPIC will not adjudicate claims. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 45 | 5.11 | The SOW directs the UPIC to provide education to, among other entities, Medicare Parts A and B providers and suppliers. If the UPIC identifies, through its access to Parts C and D claims data, the possible need for education of providers in those program, what steps should it take? | The UPIC will coordinate part C and D educational referrals with CMS. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 47 | 6.5.a) | Will FPS2 or the One PI contain provider enrollment data so that the UPIC can identify if a provider/supplier is enrolled in Medicare and Medicaid? | The UPIC will have access to provider enrollment data. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 49 | 7.3 | Are the Key Personnel to be FTE for each individual Task Order? | The FTE allocation is stipulated in the TO. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 49 | 7.1.3 | Section 7.1.3 states, "The UPIC shall coordinate with CMS to attend or establish regional fraud, waste, and abuse meetings." | ||
| How frequent and for what duration does CMS anticipate the regional fraud, waste, and abuse meetings to be? | The offeror shall propose an approach for meeting this requirement. | ||||||
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW, Section 7.3.4, Medical Director, paragraph 1 lines 1 and 2, and paragraph 4 lines 3 and 4. | 7.3.4 | There is a conflict between the required years of experience as to board certification. Paragraph 1 specifies 5 years of board-certified experience and paragraph 4 requires 3 years of board-certified experience. Will CMS confirm the requirement is 3 years of experience in both paragraphs (which is consistent with the existing ZPIC requirements for Medical Directors)? | CMS confirms that the requirement is for 3 years of experience and will amend the USOW to reflect this. | ||
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 54 | 7.4.5 | Who are the OnePI and IDR contractors? Can interested UPIC vendors attend the training referenced in this section now? If yes, please advise how to enroll in this training? | The contractors supporting OnePI/IDR are not pertinent to the offeror's ability to propose to the UPIC work. Interested vendors may not attend OnePI/IDR training. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 58 | 7.5.1.2 | "One PI includes the following tools to access data in the IDR: |
a) Business Objects, a business intelligence tool available for analyzing data in the IDR.
b) Services Tracking Analysis and Reporting System (STARS)
c) SAS Enterprise Miner"
In J.2. Appendix L, it states - "Three business intelligence (BI) applications: SAP BusinessObjects (BO), STARSInformant (formerly known as STARS), and SAS Enterprise Business Intelligence (SAS). "
| Is SAS Enterprise Miner available? If yes, is there a limit to the number of licensed users of SAS Enterprise Miner within Jurisdiction 1? | SAS Enterprise Miner is available through OnePI and there is no limit on the licenses. | ||||||
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 59 | 7.5.1.5 | If states are willing to share actual claims and encounter data with the UPIC can it be used in lieu of MSIS data? | The UPIC will not utilize MSIS data. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 59 | 7.5.1.5 | The SOW directs the UPIC to work with states to get Medicaid data pending the implementation of TMSIS. Can the UPIC obtain direct, real time access to a state's Medicaid claims and other data if the state is willing to provide it? And, assuming that is approved, can the UPIC maintain that access after TMSIS is implemented? | The UPIC shall collaborate with CMS regarding the details surrounding obtaining data from the states. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 60 | 7.5.1.7 | If claims are processed in the Medicare Fee-for-Service (FFS) Claims Processing Shared Systems and cases related to claims are managed via the UCM, what kind of information is expected to be sent to UPICs ? Would the UPICs collect ADR responses sent by providers and suppliers using their custom IT solution and then digitally transfer to UCM ? or does eSMD directly deliver DR files to UCM ? | It is the contractor's responsibility to ensure all medical records and associated documentation is obtained and uploaded into the UCM-please propose a recommended strategy. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 60 | 7.5.1.7.a) | Where are the requirements for the system inteface to accept ADR responses in PDF format through the inbound esMD system defined? | Additional information pertaining to esMD can be accessed at https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/ESMD/index.html?redirect=/esmd | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 60 | 7.5.1.7.a) | Please provide expected or current interface specifications for esMD. Also, are the number of ADR responses known? Please provide a reference for volumes or data size projections. | Additional information pertaining to esMD can be accessed at https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/ESMD/index.html?redirect=/esmd | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 60 | 7.5.1.7.c) | What does the support of esMD system through releases entail and what is the typical expected duration of support. Can you please provide an upper limt (4 or more)? | Please see esMD requirements in the USOW. Additional information pertaining to esMD can be accessed at https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/ESMD/index.html?redirect=/esmd | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 60 | 7.5.1.9 | Regarding a-h- The UPIC shall regularly update and/or use other CMS systems to conduct program integrity activities as directed.What technology would a contractor use to access these systems remotely from the UPIC office? | Please reference the UPIC USOW for requirements. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 60 | 7.5.17 | eSMD: In case of non-availability of esMD by Contract award date, what are the current format(s) / delivery methods used by Providers / Suppliers. Do we have to prepare and be ready with a Mailroom solution, to mitigate the risk of eSMD unavailability | esMD is currently available | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 61 | 7.5.2 | Would the contractor be permitted to implement a document management system to cover these functionalities or would exisiting processes or systems be provided by CMS IT ? (in reference to the recommendation under 7.5.1 in page 57) | Please refer to section 7.5.1 of the UPIC USOW | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 61 | 7.5.2 | Would the contractor have to have a mail room capability or is there a shared CMS mail room cability that can be harnessed for printing and posting outgoing paper mails ? | The contractor shall provide mail room capability | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 61 | 7.5.2 | On the last bullet in section 7.5.2 of the USOW, please consider adding the word "paper" so that it states "d) Maintain paper records and files". Otherwise this could be read to suggest that CMS expects offerors to maintain other databases of electronic records and files. If not, please clarify what records and files would be included. | Please carefully read Section 7.5.2 of the UPIC USOW. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 62 | 7.5.4 | If claims are processed in the centralized Medicare Fee-for-Service (FFS) Claims Processing Shared Systems that UPICs have access to, what does "relevant contractor interfaces with the existing shared claims processing system" refer to ? | These are the same systems | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 64 | 7.5.5 | Is a FedRAMP-JAB accreditation required? | Any federal data that is stored in a cloud environment must have FedRAMP accreditation. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 65 | 7.5.5.2 | Please clarify, "The CISS FISMA Evaluation". | The reference to CISS FISMA evalutation has been removed from the SOW | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 65 | 7.5.5.4 | Must the bidder have a CMS ATO currently in place in order to be awarded the IDIQ or Task Order? | An ATO does not have to be in place to be awarded the IDIQ or initial TO. However, the bidder is required to acquire an ATO as soon as possible after award. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 68 | 7.6 | Is UCM up and running now and if so how long has this been in production. If not when is it expected to be in production? | The UCM is expected to be in production at the time of contract award | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW UCM 1.0 - Functional Requirements Document (FRD) | 68 | 7.6 | Does the UCM currenlty have all the functionality as specified in the UCM Functional Requirememnts Document? If not what is the functionality per the FRD that is not available / implemented in the UCM? When is the remaining functionality expected to be in UCM? | The functional requirements document is a draft. We anticipate availability of preliminary workflow and case management functions at the time of award. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 70 | 7.6.3 | This section indicates: "With this in mind, the UPIC shall work with other contractors, agencies, organizations, and CMS to obtain the information needed to provide closure to the fraud, waste, and abuse program integrity work that is being performed. This follow-up loop is very important and may represent such processes as: |
ii. Status of appeals
iii. Outcomes of referrals made by the UPIC to any law enforcement entity or other organization" Regarding appeals: The UPIC may not always be notified of appeals unless the reviewing agency (e.g.. MAC, ALJ or QIC) requests participation from the UPIC. Will direction be provided to these entities requiring they notify the UPIC of the outcomes of all appeals from UPIC administrative actions?
| We expect the UPIC to actively pursue appeals outcomes. | ||||||
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 73 | 7.9 | Reference is made to the "Deliverables Schedule identified in Appendix F". Please revise to "A" instead of "F". | CMS agrees that the deliverables schedule should be identified as Appendix A-this will be amended |
| ERROR:#REF! | Scope of Medicaid Managed Care Audits | J.1 Unified Program Integrity Contract USOW | 60 | 7.4.18 | The UPIC SOW restricts Medicaid Managed Care audits to entities (Medicaid Managed Care Organizations—MCOs) subject to section 1903(m) of the Social Security Act. While Medicaid MCOs enroll the majority of Medicaid beneficiaries, over 20 million Medicaid beneficiaries are enrolled in less comprehensive risk-based entities known as Prepaid Inpatient Health Plans (PIHPs) or Prepaid Ambulatory Health Plans (PAHPs). PIHPs and PAHPs are subject to Federal regulations in 42 CFR Part 438, and not section 1903(m) of the Social Security Act. |
| Question—Does CMS intend that the UPIC will be requiring Medicaid managed care audits of PIHPs and PAHPs, and if so, should the UPIC SOW be clarified that audits of Medicaid risk-based entities include those entities subject to both section 1903(m) of the Social Security Act and regulations at 42 CFR Part 438? | CMS anticipates that UPICs will coordinate information for all managed care entities and the providers within those entities. | ||||||
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 17 & 22 | 5.2 | 5.2. states that the UPIC shall be prepared to work in CMS systems with CMS as the owner of the data, algorithms, statistical methods, and results. Yet section 4.1.4 refers to a description of the software systems, products, and tools that are proposed for use, including the licensing restrictions. If CMS owns the data and statistical methods what additional licsesning software is CMS envisioning UPICs will offer? | CMS requires a description of any software or systems that the contractor uses to meet requirements set forth in the SOW. | |
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 29-30 | 5.3.1 | The term “contractor” is used generically in 5.3.1.b. To what specific contractor is this referring? It is assumed that this means the UPIC contractor, but to be sure, might it also apply to other contractors’ work that support UPIC activities (e.g., MACs, RACs, etc.)? | The language refers to the UPIC. | |
| ERROR:#REF! | Business | J.1 Unified Program Integrity Contract USOW | Appendix D, XX | 2 | For pricing purposes, should the UPIC assume that the current contractors (ZPICs, PSCs, and MICs) will transfer active, pending and closed paper cases files to the UPIC? Is there a volume that the UPIC should assume? | See assumptions. | |
| ERROR:#REF! | Business | J.1 Unified Program Integrity Contract USOW | Appendix D, XX | Please confirm that the UPIC may image paper records, destroy the paper case file and store the image in accordance with policy. | CMS confirms that the UPIC should follow the policy as written. | ||
| ERROR:#REF! | Business | J.1 Unified Program Integrity Contract USOW | Appendix D, XX | For pricing purposes, can CMS provide the historical volume of case files/routine records that have been subject to direct release under FOIA in the past year for the proposed UPIC Jurisdiction 1 current contractors. | This information is unavailable. | ||
| ERROR:#REF! | Technical | J.1 Unified Program Integrity Contract USOW | 5.2.2.c) | Please note that the names and status of the health care databases, both internal and external to CMS are subject to change at any time and CMS expects that the UPIC shall be flexible and able to adapt as needed. | |||
| Question- To accurately plan for changes, adaptibility and flexibility, please provide the historical frequency of name and status change for healthcare database changes. | The information is unavailable. | ||||||
| ERROR:#REF! | Technical | J.1 UPIC USOW & J.6.B UPIC J1 TO SOW | multiple | multiple | We request that CMS define the following terms in the context of the UPIC program to provide more clarity to bidders: |
• Data Storage
• Data Warehouse
• Database
| • Datasets | CMS believes these terms are commonly understood. | ||||||
| ERROR:#REF! | Business | J.15 Award Fee Plan | 6-9 | 5.0 PERFORMANCE CRITERIA, WEIGHTS AND STANDARDS | Overall, the award fee plan is based on subjective criteria that are judged solely at the discretion of CMS. We would ask that CMS consider moving to more objective criteria that can be more easily reported on and agreed to by both CMS and the contractor. | CMS acknowledges this comment. | |
| ERROR:#REF! | Business | J.15 Award Fee Plan | 9 | 6.0 EXCELLENCE AWARD | While we agree that all stakeholders should contribute to the ROI and overall success of the program, the excellence award does not seem appropriate to be taken out of the award fee since the contractor does not have control over the decisions being made that ensure the program successful. It would be more appropriate for the excellence award to be above and beyond the award fee proposed by each contractor. Will CMS consider taking the excellence award out of the award fee? | CMS stands by the approach to determining the excellence award fee. | |
| ERROR:#REF! | Technical | J.2 Unified Program Integrity Contract USOW Appendices | 22-23 | UPIC SOW 5.2 | Can CMS provide a historical count of how many data analyses are performed quarterly and/or annually? Can CMS provide a count of analyses models / methods / algorithms that are currently available? Can CMS provide a count of investigations that have resulted from analyses on a quarterly and/or annual basis? Can CMS provide a historical count of how many new analytical methods have been created quarterly and / or annually that when run against the various data sets produce leads to be investigated? | Given the changing nature of the FWA landscape, this information may not be applicable. It is CMS' expectation that the contractor shall identify their best approach to identifying data analyses' count, a count of models, methods and algorithms, identifying investigations resulting from analyses and identifying new analytical methods. | |
| ERROR:#REF! | Technical | J.2 Unified Program Integrity Contract USOW Appendices | vi | Attachment A | Is the Data Matching Protocol document that is due within 30 days on contract award as specified in Attachement A in J2_Unified_Program_Integrity_Contract USOW_Appencices.doc page vi a general protocol, and then a specific one will be required for each state as specified in the document same document, Attachment G, page ci and cxxxii? | No, the data matching protocol shall be specific to each state. The timeframe for submitting the protocol is revised to 60 days to allow adequate time. | |
| ERROR:#REF! | Technical | J.2 Unified Program Integrity Contract USOW Appendices | iv | A | Will CMS add the following to the top of the UPIC Appendix A, as was done in the ZPIC Appendix A, to establish important shared expectations? |
- "Deliverable dates that fall on a weekend or holiday shall be due on the first subsequent business day after the weekend or holiday."
| - "CMS will provide comments on deliverables within 15 calendar days or will notify the contractor of an extension of CMS’ review timeframe. If no comments or extension are provided within this timeframe, then the deliverable will be considered approved and finalized. It will not be necessary to resend the unchanged Draft as Final." | CMS will include the first shared expectation. CMS does not plan to include the second expectation. | ||||||
| ERROR:#REF! | Technical | J.2 Unified Program Integrity Contract USOW Appendices | iv | A | The "Frequency" column in the Appendix A Deliverables List frequently identifies a number of "days", such as: "Once-within 10 days of contract award". Are all references to "days" to be calendar days or business days? This must be established as a shared expectation or different parties could anticpate different calculated due dates. Please document this at the top of Appendix A. | References to "days" will be "business days," unless noted otherwise. Language has been added to Appendix A to clarify the expectation for business days. | |
| ERROR:#REF! | Technical | J.2 Unified Program Integrity Contract USOW Appendices | iv | A | For deliverables identified as due "Monthly" or "Quarterly, please identify in the "Frequency" column: |
1) In what month it is to begin.
2) On what day in the month it is due.
3) For Quarterly deliverables, please additionally identify in what month in the quarter it is due.
Examples:
"Monthly, on the 20th of each month, beginning after Award" "Monthly, on the 20th of each month, beginning after Go-Live"
| "Quarterly on the 20th of January, April, July, December, beginning after Go-Live" | The deliverable schedule in Appendix A has been updated to include clarifications on when deliverables are due. | ||||||
| ERROR:#REF! | Technical | J.2 Unified Program Integrity Contract USOW Appendices | iv | A | For deliverables identified as due "Once" please identify when it is due. For example, for the "Workload Closeout Risk Management Plan", how many days before the end of the contract period is it due? | The deliverable schedule in Appendix A has been updated to include clarifications on when deliverables are due. | |
| ERROR:#REF! | Technical | J.2 Unified Program Integrity Contract USOW Appendices | iv | A | For deliverables identified as due "During Implementation period", please identify the number of days after contract award. | The deliverable schedule in Appendix A has been updated to include clarifications on when deliverables are due. | |
| ERROR:#REF! | Technical | J.2 Unified Program Integrity Contract USOW Appendices | iv | A | For the "Kickoff meeting with CMS", please identify CMS' expectation regarding the number of work days after contract award in which this meeting should take place. | The UPIC is required to complete the kick off meeting within 10 business days of award. The USOW has been revised to reflect this requirement. | |
| ERROR:#REF! | Technical | J.2 Unified Program Integrity Contract USOW Appendices | iv | A | For the "Monthly Status Report", please consider setting the Frequency as: "The 20th of each month reporting events ocurring in the preceding calendar month" so that the content of this narrative status report then aligns with the content of the Cost Report, which is already due "The 20th of each month". | The UPIC is required to submit the monthly status report on the 20th of the month. Appendix A is revised to reflect this requirement. | |
| ERROR:#REF! | Technical | J.2 Unified Program Integrity Contract USOW Appendices | iv | A | Please sequentially number the deliverables listed in Appendix A. This is extremely valuable when CMS and contractors must make reference to specific deliverables. | The deliverables are identified by name and we believe this is sufficient. | |
| ERROR:#REF! | Technical | J.2 UPIC USOW Appendices | vii | A | Can CMS confirm that the Stakeholder Education Plan and State Education Report deliverables relate to UPIC SOW 5.11.2 and 5.11.3 respectively and not 6.11.2 and 6.11.3 as stated in the Deliverables schedule? | CMS confirms that the Stakeholder education plan and Stated Education report deliverables related to UPIC SOW 5.11.2 and 5.11.3 and have revised the deliverable schedule to the correct SOW citation. | |
| ERROR:#REF! | Other | E.2.B UPIC J1 Business Proposal Spreadsheet CLIN 0002 | 2-4 | This question pertains to all 5 of the UPIC J1 Business Proposal Spreadsheets (CLIN 0001 through CLIN 0005) and to all 3 of the SLIN worksheets contained therein (SLIN 0001AA-MIP; SLIN 0001AB-DRA; SLIN 0001AC-Medi-Medi): Task C5.4.4, Appeals Support is actually a subtask that is included in Task 5.4, Investigations. Since CMS has extracted the Appeals Support subtask (C5.4.4) out of the Investigations task (C5.4) and listed it separately on the spreadsheets, should Task 5.4, Investigations state "Task 5.4 Investigations (net of C5.4.4 Appeals Support)? | Correct-offerors will identify costs associated with investigations in the Investigations columns minus appeals support which is broken out separately. | ||
| ERROR:#REF! | Other | E.2.B UPIC J1 Business Proposal Spreadsheet CLIN 0002 | This question pertains to all 5 of the UPIC J1 Business Proposal Spreadsheets (CLIN 0001 through CLIN 0005) and to all 3 of the SLIN worksheets contained therein (SLIN 0001AA-MIP; SLIN 0001AB-DRA; SLIN 0001AC-Medi-Medi): The SLINs are obviously the funding sources for this bid. Is it accurate to assume the following: (1) that any level of effort attributable to Medicaid is mapped to the MIP SLIN; (2) that any level of effort attributable to Medicare is mapped to the DRA SLIN; and (3) that any level of effort attributable to Medi Medi is mapped to the Medi Medi SLIN? | This is correct | |||
| ERROR:#REF! | Other | E.2.B UPIC J1 Business Proposal Spreadsheet CLIN 0002 | This question pertains to all 5 of the UPIC J1 Business Proposal Spreadsheets (CLIN 0001 through CLIN 0005) and to all 3 of the SLIN worksheets contained therein (SLIN 0001AA-MIP; SLIN 0001AB-DRA; SLIN 0001AC-Medi-Medi): Upon reading the Statement of Work, it appears that there is some level of effort that needs to be developed for tasks that were not included on the business proposal spreadsheets. They are as follows: Task 5.5 Cost Report Audits and Reviews, Task 5.6 Medical Review Requirements, Task 5.7 Edits, Task 5.9 Support to States, Task 7.1 Meetings, Workgroup, and Conferences, and Task 7.2 Joint Operating Agreements. Should the aforementioned tasks be added to the spreadsheet? If not, which of the existing tasks on the spreadsheet should each one of them be added to? | Cost report audits and reviews will be billed under Investigations. Medical review, edits, support to states, meetings and JOAs may fall under more than one category depending on the focus of the activity. | |||
| ERROR:#REF! | Other | E.2.B UPIC J1 Business Proposal Spreadsheet CLIN 0002 | This question pertains to all 5 of the UPIC J1 Business Proposal Spreadsheets (CLIN 0001 through CLIN 0005) and to all 3 of the SLIN worksheets contained therein (SLIN 0001AA-MIP; SLIN 0001AB-DRA; SLIN 0001AC-Medi-Medi): Is it acceptable to CMS if we rearrange tasks within each of the spreadsheets so that they are presented in numerical sequence or do we have to leave them as shown? | Please leave the tasks in the order shown. | |||
| ERROR:#REF! | Business | J.6.B _UPIC_J1_Task_Order_SOW | Atts E.2.a through E.2.E | • E.2.A.UPIC J1 Business Proposal Spreadsheet CLIN 0001 |
• E.2.B.UPIC J1 Business Proposal Spreadsheet CLIN 0002
• E.2.C.UPIC J1 Business Proposal Spreadsheet CLIN 0003
• E.2.D.UPIC J1 Business Proposal Spreadsheet CLIN 0004
• E.2.E.UPIC J1 Business Proposal Spreadsheet CLIN 0005 Attachment J.1 UPIC USOW includes the following eleven (11) functional requirements which are not listed on the Task Order J1 business proposal spreadsheets; E.2.A – E.2.E UPIC J1 Business Proposal Spreadsheets CLIN 0001-CLIN 0005.
Please confirm that the Offeror does not need to track costs by the following categories for Jurisdiction 1 SLINs; Medicare…
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