Amendment_000005_RAC_AB_QA_.docx

Exhibit E.2 Questions and Answers – HHSM-500-2016-RFP-0003

REQUEST FOR QUOTE QUESTIONS (RFQ):

Question #1 Section/ Page Number: Section B.2 Schedule of Services / p.6 Question: “Each Region will have an Administrative and Appeals Option.” Can CMS explain what this means? Is it optional?

CMS Answer for Question #1: At any time during the Recovery Audit Program, CMS may exercise the optional task of contract closeout and reconciliation. When CMS exercises this optional task, now referred to as the Closeout and Reconciliation Option, Recovery Auditors will cease active recovery auditing. This task may continue for up to two years.

The contract closeout and reconciliation period will only involve administrative activities. During this period CMS will continue to recoup funds from providers on improper payments identified during the previous active recovery auditing periods, allow the Recovery Auditor to invoice for contingency payments on eligible claims, require the Recovery Auditor to support the appeal process, and allow CMS to recoup from the Recovery Auditor contingency fees from overturned appeals.

Question #2 Section/ Page Number: Section B.2 Schedule of Services / p.6 Question: “CMS reserves the right to extend the contract until such time as all pending appeals are dispositioned.” Does the RA have to execute a modification in order for that extension to occur?

CMS Answer for Question #2: Yes.

Question #3 Section/Page Number: RFP Section B.2 Schedule of Services, Page 6 Question: Would CMS provide guidance on region-specific differences and/or anomalies that may limit availability of claims for audit? Specifically, are there providers or regional issues that exclude providers from audit?

CMS Answer for Question #3: There are several conditions or circumstances that may impact the universe of Medicare claims available for review by the Recovery Auditors. For example, any of the following may alter the volume or character of available claims: governmental and Congressional pronouncements, changes to Medicare coverage determinations at the national and local level, and CMS stakeholder activities (e.g., Medicare demonstrations, reviews by other Medicare auditors which target specific providers, claim types, service codes, etc.). Due to some systems limitations, areas with large amounts of providers receiving Periodic Interim Payments (PIP) may not be available for immediate review. Additionally, geographic areas with a high concentration of fraudulent providers who may be suppressed for other CMS program integrity and/or Federal law enforcement investigations could affect the providers/claims available for audit.

Question #4 Section/Page Number: RFP Section B.2 Schedule of Services, Page 6 Question: What is the annual FFS claims volume and claims paid amount by provider type for the most current complete Calendar or Federal Fiscal Year (e.g., hospital inpatient, hospital outpatient, physicians/non-physician practitioner, laboratory, ambulance, skilled nursing facilities, inpatient rehabilitation facilities, critical access hospitals, long term care hospitals, ambulatory surgical centers, etc.) by state for all states included in the scope of this contract?

CMS Answer for Question #4: See http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Statistics-Reference-Booklet/Downloads/CMS_Stats_2014_final.pdf #tableiii4, specifically Table III.6

Question #5 Section/Page Number: RFP Section B.2 Schedule of Services, Page 6 Question: It is not clear whether offerors’ proposed contingency fees will be evaluated to determine whether the fees are realistic for the work to be performed, or whether the fees reflect an accurate understanding of the technical requirements. Please clarify whether CMS will evaluate proposed contingency fees for realism.

CMS Answer for Question #5: Offerors have to be deemed technically acceptable to be considered for award. Cost realism will not be applied in the review of contingency fees.

Question #6 Section/Page Number: RFP Section B.2 Schedule of Services, Page 6 Question: Under the existing contract, CMS has asked Recovery Auditors to invest in enhancements to the provider portal, secure messaging and modifications to the audit technology. Additional examples include, changes to the audit due dates, ADR limits, suspense of adjustment files, correspondence confirmation letters, and multiple RACDW changes.

· Is there an expectation of vendors to support additional projects outside the scope of the SOW?

· If so, would CMS reference specific projects and technologies that may require investment so that each contractor can plan for the additional cost?

· Will CMS provide a fee increase for one-time payment or doing additional work?

CMS Answer for Question #6: There are no expectations that Recovery Auditors will be required to support additional projects outside of the scope of the Statement of Work.

Question #7 Section/Page Number: RFP Section B.2 Schedule of Services, Page 6 Question: Under the current contract, fixed costs incurred by Recovery Auditors have been estimated at over $3-5M annually, which are not covered by the current fee plus allowable scope of work.

· Does CMS anticipate changes to the program that will offset this gap?

CMS Answer for Question #7: Offerors should propose contingency fee rates necessary to cover anticipated administrative and operational costs. CMS does not anticipate changes to the program based on these fixed administrative costs.

Question #8 Section/Page Number: RFP Section B.2 Schedule of Services, Page 6 Question: Would CMS contemplate a pricing structure with fees tied to specific audit volume tiers within a region?

· For example, 1,000-2,000 and 2,000-3,000 inpatient monthly audits?

· Or, based on increases to the inpatient ADR limits by percentage?

CMS Answer for Question #8: CMS will not allow a pricing structure with fees tied to audit volume or based on increases to inpatient ADR limits. However, CMS has revised the RFP to allow Offerors to elect to propose different contingency fees depending on the type of review.

Question #9 Section/Page Number: RFP Section B.2 Schedule of Services, Pages 6-7 Question: Would CMS explain the different option periods for different Regions, and why they vary?

CMS Answer for Question #9: CMS believes it is in the best interest of the government to have varying periods of performance so in future procurements CMS can procure each region separately, without interruption to the entire Recovery Audit Program.

Question #10 Section/ Page Number: Section B.2 Schedule of Services / p.6-7 Question: The RFP describes the different number of option periods on each Region. Can CMS share the lengths of the base and option periods for these CLINS?

CMS Answer for Question #10: Please see the amended solicitation. The number of months for each CLIN has been included.

Question #11 Section/Page Number: RFP Section B.3 Schedule of Payments, Page 8 Question: Recovery Auditors develop algorithms and analyze claims data to identify claims likely to have improper payments. Once a medical record is requested, providers often perform an internal review. Sometimes the provider knows the Recovery Auditor will identify the record as improper, so the provider refunds the payment. These refunds are a direct result of Recovery Audit activities, time, expense of mailing a letter, provider service calls, etc. and would not have been disclosed by the provider if not for the Recovery Auditor. In cases such as these, why is the Recovery Auditor not entitled to a contingency fee for voluntary refunds from providers that are a direct result of Recovery Audit activity?

CMS Answer for Question #11: The Recovery Auditor will receive their fee if the request is for the same claims involved in the refund. Task 1, Section M (i) states in relevant part that “If a provider voluntarily refunds an overpayment for improperly paid claims after the Recovery Auditor issues an ADR or review results letter for the exact claims involved in the refund, the Recovery Auditor will receive their contingency fee for those corrections.”

Question #12 RFP Section/ Page Number: B. 3 Schedule of Payments/ page 8 Question: The RFP payment terms outlined in section B.3 Schedule of Payments do not align with the requirements of FAR Part 12 Subpart 12.2 Special Requirements for the Acquisition of Commercial Items. The timeline for payment terms places financial hardship on the Recovery Auditor, as it must wait for payment until conclusion of the second level of appeal. Has CMS received a waiver for the ability to include payment terms that differ from commercial practices, or is there another basis on which CMS has determined it can diverge from those terms?

CMS Answer to Question #12: Market research undertaken by CMS suggests that in the commercial marketplace, Recovery audit contractors generally are paid a contingency fee when the debt is recovered. As a result, CMS has obtained a waiver IAW the FAR for its requirements relating to when the RAC’s can invoice for their contingency fees.

Question: Will CMS consider an alternate strategy where the RAs are paid a percentage of their contingency fee based on their historical appeal denial rate, when the RA has maintained a minimum percentage level of overpayments upheld through the second level appeal?

CMS Answer for Question #12: No

Question #13 Section/Page Number: RFP Section B.3 Schedule of Payments, Page 8 Question: Would CMS please clarify the sequencing and timeline for the recoupment process? Specifically, will the MACs complete the recoupment process in accordance with existing procedures/timeframe or will this be modified under this contract?

CMS Answer for Question #13: Recoupment under this contract will follow all typical MAC recoupment process in accordance with the Medicare Financial Management Manual, Section 10, Subsection 2 (Recoupment). This section addresses offset on Day 41 (if no valid, timely appeal is received); however, MAC processes may change.

Question #14 Section/Page Number: RFP Section B.3 Schedule of Payments, Page 8 Question: If a provider appeals a claim, the following appeal timeframes are applicable:

· 120 days to file the first level of appeal (MAC)

· 60 days for the MAC to render a decision

· 180 days to file a 2nd level appeal (QIC)

· 60 days for the QIC to render a decision

This means that up to 420 days could pass before a claim exits the second level of appeal. Please confirm that a Recovery Auditor may have to wait more than 420 days from the date of the demand letter date to invoice for their contingency fee. It would seem that this will encourage providers to appeal every finding in an attempt to clog the system. What controls does CMS intend to put in place to control this?

CMS Answer for Question #14: It is possible that in some cases a Recovery Auditor may have to wait more than 420 days from the date of the demand letter date to invoice for the contingency fee. Your question highlights the maximum timeframes, and appeals frequently do not use the maximum amount of the regulatory timeframe. Additionally, many RAC determinations are not appealed.

CMS consistently monitors appeals data in the Recovery Audit Program for purposes of program oversight. However, CMS is unable to control or direct providers on the frequency or appropriateness of appealing RAC determinations.

Question #15 Section/Page Number: RFP Section B.3 Schedule of Payments, Page 8 Question: MACs and QICs currently have a backlog of cases and are not finalizing decisions within the required time period (60 days from the date the appeal is filed). If this continues, the Recovery Auditors right to invoice for a recovery can be delayed for more than one year from the demand letter date. If a claim does not leave the appeal process due to a delay in performance by the MAC or QIC, will the Recovery Auditor be allowed to invoice after the timeframe to issue a decision passes?

CMS Answer for Question #15: No, the Recovery Auditor will be able to invoice only after acceptance, which is when the appeal has exited the 2nd level or the 120 day deadline to appeal has passed.

Question #16 Section/ Page Number: Section B.3 Schedule of Payments / p. 8 Question: RAs cannot invoice until improper payments are collected and the provider’s deadline to file an appeal with the MAC has passed, the provider’s deadline to file an appeal with the QIC has passed, or the QIC has issued an unfavorable decision to the provider. Please confirm that, if a provider files an appeal with the QIC disputing an RA finding, an RA could have to wait 420 days to invoice for the work performed on that claim.

CMS Answer for Question #16: See response to question #14

Question #17 Section/ Page Number: Section B.3 Schedule of Payments / p. 8 Question: These contracts come with significant fixed costs, including but not limited to retaining Key Personnel and maintaining an ATO environment. Under the payment terms, RAs will have to wait at least six months and in most cases at least 420 days to invoice for their work on a claim. Given the significant costs of setting up the Program, can CMS relax the payment terms during the first year of the contract so that RAs can offset these costs?

CMS Answer for Question #17: No changes will be made to the timing of acceptance, invoices or payments.

Question #18 Section/ Page Number: Section B.3 Schedule of Payments / p. 8 Question: Do RAs have to wait the full 120 days following a demand letter, to allow for a provider appeal to the MAC, before invoicing on underpayments?

CMS Answer for Question #18: No.

Question #19 Section/ Page Number: Section G – Contract Administration Data, G.1.d / p. 16 Question: Do invoices need to be sent via any one of the three options? Currently, we send both email and hardcopy.

CMS Answer for Question #19: Offerors should submit their invoices in accordance with section C.1 of the solicitation.

Question #20 Section/ Page Number: Section G.11 Dissemination, Publication and Distribution of Information / p. 22 Question: Please define what is meant by “data from a non-restrictive source.”

CMS: This Section has been removed from the solicitation.

Question #21 Section/ Page Number: Section B.3, Schedule of Payments, page 8 of 96 and SOW, Task 2 - Utilization of the Data Warehouse, Sub C. Recovery Auditor Data Warehouse Reporting and Recovery Auditor Invoices/Page 37 Question: Per Section B.3, the RAC cannot invoice for any completed services until the claims have exited the second level of the appeals process. Providers have 120 days to submit their first appeal with a 60 day determination time frame and 180 days from the first level appeal determination to submit their second appeal. The QIC has 60 days to provide their determination. So, effectively the RAC cannot invoice for 420 days (120+60+180+60) after completion of the services. The invoicing process requires the RAC to finance the entire cost of operations for over a year and the RAC has an additional burden of monitoring when services associated with the claim review can be invoiced, increasing the cost of operations. This payment provision is not consistent with customary commercial practice, and it puts a severe financial burden on the RAC.

Offeror respectfully requests the ability to invoice for services at the time the claim elements are submitted to the Data Warehouse.

If CMS will not remove this term, please provide an explanation of CMS’s basis for the inclusion of this term?

CMS answer to Question 21: See response to question #12.

Question #22 Section/ Page Number: Section I.3, 52.204-14, SERVICE CONTRACT REPORTING REQUIREMENTS (JAN 2014) / page 54 Question: Offeror understands the concept behind the Service Contract Reporting requirements which allows the government to understand its contractor work force. Given the contingency fee structure of the contract, the fact that there will be no value stated in the resultant contract, and the disconnect between invoices for services rendered and direct labor hours expended on an annual basis, offeror respectfully requests that CMS delete this provision.

CMS Answer for Question #22: This clause has been removed.

Question #23 -- Section/ Page Number: Section I.5 FAR 52.217-8 Option to Extend Services / p. 55 Question: The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. Does this mean each option period will be no greater than 6 months?

CMS Answer for Question #23: No, the option periods identified in Section B.4 have different periods of performance which do not relate to the FAR clause 52.217-8 Option to Extend Services. This clause allows the Government to extend the contract beyond the identified options in Section B.4 without having to do a justification for other than full and open competition.

Question #24 -- Section/ Page Number: Section I.10 HHSAR 352.239-70 STANDARD FOR SECURITY CONFIGURATIONS (JANUARY 2010), Page 60 Question: In subsection (c), “[t]he Contractor shall use Security Content Automation Protocol (SCAP)-validated tools with FDCC Scanner capability…”. If a Contractor currently participates in the CMS Continuous Monitoring Program Enterprise Vulnerability Management Program (CMP/EVMP) which uses SCAP validated scanners operated by CMS, does this fulfill the requirement?

CMS Answer for Question #24: Yes, the above example fulfills the requirement. However, this clause has been removed due to a HHSAR update.

Question #25 Section / Page Number: Section I.10 HHSAR 352.239-70 STANDARD FOR SECURITY CONFIGURATIONS (JANUARY 2010), p. 61 Question: In subsection (f), the clause requires the Contractor to purchase card readers and use Personal Identity Verification (PIV). If the contractor uses other multi-factor technology internally and there is no need for CMS personnel to authenticate to the system, are PIV cards still required?

CMS Answer for Question #25: This clause has been removed due to a HHSAR update.

Question #26 Section / Page Number: Section K.2 FAR 52.204-7 System for Award Management, a Definitions, (b)(2), p. 64 Question: The text refers the offeror to “enter, in the block with its name and address on the cover page of its offer…” Is CMS referring to a block in Standard Form 33 or another document such as a cover letter? If SF 33, are you referring to block 15A?

CMS Answer for Question #26: Solicitation has been amended.

Question #27 Section/Page Number: RFP Section K.3 FAR 52.204-8 Annual Representations and Certifications (Dec 2014), Page 65 Question: Does CMS have a small business subcontracting goal for this RFP?

CMS Answer for Question # 27: No, since these contracts do not have funding obligated to them CMS will not be mandating small business subcontracting goals.

Question #28 Section / Page Number: Section L, L.3 FAR 52.215-1 Instructions to Offerors – Competitive Acquisitions (Jan 2004) (Deviation), (c), (2) The first page of the proposal must show, (i), (ii), (iii), (iv), (v)/ p. 71.

Question: Is CMS asking the offeror to add the requirements ((i), (ii), (iii), (iv), (v)) to the Cover Page document provided? Or is this information to be acknowledged in a cover letter?

CMS Answer for Question #28: Solicitation has been amended.

Question #29 Section/ Page Number: Section L.3 FAR 52.215-1 Instructions to Offerors – Competitive Acquisition, (f) Definitions / p. 74.

Question: Section L.3(f)(1) of the solicitation, “Contract award”, found on page 74 of the RFP, provides that, “The Government intends to award a contract or contracts resulting from this solicitation to the responsible offeror(s) whose proposal(s) represents the best value after evaluation in accordance with the factors and subfactors in the solicitation”. Section M.1. of the solicitation, “General Procedures for Award of Contracts”, found on page 88 of the RFP, provides that, “The Centers for Medicare & Medicaid Services (CMS) will conduct a comprehensive evaluation of all proposals and select the offer based upon an assessment of the technical and business proposals that, in the Government’s estimation, provides a technically acceptable approach to performing the Statement of Work while providing the lowest price/firm fixed contingency fee percentage to the Government.” Accordingly, there is an inconsistency in the solicitation’s stated source selection criteria. Please respond to the following regarding the source selection criteria:

· Please clarify if the basis for source selection will be “best value” or “low fee technically acceptable.”

· If CMS intends to make source selection decisions on the basis of low fee technically acceptable criteria, we request that CMS instead utilize best value source selection for the RAC contracts. CMS’s primary need for the RAC program is to contract with entities that can maximize Medicare Trust Fund recoveries within the audit parameters CMS establishes. In evaluating the proposals for purposes of making a source selection decision, the level of the contingency fee is significantly less important than the capability and capacity of an offeror to effectively perform audits and to maximize Medicare Trust Fund recoveries. The concern would be that new bidders will base their contingency rate unrealistically on fees realized by the current contractors and not be aware of the changes to the program that significantly impact costs per review and drive revenue downward. By using a technically acceptable/ low bid source selection, CMS might find itself with a contractor unable or unwilling to perform the work at the fee rates bid once the full scope of the project is understood.

CMS Answer for Question #29: The solicitation has been amended and the basis for source selection will be lowest price, technically acceptable.

Question #30 Section/ Page Number: Section L.3 FAR 52.215-1 Instructions to Offerors – Competitive Acquisition, (f) Definitions / p. 74.

Question: Can CMS share how proposals will be rated, including the rating criteria and scales?

CMS Answer for Question # 30: The Evaluation Factors for Award can be found at Section E.

Question #31 Section/Page Number: RFP Section L.7 General, Page 77 Question: What is the anticipated award date and start date?

CMS Answer for Question #31: CMS estimates the contract award and start date to be in the Summer of 2016.

Question #32 Section/Page Number: RFP Section L.7 General, Page 77 Question: What is the anticipated period of transition between outgoing and incoming Recovery Auditors?

CMS Answer for Question #32: The CMS does not anticipate a significant gap between when the outgoing Recovery Auditor receives its last batch of medical records and when the incoming Recovery Auditor may begin to send ADRs; however, at no time will providers have to submit medical records to two different Recovery Auditors, submit medical records more frequently than every 45 days, or submit records above the current ADR limits.

Question #33 Section/Page Number: RFP Section L.7 General, Page 77 Question: If CMS will not be able to respond to the offerors’ questions within the timeframe outlined in the RFP, will CMS issue an extension to the due date?

CMS Answer for Question #33: Yes.

Question #34 Section/Page Number: RFP Section L.8 Proposal Organization, Page 78 Question: Please confirm resumes for Key Personnel can be provided in an appendix outside of page count.

CMS Answer for Question #34: Yes.

Question #35 Section/Page Number: RFP Section L.8 Proposal Organization, Page 78 Question: For the technical proposal, can an appendix be used?

· If so, will the pages in the appendix be counted towards the 50 page limit?

· What can/cannot be included in an appendix?

CMS Answer for Question #35: Appendices will not count toward the page limit. Appendices should include resumes, organizational charts, letters of intent, past performance disclosures, and any relevant financial information.

Question #36 Section/ Page Number: L. 8 Proposal Organization c. / page 78 Question: Font size is identified as Times New Roman 12. Would the Government consider allowing Offerors to use Arial Narrow 10 for graphics and tables?

CMS Answer for Question #36: Yes, graphics and tables may use Arial narrow 10.

Question #37 RFP Section/ Page Number: L.7 GENERAL, Specifications for CD submissions / page 78 Question: Please confirm that Microsoft Office 2007 is the correct version for compatibility of files.

CMS Answer for #37: No, Microsoft Office 2010 is the correct version.

Question #38 Section / Page Number: Section L.11. Submission of Proposals / p. 79-80.

Question: If an offeror has the same technical approach and proposed firm fixed contingency fee for more than one region, the offeror can indicate that in their proposal and only submit one proposal for those regions. If an offeror has the same technical approach, but a different firm fixed contingency fee for more than region, can the offeror submit one proposal but indicate on its cover letter what the firm fixed contingency fee proposed for each region is?

CMS Answer for Question #38 – The Offeror shall include this information in attachment Exhibit E.1 Proposed Contingency Fee. The cover sheet is to identify which regions an offerors proposal applies to.

Question #39 Section / Page Number: Section L.12.A. Technical Approach for Identifying Improper Payments, Page 81 Question: The written technical proposal shall not exceed fifty (50) pages. Please confirm that the page limit does not include: documents related to Key Personnel, resumes, organizational charts, and financial information.

CMS Answer for Question # 39: See response to question #35 Question #40 Section/Page Number: RFP Section L.12.A. Technical Proposal Instructions (Volume I), Factor 1, Sub-Factor 1; Page 81 Question: The RFP requests examples of past performance on projects of similar size and complexity. Since the federal RAC contracts are the largest projects of their kind in size and complexity, does this requirement eliminate non-incumbents from consideration, as there are no projects of similar size that non-incumbents could use to fulfill this requirement?

· If no, will CMS please provide examples of other projects of similar size and complexity that would be acceptable?

CMS Answer for question #40 –. This requirement does NOT eliminate non-incumbents. The Offeror should use its judgment to showcase contracts that are most relevant to the services required under the Recovery Audit Program contract, as well as contracts that are of similar complexity or size.

Question #41 Sections/Page Numbers: Sections G.6/p. 20; G.10/p.22; G.11/p.22; H.1/p. 25; H.2/p. 35; H.10/p.47; I.1/p.50; I.3/p.54; I.7/p. 56; I.10/p.60; J/p.62; L.3/p.70; and L.12/p.81, 85, 86.

Question: Can CMS better define the term, “subcontractor,” as referenced in these sections? Subcontractor is generally referred to as an entity that enters into a subcontract – an agreement entered into by a [g]overnment prime contractor . . . calling for supplies and/or services required for performance of the contract (FAR 19.701). However, the term subcontractor can also refer to a supplier, distributor, vendor or firm that furnishes supplies or service to or for a prime contractor (FAR 44.101). The more general definition of subcontractor, under FAR 44.101, would include traditional overhead or administrative expenses that are not required for performance of the contract. However, the more specific, and widely recognized definition, under FAR 19.702, would generally not include such overhead and administrative expenses.

CMS Answer for Question #41: As noted above, In accordance with FAR 44.101 a subcontractor means any supplier, distributor, vendor, or firm that furnishes supplies or services to or for a prime contractor or another subcontractor.

Question #42 Section / Page Number: Section L.12.A.1 Technical Approach for Identifying Improper Payments, Page 82 Question: Under Sub-Factor 4: Security Plan, the fourth bullet refers to “Core Security requirement 10.9.1”. Has this been superseded by the current version of the Internet-Only Manual (IOM) Pub 100-17 - CMS/Business Partners Systems Security Manual? If not, can you provide a reference?

CMS Answer for Question #42: Changes have been made to Sub-factor 4: Security plan to reflect IOM Pub 100-17 CMS/Business Partners System Security Manual as the principal authority. Generally, CMS policy is considered cumulative.

Question #43 Section / Page Number: Section Sub-Factor 3: IT Specifications / p. 82 Question: Please define what is meant by a “document management system.”

CMS Answer for Question #43: The criteria has been revised and no longer contains a reference to a document management system.

Question #44 RFP Section/ Page Number: L.12 PROPOSAL ORGANIZATION; A. TECHNICAL PROPOSAL INSTRUCTIONS (VOLUME I); Factor 1: Technical Approach for Identifying Improper Payments; Sub-Factor 2: Key Personnel and Staffing Plan / page 82 Question: If an offeror is submitting one proposal with the same technical approach and pricing covering multiple regions, providing Key Personnel resumes specific to each region will use additional pages within the 50-page technical volume. Would CMS consider excluding the additional Key Personnel resumes from the page count for multiple-region proposals (e.g. designate an Appendix for these resumes)?

CMS Answer for Question #44: See response to question #35

Question #45 Section / Page Number: Proposal Organization, Sub-Factor 6: Requesting Medical Records / p. 83 Question: The 3rd bullet states: “Process for properly documenting provider contract information on a provider portal.” Is the word “contract” meant to be “contact”?

CMS Answer for Question #45: The solicitation has been amended.

Question #46 Section/ Page Number: Section L.12 Proposal Organization, A.2. Past Performance / p. 84 Question: CMS defines relevant past performance as work that is similar in size, scope and complexity to this contract. Please clarify whether performing medical chart reviews in the Medicare managed care space would constitute relevant past performance.

CMS Answer: Based upon our interpretation of the nature of this work, we believe that in some cases, performing medical review of Medicare, managed care claims may constitute relevant past performance.

Question #47 Section/ Page Number: Section L.12 Proposal Organization, A.2. Past Performance / p. 84 Question: How will CMS determine the past performance of companies that haven’t worked for the RA program before?

CMS Answer for Question #47: CMS will assess work that is comparable or similar to the work required of the RACs, such as data analysis of health insurance claims and performing medical review. Please see Section E of the RFP for more information on the Evaluation Criteria

Question #48 Section/ Page Number: Section B. Business Proposal Instructions (Volume II), Page 85 Question: In the second sentence, the RFP refers to an excel spreadsheet as Exhibit E2. Can you please confirm if you actually are referring to Exhibit_E.1_-_Proposed_Contingency_Fee.xlsx?

CMS Answer for Question #48: This sentence has been revised.

Question #49 Section/ Page Number: L.12 Proposal Organization 2. b. 8. / page 85 – Past Performance Information Question: CMS has requested additional information on contracts for which performance was documented as “less than satisfactory”. Please confirm that documentation of "less than satisfactory" performance is based on government evaluations within the PPIRS system.

CMS Answer for Question #49 – The definition for satisfactory is performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory. An offeror shall submit additional information for which performance was documented to be less than the definition of satisfactory (i.e., Marginal or unsatisfactory).

Question #50 Section/Page Number: RFP Section 2.b. Page 85 and Attachment J.3, Past Performance Questionnaire Question: Are all offerors required to submit past performance questionnaires, or only offerors who do not have the relevant experience as described in Sub-Factor 1, Legislative Requirement?

CMS Answer: Yes, all offerors are required to submit past performance questionnaires.

Question #51 RFP Section/ Page Number: L.12 Proposal Organization; B. Business Proposal Instructions/ page 85 Question: Section B paragraph 1 - references an "excel spreadsheet (Exhibit E.2)". Please confirm this should be Exhibit E.1.

CMS Answer for Question #51: The solicitation has been amended.

Question #52 RFP Section/ Page Number: L.12 Proposal Organization; B. Business Proposal Instructions/ pages 85-86 Question: Two items from Section J, Attachment J.4 Subcontractor Checklist and Attachment J.6 Consent to Subcontract, inquire about the subcontractor’s cost or pricing data. Please clarify that subcontractor cost or pricing data is not required in the Business Proposal, due to the contingency fee contract type.

CMS Answer for Question 52: Cost or pricing data is not necessary for this procurement.

Question #53 Section/Page Number: RFP Section B.(d), Business Proposal Instructions (Volume II), Financial Capability, Page 86 Question: In order to evaluate an Offeror’s financial capability, what amount of financial resources must an Offeror demonstrate?

CMS Answer for Question #53: An offeror shall provide all the information stated in section E, B (c). An offeror must demonstrate that the offeror has adequate financial resources to sustain operations without any payment from CMS during the initial phases of the contract (at least one year) or for any period of work stoppage. “

Question #54 Section/Page Number: RFP Section M Evaluation Factors for Award, Page 88 Question: This section allows for bidders to offer different contingency fees for each contact year and indicates the values will be averaged to determine the bidder’s pricing for evaluation. However, Exhibit E.1. is in a format requiring only one single contingency fee. Would CMS clarify how a bidder is to respond correctly to the pricing section?

CMS Answer for Question #54: The solicitation has been amended.

Question #55 Section/Page Number: RFP Section M Evaluation Factors for Award, Page 88 Question: What’s the criteria to rate an offeror as acceptable versus unacceptable?

CMS Answer for Question#55: Please refer to section E of the solicitation.

Question #56 Section/Page Number: RFP Section M Evaluation Factors for Award, Page 88 Question: Are any of the Sub-Factors in Factor 1 weighted differently? If so, please indicate the order of importance.

CMS Answer for Question #56: CMS has revised the evaluation criteria to ensure that each sub-factor is of equal weight and that each criteria allows for a determination of technically acceptable or technically unacceptable. An offeror will be considered fully technically acceptable if they are rated as acceptable in all sub-factors as identified in Section E.

Question #57 Section/Page Number: RFP Section M Evaluation Factors for Award, Page 88 Question: In the evaluation, what weight, if any, will be given to the small business subcontracting plans of offeror’s that are considered other than small businesses?

CMS Answer for Question #57: Small business subcontracting plans are not required for this solicitation since it is a contingency fee type contract.

Question #58 Section/Page Number: RFP Section M Evaluation Factors for Award, Page 88 Question: How is past performance evaluated? Is Medicare recovery audit experience weighted more highly than other cost control contracts?

CMS Answer for Question #58: Past Performance will be evaluated in accordance with the terms in the solicitation. The currency and relevancy of the past performance will be considered.

Question #59 Section/Page Number: RFP Section M Evaluation Factors for Award, Page 88 Question: How will the past performance be evaluated for subcontractors? How will it be weighed against the prime’s past performance experience?

CMS Answer for Question #59: CMS plans to review all submitted past performance information for prime contractors and subcontractors by determining the following:

Currency and relevancy of the past performance will be considered for both the prime contractor and the subcontractor.

Question #60 RFP Section/ Page Number: M.1 General Procedures for Award of Contracts / page 88 Question: As CMS acknowledged in the TDL issued in November 2015, changes in ADR limits greatly impact the RA’s operating model and therefore warrant a change in the RA’s contingency fee. To expedite the process of adjusting contingency fees as a result of changing ADR limits throughout the contract, we recommend CMS allow offerors to bid multiple contingency fees based on predefined ADR limits – establishing a “rate sheet”. Would CMS consider this approach?

CMS Answer for Question #60: No.

Question #61 RFP Section/ Page Number: M.1 General Procedures for Award of Contracts / page 88 Question: Would CMS consider a contingency fee structure based on claim type?

For example, could the bid include higher contingency fees for physician claims, or must the annual contingency fee be standardized across all claims for each region bid?

CMS Answer for Question #61: No.

Question #62 RFP Section/ Page Number: M.1 General Procedures for Award of Contracts / page 88 Question: If CMS would accept a contingency fee structure based on claim type, and/or ADR limits, how would CMS weight differing contingency fee structures for different claim types within each CLIN, for the purpose of arriving at an overall contingency fee average as described on page 88 of 96 in the RFP?

CMS Answer for Question #62: CMS is not allowing a contingency fee structure based on claim type and/or ADR limits.

Question #63 RFP Section/ Page Number: M.1 General Procedures for Award of Contracts / page 88 Question: Is there any ability to establish separate contingency fees for CMS-prescribed reviews as described in Task 6, E. Referrals? Alternatively, would CMS consider allowing for adjustment of contingency fees if CMS-prescribed reviews reach or exceed a certain number or percentage of total claims review volume?

CMS Answer for Question #63: No.

Question #64 RFP Section/ Page Number: Section M - Evaluation Factors for Award / pages 88-96 Question: Regarding the evaluation approach described on page 88-96 of the RFP: do all factors have to be scored as acceptable in order for an offeror to be included in the competitive range?

CMS Answer for Question #64: The solicitation has been amended.

Question #65 RFP Section/ Page Number: Section M - Evaluation Factors for Award / pages 88-96 Question: If not all factors need to be scored acceptable for the competitive range threshold, is there a minimum number of factors that have to be scored as acceptable in order to be included in the competitive range?

CMS Answer for Question #65: The solicitation has been amended.

Question #66 RFP Section/ Page Number: Section M - Evaluation Factors for Award / page 89 Question: What does inclusion in the competitive range discussed on page 89 (based on technical and business components) signify given the government’s intention to award to the lowest fee contractor that meets an acceptable technical approach?

CMS Answer for Question #66: The solicitation has been amended.

Question #67 RFP Section/ Page Number: M.3 Technical Evaluation/ pages 90-95 Question: In determining if a factor is to be rated as acceptable, will CMS take into account the time an offeror requires to begin operations and ramp up the full project plan and level of activity CMS desires?

CMS Answer for Question #67: CMS will consider the information provided in the proposal by reference to the stated evaluation factors.

Question #68 Section/ Page Number: RFP, M.3 TECHNICAL EVALUATION/Factor 1, Sub-factor 1: Legislative Requirement /page 91 Question: As the RFP notes, under the Tax Relief and Healthcare Act, Section 302, CMS is required to “give preference to those risk entities that the Secretary determines have demonstrated more than 3 years direct management experience and a proficiency for cost control or recovery audits with private insurers, health care providers, health plans, under the Medicaid program under title XIX, or under this title.” In light of the requirement for a “preference” and the LPTA Acceptable/Unacceptable evaluation methodology, can CMS please clarify how an entity without the minimum three years of experience would be rated? If an entity without such experience would be rated as Acceptable, please explain how CMS will give preference, if any, to offerors that do possess such experience.

CMS Answer for Question 68: Section E – Evaluation factors for award has been updated to reflect how CMS will apply the statutory preference in awarding these contracts.

Question #69 Section/ Page Number: RFP, M.3 TECHNICAL EVALUATION/Note /page 95 Question: After explaining the technical evaluation factors but before explaining the price evaluation methodology, the RFP notes that “In the case of a tie, CMS will award to the Offeror who has demonstrated a better overall past performance.” Does this statement mean that if multiple offerors are rated as technically acceptable under the technical factors, CMS will award to the offeror with the superior past performance (regardless of price), or does this statement mean that CMS will compare offerors’ respective past performance records only if they are both technically acceptable and propose identical contingency fee rates?

CMS Answer for Question #69: The RFP has been updated to remove that sentence.

Question #70 RFP Section/ Page Number: M.4 Price Evaluation/Responsibility Determination / page 95 Question: Please clarify how CMS plans to evaluate price reasonableness in order to select a "technically acceptable" vendor with a realistic proposed firm fixed contingency fee.

CMS Answer for Question #70: Cost realism will not be applied to this solicitation. CMS has amended the solicitation.

Question #71 RFP Section/ Page Number: M.4 Price Evaluation/Responsibility Determination / page 95 Question: How will the review of financial capability statements factor into the contract award decision?

For example, will offerors without the capability to sustain operations without payment for one year be disqualified?

CMS Answer for Question #70: yes, CMS will review the financial capability statements to determine responsibility of the Offeror. Offeror’s who are found to be non-responsible, in accordance with FAR 9.104-1, will not be eligible for award.

Question #72 Section/Page Number: RFP General Question Question: Does CMS have a specific dollars recovered and/or a findings goal by region? If so, please provide.

CMS Answer for Question #72: Dollars recovered regionally from previous years may be found in CMS’ Recovery Audit Report to Congress (found in the Downloads section here: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/). CMS does not establish a findings goal.

Question #73 Section/Page Number: RFP General Question Question: If CMS is more interested in reducing the errors across all claim types, would CMS consider a per audit fee so that RA’s will be incented to work on low dollar claims? For example, for certain audit types with low dollar amounts, would CMS consider a fixed fee to more properly incentivize RAs CMS Answer for Question #73: No.

Question #74 Section/Page Number: RFP General Question Question: According to publicly available information, the recovery data for each region under the current contract is not relevant to the new contract based on the new scope that has decreased audit volumes and has additional limits. Based on that, what are the expectations for recovery limits on the new contract?

CMS Answer for Question #74: CMS does not have expectations for recovery limits.

Question #75 Section/Page Number: RFP General Question Question: Assuming an incumbent RA wins a region with the majority of the same states it has been auditing under the current contract, does CMS expect any kind of stop-work period that the RA should plan for? Or will it be business as usual for the states that remain in the region?

CMS Answer for Question #75: CMS does not anticipate a stop-work period for states that remain under the same Recovery Auditor.

Question #76 Section/Page Number: RFP General Question Question: Is there any specific reason why the language for H.7 was deleted in the first RFP amendment?

CMS Answer for Question #76: CMS did not find H.7 to be necessary since an offeror is already required to determine when hiring former CMS personnel that no law, regulations, or policies have been violated and that no appearance of a conflict of interest exist.

MISCELLANEOUS:

Question # 1 Section/ Page Number: N/A Question: There has been an RA moratorium imposed on inpatient patient status reviews since October, 2013. Based on recent CMS guidance, the QIOs will perform patient status reviews on inpatient claims and refer providers with high findings rates to the RA. When does CMS expect RAs to resume auditing these claims following QIO referrals?

CMS Answer for Question #1: CMS anticipates that the QIOs will perform several rounds of reviews and education before referring to the Recovery Auditors. CMS estimates this to be at least 6 months.

Question # 2 Section/ Page Number: N/A -- Question: When does CMS anticipate awarding these contracts?

CMS Answer for Question #2: CMS estimates award of these contracts in summer of 2016.

Question # 3 Section/ Page Number: N/A Question: If an offeror has been awarded two contracts, and there are no technically acceptable bids on a third contract, can the offeror be awarded that third contract?

CMS Answer for Question #3: No. There is a maximum of two awards per offeror. Please refer to section E.3 of the RFP.

Question # 4 Section/ Page Number: N/A Question: Will these contracts come with any pre-approved New Issues RAs can begin auditing under immediately?

CMS Answer for Question #4: Yes, CMS will provide several pre-approved issues for review.

Question #5 Section/ Page Number: N/A Question: Though DME, HH, and Hospice claims will be audited under one national contract, RAs operating under the A/B contracts should still receive DME, HH and Hospice claims data, and vice versa. There are a number of vulnerabilities that require A/B RAs to have DME, HH, and Hospice data and there are a number of vulnerabilities that require the DME, HH, and Hospice RA to have the A/B data. Please confirm that all RAs will have access to all data types, regardless of Region.

CMS Answer for question #5: All Recovery Auditors will have access to all data types.

Question #6 Section/ Page Number: N/A Question: Are there are any preclusions from performing any of the work under this RFP or SOWs offshore?

CMS Answer for Question #6: If an Offeror is planning to have any of the work performed offshore, they should identify this within their proposal. CMS will review this and determine if there are any OCI issues or other risks involved.

Question #7 Section/ Page Number: N/A Question: “Offerors can be awarded up to two contracts. “Please confirm that an offeror could be awarded two A/B contracts.

CMS Answer for Question #7: Yes, an offeror can be awarded a maximum of two regions.

Question #8 Section/ Page Number: N/A Question: Are Offerors to include a completed SF33 with our responses (Technical, Business, COI)? If yes, please provide direction for its placement within our responses.

CMS Answer for Question #8: The applicable form for this solicitation shall be one of the first documents in the proposal.

Question #9 Section/Page Number: Attachment J.3, Past Performance Questionnaire Question: Is the past performance questionnaire due to CMS on the proposal due date (December 11)?

CMS Answer for Question #9: All questionnaires shall be received by CMS on or before the proposal due date found in the RFP.

Question #10 Section/Page Number: Attachment J.4, Subcontract Checklist Question: Does CMS require that questions 1-13 in FAR 44.202-2(a) be completed and submitted with the proposal, or is CMS simply looking for the Offeror’s comments and signature?

CMS Answer for Question # 10: This has been removed.

Question #11 Section/Page Number: Attachment J.6, Consent to Subcontract Question: Is the Consent to Subcontract form required to be completed and submitted with the Offeror’s proposal? If so, in what section should this form be included?

CMS Answer for Question #11: This has been removed.

Question #12 Section/ Page Number: General/Infrastructure Question: If an offeror is awarded more than one region, is it acceptable to share the IT infrastructure between the regions, or will CMS require separate infrastructure (network, storage, hardware) for each region?

CMS Answer for Question #12: Because the equipment is CMS dedicated, if an offeror is awarded more than one region it is acceptable to share the IT infrastructure between the regions, as long as the Recovery Auditor meets all CMS system security requirements.

Question #13 Attachment J.6 Consent to Subcontract:

Section/ Page Number: Attachment J.6, Consent to Subcontract Question: Offeror understands the need for CMS to evaluate the involvement of subcontractors, if any, in the proposed technical approach and to validate that the prime contractor has followed the FAR…