HHSM-500-2016-RFP-0003_Recovery_Audit_Contractor.pdf

HHSM-500-2016-RFP-0003

SOLICITATION, OFFER AND AWARD

4. TYPE OF SOLICITATION2. CONTRACT NUMBER 3. SOLICITATION NUMBER

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than Item 7)

ORDER UNDER DPAS (15 CFR 700)

6. REQUISITION/PURCHASE NUMBER

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

NEGOTIATED (RFP)

SEALED BID (IFB)

5. DATE ISSUED

1. THIS CONTRACT IS A RATED RATING PAGE OF PAGES

1 96

C. E-MAIL ADDRESS

EXT.NUMBERAREA CODE

B. TELEPHONE (NO COLLECT CALLS)A. NAME

10. FOR

INFORMATION

CALL:

CAUTION: LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

(Date)(Hour) local timeuntildepository located in copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the

SOLICITATION

9. Sealed offers in original and

PART IV - REPRESENTATIONS AND INSTRUCTIONS

OTHER STATEMENTS OF OFFERORS

EVALUATION FACTORS FOR AWARD

INSTRS., CONDS., AND NOTICES TO OFFERORS

REPRESENTATIONS, CERTIFICATIONS AND

LIST OF ATTACHMENTS

CONTRACT CLAUSES

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

I

J

K

L

M SPECIAL CONTRACT REQUIREMENTS

CONTRACT ADMINISTRATION DATA

DELIVERIES OR PERFORMANCE

INSPECTION AND ACCEPTANCE

PACKAGING AND MARKING

DESCRIPTION/SPECS./WORK STATEMENT

SUPPLIES OR SERVICES AND PRICES/COSTS

SOLICITATION/CONTRACT FORM

PART II - CONTRACT CLAUSESPART I - THE SCHEDULE

H

G

F

E

D

C

B

A

SEC. DESCRIPTION PAGE(S) (X) DESCRIPTION SEC. (X)

11. TABLE OF CONTENTS

18. OFFER DATE17. SIGNATURE

SUCH ADDRESS IN SCHEDULE.

IS DIFFERENT FROM ABOVE - ENTER

15C. CHECK IF REMITTANCE ADDRESS

EXT.NUMBERAREA CODE

15B. TELEPHONE NUMBER

(Type or print)AND

ADDRESS

OF

OFFEROR

CODE FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER15A. NAME

DATEAMENDMENT NO.DATEAMENDMENT NO.

and related documents numbered and dated):

amendments to the SOLICITATION for offerors

(The offeror acknowledges receipt of

14. ACKNOWLEDGEMENT OF AMENDMENTS

CALENDAR DAYS (%)30 CALENDAR DAYS (%)20 CALENDAR DAYS (%)10 CALENDAR DAYS (%)

(See Section I, Clause No. 52.232.8)

13. DISCOUNT FOR PROMPT PAYMENT

designated point(s), within the time specified in the schedule.

by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the

12. In compliance with the above, the undersigned agrees, if this offer is accepted within ______________ calendar days (60 calendar days unless a different period is inserted

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

OFFER (Must be fully completed by offeror)

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

28. AWARD DATE

(Signature of Contracting Officer)

27. UNITED STATES OF AMERICA

25. PAYMENT WILL BE MADE BY

26. NAME OF CONTRACTING OFFICER (Type or print)

CODE 24. ADMINISTERED BY (If other than Item 7)

ITEM

(4 copies unless otherwise specified)

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

41 U.S.C. 253 (c) ( 10 U.S.C. 2304 (c) (

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

21. ACCOUNTING AND APPROPRIATION20. AMOUNT19. ACCEPTED AS TO ITEMS NUMBERED

AWARD (To be completed by government)

CODE

11/06/2015 X

ASG - DPIFMC

CMS,OAGM,ASG,DPIFMC

7500 SECURITY BLVD., MS: B3-30-03

BALTIMORE MD 21244-1850

B3-30-03 1100 ES 12/11/2015

Justin Menefee 410 Justin.Menefee@cms.hhs.gov

786-7629

X

X

X

X

X

X

X

X

X

X

X

X

X

PAGE(S)

Nicole Hoey

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

Prescribed by GSA - FAR (48 CFR) 53.214(c)

6-8

12-14 15-24 25-49

50-61

63-69

70-87

88-96

HHSM-500-2016-RFP-0003 Page 2 of 96 Recovery Audit Contractor (RAC)

TABLE OF CONTENTS

PART I - THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICES/COSTS

B.1 GENERAL DESCRIPTION

B.2 SCHEDULE OF SERVICES

B.3 SCHEDULE OF PAYMENTS

SECTION C - DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

C.1 STATEMENT OF WORK

SECTION D - PACKAGING AND MARKING

D.1 PACKAGING AND MARKING

SECTION E - INSPECTION AND ACCEPTANCE

E.1 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

E.2 INSPECTION AND ACCEPTANCE

SECTION F - DELIVERIES OR PERFORMANCE

F.1 52.252-2 CONTRACT CLAUSES INCORPORATED BY REFERENCE (FEB

1998)

F.2 PERIOD OF PERFORMANCE (JAN 2014)

F.3 DELIVERABLES

SECTION G - CONTRACT ADMINISTRATION DATA

G.1 PAYMENTS – INVOICES – FIRM FIXED PRICE CONTRACTS (OCT 2015)

G.2 CONTRACTING OFFICER’S REPRESENTATIVE (COR)

G.3 TECHNICAL DIRECTION

G.4 CONTRACTING OFFICER RESPONSIBILITY

G.5 HHSAR 352.242-70 KEY PERSONNEL (JAN 2006)

G.6 SERVICE OF CONSULTANTS/SUBCONTRACTORS

G.7 CORRESPONDENCE PROCEDURES

G.8 USE OF GOVERNMENT DATA (REPORTS/FILES/COMPUTER TAPES OR

DISCS)

G.9 PROPERTY ADMINISTRATION

G.10 DATA TO BE DELIVERED

HHSM-500-2016-RFP-0003 Page 3 of 96

G.11 DISSEMINATION, PUBLICATION AND DISTRIBUTION OF

INFORMATION

G.12 CONTRACTOR PAST PERFORMANCE EVALUATION(S) (OCT 2014)

SECTION H - SPECIAL CONTRACT REQUIREMENTS

H.1 BUSINESS ETHICS, CONFLICT OF INTEREST, AND COMPLIANCE (OCT

2015)

H.2 HIPAA BUSINESS ASSOCIATE PROVISION

H.3 CMS-INFORMATION SECURITY (APR 2013)

H.4 SECURITY CLAUSE – BACKGROUND-INVESTIGATION FOR

CONTRACTOR PERSONNEL

H.5 CONFIDENTIALITY OF INFORMATION

H.6 DISCLOSURE OF INFORMATION

H.7 EMPLOYMENT OF CMS PERSONNEL RESTRICTED

H.8 REPORTABLE EVENTS

H.9 REVOKING SYSSTEM ACCESS UPON EMPLOYEE DEPARTURE

H.10 SYSTEMS OF RECORDS

H.11 PROVISIONS FOR HIGH VISIBILITY/HIGH PUBLIC INTEREST

CONTRACTS (OCT 2013)

PART II - CONTRACT CLAUSES

SECTION I - CONTRACT CLAUSES

I.1 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

I.2 HHSAR 352.252-20 DEPARTMENT OF HEALTH AND HUMAN SERVICES

ACQUISITION REGULATION (HHSAR)

I.3 FAR 52.204-14 SERVICE CONTRACT REPORTING REQUIREMENTS (JAN

2014)

I.4 FAR 52.204-19 INCORPORATION BY REFERENCE OF

REPRESENTATIONS AND CERTIFICATIONS (DEC 2014)

I.5 FAR 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

I.6 FAR 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR

2000)

I.7 FAR 52.222-40 NOTIFICATION OF EMPLOYEE RIGHTS UNDER THE

NATIONAL LABOR RELATIONS ACT (DEC 2010)

I.8 FAR 52.243-7 NOTIFICATION OF CHANGES (APR 1984)

I.9 FAR 52.252-6 AUTHORIZED DEVIATIONS IN CLAUSES (APR 1984)

I.10 HHSAR 352.239-70 STANDARD FOR SECURITY CONFIGURATIONS

(JANUARY 2010)

I.11 HHSAR 352.239-73 ELECTRONIC AND INFORMATION TECHNOLOGY

ACCESSIBILITY (JANUARY 2010)

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PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS

SECTION J - LIST OF ATTACHMENTS AND EXHIBITS

J.1 RECOVERY AUDIT CONTRACTOR (RAC) PROGRAM –FEE-FOR-

SERVICE STATEMENT OF WORK (SOW)

• REGION 1 SOW

• REGION 2 SOW

• REGION 3 SOW

• REGION 4 SOW

• REGION 5 SOW

J.2 RESERVED FOR INCORPORATION OF CONTRACTORS

ORGANIZATIONAL CONFLICT OF INTEREST CERTIFICATE

(INCORPORATED BY REFERENCE)

J.3 PAST PERFORMANCE QUESTIONNAIRE

J.4 SUBCONTRACT CHECKLIST

J.5 VIRUS DETECTION CERTIFICATION

J.6 CONSENT TO SUBCONTRACT

J.7 RESPONSIBILITY QUESTIONNAIRE

J.8 CONTRACTOR BUSINESS ETHICS, COI AND COMPLIANCE PROGRAM

REQUIREMENTS

J.9 PERSONAL CONFLICTS OF INTEREST FINANCIAL DISCLOSURE FINAL

J.10 NON-DISCLOSURE STATEMENT

J.11 LIST OF PRIME AND SUBCONTRACTORS

E.1 PROPOSED FIRM FIXED CONTINGENCY FEE

E.2 QUESTIONS TEMPLATE

PART IV -- REPRESENTATIONS AND INSTRUCTIONS

SECTION K – REPRESENTATIONS, CERTIFICATIONS, AND OTHER

STATEMENTS OF OFFERORS OR RESPONDENTS

K.1 FAR 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE (FEB 1998)

K.2 FAR 52.204-7 SYSTEM FOR AWARD MANAGEMENT (JUL 2013)

K.3 FAR 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS

(DEC 2014)

K.4 FAR 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS

(JUL 2013)

SECTION L – INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS OR

RESPONDENTS

L.1 FAR 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE (FEB 1998)

HHSM-500-2016-RFP-0003 Page 5 of 96

L.2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ACQUISITION

REGULATIONS (HHSAR) PROVISIONS INCORPORATED BY

REFERENCE

L.3 FAR 52.215-1 INSTRUCTIONS TO OFFERORS – COMPETITIVE

ACQUISITION (JAN 2004)

L.4 FAR 52.216-1 TYPE OF CONTRACT (APR 1984)

L.5 FAR 52.233-2 SERVICE OF PROTEST (SEP 2006)

L.6 FAR 52.252-5 AUTHORIZED DEVIATIONS IN PROVISIONS (APR 1984)

L.7 GENERAL

L.8 PROPOSAL ORGANIZATION

L.9 SUBMISSION OF QUESTIONS

L.10 INTENT TO SUBMIT A PROPOSAL

L.11 SUBMISSION OF PROPOSALS

L.12 PROPOSAL ORGANIZATION

SECTION M – EVALUATION FACTORS FOR AWARD

M.1 GENERAL PROCEDURES FOR AWARD OF CONTRACTS

M.2 FAR 52.217-5 EVALUATION OF OPTIONS (JUL 1990)

M.3 TECHNICAL EVALUATION

M.4 PRICE EVALUATION/RESPONSIBILITY DETERMINATION

M.5 EVALUATION OF CONFLICT OF INTEREST

HHSM-500-2016-RFP-0003 Page 6 of 96

SECTION B - SUPPLIES OR SERVICES AND PRICES/COSTS

B.1 GENERAL DESCRIPTION

The contractor shall perform the effort required by this contract on a Firm Fixed Contingency fee basis. The work shall be performed in accordance with all sections of this contract. Depending on the region being awarded will determine which sections should apply for its respective terms and conditions.

B.2 SCHEDULE OF SERVICES

This solicitation includes the award of five total regions. Each chart below will depict an Offeror’s applicable firm fixed contingency fee proposed and distinct period of performance per contract. One firm fixed contingency fee shall be proposed for the Base and each option period that will be applied to all recoupments and underpayments. Each Region will have an Administrative and Appeals Option. During this period, CMS will continue to recoup funds from providers, allow the Recovery Auditor to invoice for recoupments received, allow the Recovery Auditors to support the appeal process and allow CMS to recoup overturned appeals from the Recovery Auditor. CMS reserves the right to extend the contract until such time as all pending appeals are dispositioned.

Region 1 -

The total negotiated firm fixed Contingency fee for this contract is TBD%

CLIN Description Firm Fixed Contingency Fee Period of Performance

0001 Base Period Date of Award - TBD 0002 Option Period 1 TBD-TBD 0003 Option Period 2 TBD-TBD 0004 Option Period 3 TBD-TBD 0005 Option Period 4 TBD-TBD 0006 Administrative and Appeals Option N/A TBD-TBD

Region 2 -

CLIN Description Firm Fixed

Contingency Fee

Period of Performance

0001 Base Period Date of Award - TBD 0002 Option Period 1 TBD-TBD 0003 Option Period 2 TBD-TBD

HHSM-500-2016-RFP-0003 Page 7 of 96

0004 Option Period 3 6 Months(TBD) 0005 Administrative and Appeals Option N/A TBD-TBD

Region 3 -

Contingency Fee

Period of Performance

0001 Base Period Date of Award - TBD 0002 Option Period 1 TBD-TBD 0003 Option Period 2 TBD-TBD 0004 Option Period 3 TBD-TBD 0005 Administrative and Appeals Option N/A TBD-TBD

Region 4 -

Contingency Fee

Period of Performance

0001 Base Period Date of Award - TBD 0002 Option Period 1 TBD-TBD 0003 Option Period 2 TBD-TBD 0004 Option Period 3 TBD-TBD 0005 Option Period 4 6 Months (TBD)

Region 5 -

Contingency Fee

Period of Performance

0001 Base Period Date of Award - TBD 0002 Option Period 1 TBD-TBD 0003 Option Period 2 TBD-TBD 0004 Option Period 3 TBD-TBD 0005 Option Period 4 TBD-TBD

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B.3 SCHEDULE OF PAYMENTS

The contractor shall be paid in accordance with their firm fixed contingency fee as described above. Recovery Auditors shall not receive any payments for the mere identification of improper overpayments. Recovery Auditors may invoice for the applicable firm fixed contingency fees when all required claim elements are input into the Data Warehouse and the improperly paid claims have exited the second level of the appeals process (QIC level). There are specific statutory timeframes for filing appeals at each level. If no appeal has been filed within the initial 120 days that a provider has to appeal, Recovery Auditors may then invoice for their firm fixed contingency fee payment. If no additional appeal is submitted within the required timeframe, the claim may be invoiced for payment.

The firm fixed contingency fee will be determined by the overpayments collected without netting out the underpayments. Underpayments in a claim are counted separately. Amounts attributed to interest will not be included in the fee.

If a provider files an appeal disputing the overpayment determination and the appeal is adjudicated in the provider’s favor at ANY level, the Recovery Auditor shall repay Medicare the contingency payment for that recovery. Repayment to Medicare will be subtracted from the next applicable invoice, or be paid to CMS by the Recovery Auditor after receipt of a demand letter.

HHSM-500-2016-RFP-0003 Page 9 of 96

SECTION C - DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

The purpose of this solicitation is to acquire a Recovery Auditor Contractor (RAC) to identify underpayments and overpayments, and recoup overpayments associated with services for which payment is made under Medicare including Part A or B of Title XVIII of the Social Security Act.

The SOW, Section J, Attachment J.1 (Regions 1-5), is provided for further details.

HHSM-500-2016-RFP-0003 Page 10 of 96

SECTION D - PACKAGING AND MARKING

D.1 PACKAGING AND MARKING

Deliverables shall be marked in accordance with the contract Section G.7, Correspondence Procedures, and the SOW, Section J, Attachment J.1.

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SECTION E - INSPECTION AND ACCEPTANCE

E.1 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available.

Also, the full text of a clause may be accessed electronically at this address:

http://www.acquisition.gov/far/

Federal Acquisition Regulation (FAR) Clauses:

52.246-4 INSPECTION OF SERVICES – FIXED-PRICE (AUG1996)

E.2 INSPECTION AND ACCEPTANCE

a. All work under this contract is subject to inspection and final acceptance by the Contracting Officer or the duly authorized representative of the Government.

b. The Contracting Officer Representative or Alternate Contracting Officer

Representative is a duly authorized representative of the Government and is responsible for inspection and acceptance of all items to be delivered under this contract.

c. Inspection and acceptance of the Contractor's performance shall be in accordance with the applicable FAR Clauses in Section E.1 above.

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SECTION F - DELIVERABLES OR PERFORMANCE

F.1 FAR 52.252-2 CONTRACT CLAUSES INCORPORATED BY REFERENCE (FEB

1998)

This contract incorporates one or more clauses by reference with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address:

52.242-15 STOP-WORK ORDER (AUG 1989)

52.242-17 GOVERNMENT DELAY OF WORK (APR 1984)

52.247-34 F.O.B. DESTINATION (NOV 1991)

F.2 PERIOD OF PERFORMANCE (JAN 2014)

This solicitation includes the award of five total regions. Each Region will have its own distinct period of performance.

Region 1 -

The period of performance for Region 1 is <TBD > through <TBD>.

This contract includes the following Option Periods:

CLIN Description Period of Performance 0001 Base Period TBD- TBD 0002 Option Period 1 TBD- TBD 0003 Option Period 2 TBD- TBD 0004 Option Period 3 TBD- TBD 0005 Option Period 4 TBD- TBD

Region 2 -

The period of performance for Region 2 is <TBD > through <TBD>.

This contract includes the following Option Periods:

HHSM-500-2016-RFP-0003 Page 13 of 96

CLIN Description Period of Performance 0001 Base Period TBD- TBD 0002 Option Period 1 TBD- TBD 0003 Option Period 2 TBD- TBD 0004 Option Period 3 6 Months (TBD)

Region 3 -

The period of performance for Region 3 is <TBD > through <TBD>.

This contract includes the following Option Periods:

CLIN Description Period of Performance 0001 Base Period TBD- TBD 0002 Option Period 1 TBD- TBD

Region 4 -

The period of performance for Region 4 is <TBD > through <TBD>.

This contract includes the following Option Periods:

CLIN Description Period of Performance 0001 Base Period TBD- TBD 0002 Option Period 1 TBD- TBD 0003 Option Period 2 TBD- TBD

0005 Option Period 4 6 Months (TBD)

Region 5 -

The period of performance for Region 5 is <TBD > through <TBD>.

This contract includes the following Option Periods:

CLIN Description Period of Performance 0001 Base Period TBD- TBD

HHSM-500-2016-RFP-0003 Page 14 of 96

0002 Option Period 1 TBD- TBD

0005 Option Period 4 TBD- TBD

F.3 DELIVERABLES

Task Number Deliverable

Number

Deliverable Due Date (from contract award date) General

Requirements - A.

1 Initial Meeting 2 weeks from date of award

General Requirements

– A.1

2 Project Plan Within 2 weeks of the initial meeting

General Requirements -

C

3 Conference Calls Weekly or as needed

General Requirements

– D.1

4 Monthly Progress Reports

Monthly – by COB on the fifth business day following the end of the month

General Requirements

– D.2

5 Appeals Report Monthly – by COB on the fifth business day following the end of the month

Administrative and

Miscellaneous Issues - E

6 Case File Transfers Within 15 days prior to the end of the contract period

Administrative and

Miscellaneous Issues - L

7 Final Report- Draft Within 4 weeks prior to the end of the contract period

Administrative and

Miscellaneous Issues - L

8 Final Report- Final Within 4 weeks prior to the end of the contract period

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SECTION G - CONTRACT ADMINISTRATION DATA

G.1 PAYMENTS - INVOICES (Firm Fixed Price Contracts (OCT 2015)

a. GENERAL: The Contractor shall submit to the Government an invoice for payment in accordance with the instructions below.

b. METHOD OF PAYMENT: CMS shall only make an electronic payment of invoices in accordance with FAR 52.232-33, Payments by Electronic Funds Transfer – System for Award Management. In order to receive payments, the contractor shall register in the System for Award Management (SAM) database, in accordance with FAR 52.204-7, System for Award Management.

ADDRESS CHANGES: The contractor shall notify CMS’ Division of Accounting Operations of all banking and address changes in SAM via the following email address:

CCRChanges@cms.hhs.gov.

c. CONTENT OF INVOICE - Invoices shall include, at a minimum:

• Contractor’s name and address;

• Contractor’s Tax Identification Number (TIN);

• Contractor’s DUNS Number;

• Invoice date;

• Invoice Number to include the designation of the Contract Payment Category Type as follows:

Contract Payment Category Type I, II, III, IV (TBD upon award)

INVOICE/VOUCHER REVIEW/APPROVAL PROCESSING TIME FRAMES

Contract Payment Category Types ($ = Total Contract Value) Days = Calendar Days

TYPE I TYPE II TYPE III TYPE IV

Type IA Type IB Type IIIA Type IIIB

TEAM

MEMBER

All Small Businesses (No $ Limit)

All QIOs (No $ Limit)

All Other Contracts

(No $ Limit)

Simplified Acquisitions

$3K to $150K (Small

Businesses)

Simplified Acquisitions $3K to $6.5M

(Large Businesses)

All Large Business

Prime Contracts with Small Business Subcontractors

OFM/DAO 7 Days 7 Days 14 Days 7 Days 22 Days 12 Days

COR 4 Days 0 Days 8 Days 8 Days 8 Days 8 Days

CS/CO 4 Days 8 Days 8 Days N/A N/A 8 Days mailto:CCRChanges@cms.hhs.gov

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Total Processing

Time

15 Days Not-to-

Exceed 30 Days

15 Days Not-to-

Exceed 30 Days 30 Days

15 Days Not-to-Exceed

30 Days 30 Days

28 Days Not-to-Exceed

30 Days

• Contract and Order Number, as applicable;

• Contract line item number and/or Subcontract line item number;

• Description, quantity, unit of measure, unit price and extended price of the items actually delivered or services rendered;

• Shipping and payment terms;

• Terms of any discount for prompt payment offered;

• Other substantiating documentation or information as required by the contract;

• Name, title, phone number and complete mailing address of responsible official to whom payment is to be sent;

• Name, title, phone number of person to notified in the event of a defective invoice;

and,

• Period of performance or delivery date of goods or services provided.

d. MAILINGS: Invoices shall be submitted as follows:

1. ELECTRONIC MAIL: The contractor shall submit an electronic copy of the invoice to both of the following individuals:

• Contract Specialist – Justin.menefee@cms.hhs.gov ; and

• COR - xxxx.xxxxx@CMS.HHS.Gov.

2. REGULAR MAIL: An original hard copy shall be submitted to the address below:

Department of Health & Human Services Centers for Medicare & Medicaid Services OFM/Division of Accounting Operations P.O. Box 7520 Baltimore, MD 21207-0520

3. OVERNIGHT MAIL: If the contractor chooses to use an overnight mail carrier, the original hard copy of the invoice shall be submitted to the address below:

Department of Health & Human Services

OFM/Division of Accounting Operations 7500 Security Boulevard/Mailstop: C3-11-03 Baltimore, MD 21244-1850

e. PAYMENTS: The Government shall make payment of all invoices in accordance with mailto:Justin.menefee@cms.hhs.gov mailto:xxxx.xxxxx@CMS.HHS.Gov

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• FAR 52.232-1 Payments, and

• FAR 52.212-4 Contract Terms and Conditions – Commercial Items (If applicable) upon acceptance by the Contracting Officer’s Representative (COR) in accordance with the applicable FAR Inspection and Acceptance clause and the Contracting Officer’s approval, as appropriate.

Reimbursement for invoices submitted under this contract shall be made not later than thirty (30) calendar days after receipt of an acceptable invoice from the Contractor requested at the paying office designated above. Any discrepancies determined as a result of the audit could delay the processing of the invoice and may result in the invoice being returned to the Contractor for corrections.

f. INTEREST ON OVERDUE PAYMENT

The Prompt Payment Act, Public Law 97-177 (96 Stat.85.31 U.S.C. 1801) is applicable to payments under this contract and requires the payment of interest on payments made more than 30 calendar days after receipt of an invoice by the Division of Accounting Operations.

Determinations of interest due will be made in accordance with the provisions of the Prompt Payment Act and Office of Management and Budget Circular A-125.

G.2 CONTRACTING OFFICER’S REPRESENTATIVE (COR)

___TBD_______is hereby designated as the Contracting Officer’s Representative. The COR responsibilities shall include continuous monitoring of the Contractor’s compliance with all substantive project objectives. Specific duties and responsibilities are identified in Technical Direction below.

Provider Compliance Group (PCG) 410-786-____ (desk) 410-786-_____(fax)

G.3 TECHNICAL DIRECTION

a. Performance of the work under this contract shall be subject to the technical direction of the COR. The term “Technical Direction” is defined to include, without limitation, the following:

1. Directions to the Contractor that redirect the contract effort, shift work emphasis between work areas or tasks, require pursuit of certain lines of inquiry, fill in details or otherwise serve to accomplish the contractual statement of work.

2. Provision of information to the Contractor that assists in the interpretation of

HHSM-500-2016-RFP-0003 Page 18 of 96 drawings, specifications, or technical portions of the work description.

3. Review and, where required by the contract, approval of technical reports, drawings, specifications, and technical information to be delivered by the Contractor to the Government under the contract.

b. Technical direction must be within the general Statement of Work stated in the contract.

The Contracting Officer’s Representative does not have the authority to, and may not issue, any technical directions which:

1. Constitutes an assignment of additional work outside the general Statement of Work of the contract.

2. Constitutes a change as defined in:

FAR 52.243-1 CHANGES – FIXED PRICE (AUG 1987)

3. In any manner causes an increase or decrease in the total estimated contract cost, fixed-fee, or the time required for contract performance.

4. Change any of the expressed terms, conditions, or specifications of the contract.

c. All technical direction shall be issued in writing by the Contracting Officer’s Representative or shall be confirmed by him/her in writing within five working days after verbal issuance.

1. Technical direction which is not in writing within the 5 day period must cease until written direction is received from the COR.

2. Technical direction received from individuals other than the COR will not be executed until such time as the contractor has received the proper documentation instructing the contractor to comply with said direction from either the COR or CO.

3. Government Task Order Leads (GTLs) and Business Functional Lead (BFLs) are not Contracting Officer Representatives; these individuals do not have the authority to provide technical direction.

The contractor and not the Government is responsible for any costs incurred as a result of technical direction which was initiated prior to receiving proper authorization from those individuals who have the authority to provide such direction.

d. The Contractor shall proceed promptly with the performance of technical direction duly issued by the Contracting Officer’s Representative in the manner prescribed by this article and within his/her authority under the provisions of this article.

e. If, in the opinion of the Contractor, any instruction or direction issued by the Contracting

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Officer’s Representative is within one of the categories as defined in G.6.b(l) through (4) above, the Contractor shall not proceed but shall notify the Contracting Officer in accordance with FAR 52.243-7, Notification of Changes.

G.4 CONTRACTING OFFICER RESPONSIBILITY

In accordance with HHSAR 352.202-1 Definitions, the term Contracting Officer means a person with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings. The term includes certain authorized representatives of the Contracting Officer acting within the limits of their authority delegated by the Contracting Officer.

Notwithstanding any of the other provisions of this Contract, the Contracting Officer shall be the ONLY individual authorized to:

a. enter into and commit/bind the Government by contract for supplies or services;

b. accept nonconforming work or waive any requirement of this Contract;

c. authorize reimbursement to the Contractor for any costs incurred during the performance of the Contract, and

d. modify any term or condition of this Contract, i.e., make any changes in the

Statement of Work; modify/extend the period of performance; change the delivery schedule.

G.5 HHSAR 352.242-70 KEY PERSONNEL (JAN 2006)

The personnel specified in this contract are considered to be essential to the work being performed hereunder. Prior to diverting any of the specified individuals to other programs, the Contractor shall notify the Contracting Officer reasonably in advance and shall submit justification* (including proposed substitutions) in sufficient detail to permit evaluation of the impact on the program. No diversion shall be made by the Contractor without the written consent of the Contracting Officer; provided, that the Contracting Officer may ratify in writing such diversion and such ratification shall constitute the consent of the Contracting Officer required by the clause. The contract may be amended from time to time during the course of the contract to either add or delete personnel, as appropriate.

*All proposed substitutions shall be submitted, in writing, to CMS at least 30 days prior to the proposed substitution. Each request shall provide a detailed explanation of the circumstance necessitating the proposed substitution, a complete resume and any other information required by CMS. All proposed substitutions shall have qualifications equal to or greater than the person being replaced.

The following individuals are considered key personnel under this contract:

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Project Manager Completed at award Medical Director Completed at award

G.6 SERVICE OF CONSULTANTS/ SUBCONTRACTORS

a. For the purposes of this contract, consultants are considered subcontractors.

b. The Contractor shall follow the procedures established in the following Federal

Acquisition Regulation (FAR) clauses when requesting Contracting Officer consent to subcontract for Consultants and/or other subcontracts:

52.244-5 Competition in Subcontracting (DEC 1996) 52.244-6 Subcontracts for Commercial Items (APR 2015)

G.7 CORRESPONDENCE PROCEDURES

To promote timely and effective administration, correspondence (except for invoices) submitted under this contact shall be subject to the following procedures:

a. Technical Correspondence - Technical correspondence (as used herein, this term excludes technical correspondence which proposes or otherwise involves waivers, deviations or modifications to the requirements, terms or conditions of this contract) shall be addressed to the COR with an informational copy of the basic correspondence to the Contracting Officer.

b. Other Correspondence - All other correspondence shall be addressed to the Contracting Officer, in duplicate, with an informational copy of the basic correspondence to the COR.

c. Subject Lines - All correspondence shall contain a subject line, commencing with the contract number as illustrated below:

EXAMPLE: Contract No.

Request for Subcontract Consent

G.8 USE OF GOVERNMENT DATA (REPORTS/FILES/COMPUTER TAPES OR

DISCS)

Any data given to the contractor by the Government shall be used only for the performance of the contract unless the Contracting Officer specifically permits another use, in writing. Should the Contracting Officer permit the contractor the use of Government-supplied data for a purpose other than solely for performance of this contract and if such use could result in a commercially viable product, the Contracting Officer and the contractor must negotiate a financial benefit to

HHSM-500-2016-RFP-0003 Page 21 of 96 the Government. This benefit should most often be in the form of a reduction in the price of the contract; however, the Contracting Officer may negotiate any other benefits he/she determines are adequate compensation for the use of these data.

Upon the request of the Contracting Officer or the expiration date of this contract, whichever shall come first, the contractor shall, upon instructions from the Contracting Officer, return or destroy all data given to the contractor by the Government. However, the Contracting Officer may direct that the data be retained by the contractor for a specific period of time, which period shall be subject to agreement by the contractor. Whether the data are returned, retained, or destroyed shall be the decision of the Contracting Officer with the exception that the contractor may refuse to retain the data. The contractor shall retain no data, copies of data, or parts thereof, in any form, when the Contracting Officer directs that the data be returned or destroyed. If the data are to be destroyed, the contractor shall directly furnish evidence of such destruction in a form the Contracting Officer shall determine is adequate. In absence of direction from the CO, the Contractor shall assume data will need to be returned to the Government.

G.9 PROPERTY ADMINISTRATION

a. General:

The CMS Contract Property Administrator, Mr. Tyrone Harris, Office of Operations Management, Administrative Services Group, Division of Printing, Mail, and Logistics at (410) 786-2923, 7500 Security Blvd., Baltimore, Md. 21244, is hereby designated the property administration function for this contract. The Contractor agrees to furnish information regarding Government Property to the Property Administrator in the manner and to the extent required by the Property Administrator, his duly designated successors, and in accordance with FAR Part 45 and DHHS Manual entitled, Contractor's Guide for Control of Government Property, (July 2009).

If equipment is procured in order to provide services, CMS will retain title to the equipment. CMS must be notified as part of the itemized billing arrangement if there is an equipment acquisition, included in the cost of the contract.

All original tapes, video, CD ROM(s), manual, brochures, pamphlets shall remain the property of the CMS. The contractor shall provide to CMS all final, complete and editable web-based training course files.

b. Notice of Non-Allowability of Costs for General Purpose Office Equipment:

General Purpose Office Equipment (GPOE) means those equipment’s normally found in a business office such as desks, chairs, typewriters, calculators, file cabinets, etc., that are obtainable in the open market.

Contractors are expected to have the necessary facilities to perform the requirements of this solicitation/contract. This includes any GPOE necessary to perform the requirements herein.

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Notwithstanding the "Allowable Cost and Payment" clause of this contract, costs for the acquisition of GPOE shall not be considered as an allowable direct charge to this

G.10 DATA TO BE DELIVERED

a. Any working papers, interim reports, data given by the Government or first produced by the Contractor under the contract or collected or otherwise obtained by the Contractor under the contract, or results obtained or developed by the Contractor (subcontractor or consultants) pursuant to the fulfillment of this contract are to be delivered, documented, and formatted as directed by the Contracting Officer.

b. In addition, information and/or data, which are held by the Contractor related to the operation of their business and/or institution and which are obtained without the use of Federal funds, shall be considered “PROPRIETARY DATA” and are not subject data to be delivered under this contract.

G.11 DISSEMINATION, PUBLICATION AND DISTRIBUTION OF INFORMATION

a. Data and information either provided to the Contractor, or to any subcontractor or generated by activities under this contract or derived from research or studies supported by this contract, shall be used only for the purposes of the contract. It shall not be duplicated, used or disclosed for any purpose other than the fulfillment of the requirements set forth in this contract. This restriction does not limit the contractor's right to use data or information obtained from a non-restrictive source. Any questions concerning "privileged information" shall be referred to the Contracting Officer.

b. Some data or information may require special consideration with regard to the timing of its disclosure so that preliminary findings which could create erroneous conclusions are not disclosed. Also, some data or information, which relate to policy matters under consideration by the Government, may also require special consideration with regard to the timing of its disclosure so that the open and vigorous debate, within the government, of possible policy options is not damaged.

c. Any questions about use or release of the data or information or handling of material under this contract shall be referred to the Contracting Officer who must render a written determination. The Contracting Officer's determinations will reflect the results of internal coordination with appropriate program and legal officials.

d. Written advance notice of at least forty-five (45) days shall be provided to the

Contracting Officer of the Contractor's desire to release findings of studies or research or data or information described above. If the Contractor disagrees with the Contracting Officer's determination, and if this disagreement cannot be settled by the Contractor and the Contracting Officer in a mutually satisfactory manner, then the issue will be settled pursuant to the "Disputes" clause.

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e. Any presentation of any report, statistical or analytical material based on information obtained from this contract shall be subject to review by the COR before dissemination, publication, or distribution. Presentation includes, but is not limited to, papers, articles, professional publications, speeches, testimony or interviews with public print or broadcast media. This does not apply to information that made available under the Federal Freedom of Information Act.

f. The COR review shall cover accuracy, content, manner of presentation of the information, and also the protection of the privacy of individuals. If the review finds that the Privacy Act is or may be violated, the release/use of the presentation shall be denied until the offending material is removed or until the Contracting Officer makes a formal determination, in writing, that the privacy of individuals is not being violated.

g. If the review shows that the accuracy, content, or manner of presentation is not correct or is inappropriate in the light of the purpose of the project, the COR shall immediately inform the Contractor, in writing, of the nature of the problem. If the Contractor disagrees, the COR may insist that the presentation contain, in a manner of equal importance, materials which show the government's problem with the presentation.

h. The Contractor agrees to acknowledge support by CMS whenever reports of project funding levels, in whole or in part, by this contract are published in any medium. The Contractor shall include in any publication resulting from work under this contract, an acknowledgement substantially, as follows:

"The analyses upon which this publication is based were performed under Contract Number [ ], entitled, "[ ]," sponsored by the Centers for Medicare and Medicaid Services, Department of Health and Human Services."

Any deviation from the above legend shall be approved, in writing, by the Contracting Officer.

G.12 CONTRACTOR PAST PERFORMANCE EVALUATION(S) (OCT 2014)

a. General:

In accordance with Federal Acquisition Regulation (FAR) 42.15, Contractor Performance Information, past performance evaluations shall be prepared at least annually and at the time the work under a contract or order is completed. Additional interim performance evaluations may be prepared at Contracting Officer discretion, as necessary.

CMS will utilize the Contractor Performance Assessment Reporting System (CPARS), the Government-wide evaluation reporting tool for all past performance reports on contracts and orders, as appropriate. CPARS is a secure Internet website

HHSM-500-2016-RFP-0003 Page 24 of 96 located at https://www.cpars.gov.

b. CPARS Process:

1. CPARS Training: Contractors may obtain CPARS training material and register for on-line training https://www.cpars.gov.

2. Post-Award Contract Registration: CMS is responsible for registering the contract in CPARS within 30 calendar days of contract award. The Contractor shall:

i. Designate at least one (1) point of contact that will be responsible for serving as the Contractor’s Representative (CR). Additional CRs may also be identified; and,

ii. Provide the CMS Contract Specialist with the name(s) and email address(es) of the CPARS point(s) of contact.

Once CMS registers the contract in CPARS, the CR(s) will receive an automated CPARS email message that contains User IDs and instructions for creating a password for future past performance evaluation processing.

3. Interim, Annual and Final Past Performance Evaluation Reports:

i. Issuing the Evaluation: Once the CMS Assessing Official (AO) issues an evaluation to the Contractor in CPARS, the CR(s) will receive an email instructing them to login to CPARS to review the evaluation.

ii. Contractor Comments: The CR has the option to provide comments on the evaluation, indicate if they concur or do not concur with the evaluation, sign, and then return the evaluation to the AO. The CR has a total of 60 days following the AO’s evaluation signature date to submit comments. If the CR submits comments within the first 14 days following the AO’s signature date and the AO closes the evaluation, the evaluation will become available in Past Performance Information Retrieval System - Report Card (PPIRS-RC) within 1 day.

On day 15 following the AO’s evaluation signature date, the evaluation will become available in PPIRS-RC with or without CR comments and whether or not it has been closed by the AO. If no CR comments have been sent and the evaluation has not been closed, it will be marked as “Pending” in

PPIRS-RC.

If the CR sends comments at any time prior to 61 days following the AO’s evaluation signature date, those comments will be reflected in PPIRS-RC within 1 day. On day 61 following the AO’s evaluation signature date, the CR will be “locked out” of the evaluation and may no longer send https://www.cpars.gov/ https://www.cpars.gov/

HHSM-500-2016-RFP-0003 Page 25 of 96 comments.

SECTION H - SPECIAL CONTRACT REQUIREMENTS

H.1 BUSINESS ETHICS, CONFLICT OF INTEREST AND COMPLIANCE

(OCT 2015)

a. General: It is imperative that the Contractor and the services provided under this contract be free, to the greatest extent possible, of all Organizational and Personal Conflicts of Interest. In this clause, all references to Organizational and/or Personal Conflicts of Interests will be referred to individually or collectively, as the text justifies, as Conflicts of Interest (COI). Except as provided below, the Contracting Officer shall not maintain a contract with a Contractor that the Contracting Officer determines has, or has the potential for, an unresolved COI. However, in accordance with FAR 9.503 Waiver, the Contracting Officer may contract with a Contractor that has an unresolved COI if the Contracting Officer determines that it is in the best interest of the Government to do so.

b. Definitions:

Actual COI– means that the COI is currently in existence as determined by the Offeror’s or Contractor’s Compliance Officer and/or as determined by CMS. This form of COI will require avoidance, neutralization or mitigation acceptable to CMS.

Affiliates – As defined in FAR 2.101 means associated business concerns or individual(s) if, directly or indirectly either one controls or can control the other; or a third party controls or can control both.

For purposes of this contract, affiliate control or influence may include, but is not limited to:

(a) Interlocking management or ownership (e.g., individuals serving in similar capacities in several companies);

(b) Identity of interests among family members such as spouse/domestic partner and/or any dependent of the respondent;

(c) Shared facilities and equipment;

(d) Common use of employees; or

(e) A business concern organized just prior to, or immediately following, the release of a solicitation or request for information, which has the same or similar management, ownership, or principal employees as the offeror or Contractor.

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Any business, whether or not it is organized for profit or located in the United States or its outlying areas, or person may be found to be an affiliate. Control may be affirmative or negative and it is immaterial whether it is exercised so long as the power to control exists.

Apparent (Perceived) COI – means that the COI on first observation appears to be an actual or potential COI, but may or may not be after analysis. Even if the apparent COI is determined to be non-existent, this perception may still require further explanation.

Avoidance – means Government action taken in one acquisition that is intended to prevent a COI in that acquisition or in a future action. Methods of avoiding COIs include, but are not limited to:

• Drafting the statement of work (SOW) to exclude tasks that require Contractors to utilize subjective judgment; or

• Obtaining advice from more than one source on any issue on which there are concerns about an COI so that there is no area in which the Government is relying solely on the advice of any one of the sources; or

• Excluding an offeror from participation in a contract award.

Financial Interests/Relationships – means a healthcare related direct or indirect ownership or investment interest (including an option or non-vested interest) in any entity that exists through equity, debt, or other means and includes any indirect ownership or investment interest no matter how many levels removed from a direct interest.

A financial interest/relationship may arise from the following non-exclusive examples:

(a) Compensation, including wages, salaries, commissions, professional fees, or fees for business referrals;

(b) Current or known future arrangements or requirements for which you are defined as an interested party, including, but not limited to, an entity that may create one or more of the three forms of COI;

(c) Consulting relationships, including commercial and professional consulting and service arrangements, scientific and technical advisory board memberships, or serving as an expert witness in litigation;

(d) Services provided in exchange for honorariums including travel expense reimbursements;

(e) Research funding or other forms of research support;

(f) Healthcare related investment in the form of stock or bond ownership, including healthcare sector investment only mutual funds;

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(g) Healthcare business ownership or partnership interests;

(h) Patents, copyrights, and other intellectual property interests;

(i) Seeking or negotiating for prospective employment or business; or

(j) Gifts, including travel.

Mitigation– means action taken by the Contractor to reduce the COI risk to a level acceptable to CMS on a present contract.

Neutralization – means excluding or restricting a Contractor from offering, as a prime or subcontractor, on future contracts while allowing the Contractor to perform on the instant contract. This method protects the Government’s interests in cases where the Contractor’s work on the instant contract could be biased or impaired by virtue of its expectation of future work, or when the Contractor would have an unfair advantage in competing for award of the future work.

Organizational Conflict of Interest – In accordance with FAR 2.101 Definitions, means that because of other activities or relationships with other persons, a person is unable, or potentially unable, to render impartial assistance or advice to the Government, or the person’s objectivity in performing the contract work is, or might be, otherwise impaired, or a person has an unfair competitive advantage.

For purposes of this contract, the conflict of interest definition includes direct or indirect relationships including, but not limited to, the Contractor and its parent company, subsidiaries, affiliates, subcontractors, clients and principals.

Personal Conflicts of Interest – A situation in which a person has a financial interest, personal activity, or relationship that could impair the person’s ability to act impartially and in the best interest of the Government when performing under this contract.

(a) Among the sources of personal conflicts of interest are—

(i) Financial interests of the person, spouse/domestic partner and/or any other dependent of the person, as defined for Federal tax purposes;

(ii) Other employment or financial relationships (including seeking or negotiating for prospective employment or business) and,

(iii) Gifts, including travel.

(b) For example, financial interests referred to in paragraph (a)(i) of this definition may arise from—

(i) Compensation, including wages, salaries, commissions, professional fees, or fees for business referrals;

HHSM-500-2016-RFP-0003 Page 28 of 96

(ii) Consulting relationships;

(iii) Services provided in exchange for honoraria or travel expense reimbursements;

(iv) Research funding or other forms of research support;

(v) Healthcare related investments;

(vi) Real estate investments;

(vii) Patents, copyrights, and other intellectual property interests; or

(viii) Business ownership and investment interests.

Potential COI – means that the COI could become an actual COI due to contingency Events and/or as determined by CMS. This form of COI will require avoidance, neutralization or mitigation acceptable to CMS.

Principal – As defined in FAR 52.203-13, Contractor Code of Business Ethics and Conduct, means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager, plant manager, head of a division or business segment, and similar positions).

Three (3) Types of COIs include:

Conflict Types Definitions

Biased Ground Rules

Consists of situations in which a firm, as part of its performance of a Government contract, has helped (or is in a position to help) set the ground rules for another Government contract by, for example, writing the statement of work or the specifications, or establishing source-selection criteria. In these “biased ground rules” cases, the primary concern is that the firm could skew the competition, whether intentionally or not, in favor of itself and/or its affiliates.

Impaired Objectivity

Consists of situations where a firm has an interest (typically financial) that may conflict with the interest of the Government to whom the firm has a contractual obligation, and the firm’s work under the Government contract could give the firm the opportunity to benefit its other business interests. If the firm is providing recommendations, judgment or advice, and its other business interests could be affected by that recommendation, judgment or advice, the firm’s objectivity may be impaired. An example is where the firm was evaluating itself, an affiliate or a competitor, either through an assessment of performance under another contract or an evaluation of proposals.

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Unequal Access to Information

“Unfair” access to non-public information – Consists of situations in which a firm has access to nonpublic information (including proprietary information and non-public source-selection information) as part of its performance of a Government contract and that information may provide the firm with a competitive advantage in a later competition for a Government contract. In these “unequal access to information” cases, the concern is limited to the risk of the firm gaining an unfair competitive advantage;

there is no issue of bias. Note: Incumbency alone does not constitute…