J8 Sections B-M Final Draft clean.docx

SECTION B - SUPPLIES OR SERVICES AND PRICES/COSTS

B.1 BRIEF DESCRIPTION OF SERVICES

The purpose of this contract is to obtain a Part A/Part B (A/B) Medicare Administrative Contractor (hereinafter referred to as “the contractor” or “MAC” or “A/B MAC”) to provide specified health insurance benefit administration services, including Medicare claims processing and payment services, in support of the “traditional” Medicare program (also known as the Medicare fee-for-service or FFS, program) for Jurisdiction 8 (J8). Jurisdiction 8 includes the states of Indiana and Michigan.

B.2 CONTRACT TYPE

The Centers for Medicare & Medicaid Services (CMS) anticipates awarding a Cost Reimbursement type contract. In accordance with FAR 16.101 (a) Policies, “Unless expressly prohibited by statute or this regulation, contract types that promote the best interests of the Government, but are not described in this regulation, are permitted for use in accordance with agency procedures (see 10 U.S.C. 3321(a) and 41 U.S.C. 3901). Ensure selection of contract type is consistent with the Guiding Principles for the System in 1.102The primary pricing arrangement is anticipated to be Cost- Plus- Award-Fee (CPAF).

B.3 AWARD FEE

The amount of award fee the Contractor earns, if any, will be based upon an evaluation by the Government of the contractor’s performance in accordance with the Performance Evaluation Award Fee Plan (Attachment J.07). The CMS Fee Determination Official (FDO) will determine the amount of award fee earned by the contractor for the evaluation period. The determination of the amount of the award fee for the evaluation period is a unilateral decision made solely at the discretion of the FDO. Upon receiving written notification from the FDO of the amount of award fee earned for the evaluation period, the Contractor may submit an invoice for the earned award fee. The Government may unilaterally change the Performance Evaluation Award Fee Plan at any time. However, any revisions to the evaluation factors in the Performance Evaluation Award Fee Plan shall be presented to the Contractor prior to the evaluation period in which it will be used.

The award fee evaluations will be performed on an annual basis with the actual evaluation beginning in the month immediately following the evaluation period. The award fee available for each period shall be a portion of the total award fee pool available for the entire contract period (see Section G.18). Award fee evaluations will not be applied to contract period of 6 months or less.

*Note: A sample Performance Evaluation Award Fee Plan (Attachment J.07) is provided. The final Performance Evaluation Award Fee Plan will be provided at time of contract award.

B.4 ESTABLISHED COST AND AWARD FEE

The estimated cost of this contract is detailed in the chart below.

B.5 TASK DIRECTIVES

The Contracting Officer may use individual Task Directives with specifically defined scopes and schedules to direct the contractor to perform special projects. Task Directives may also be issued to request a special administrative or user support services project. This mechanism will be used on a project-by-project basis and will be incorporated into the contract through the Changes clause (FAR 52.243-2 Alternate I).

Task Directives issued under this contract may be fixed-price or cost reimbursement. The contractor is required to establish separate cost accounts for each Task Directive issued and to segregate those costs in their vouchers.

B.6 SCHEDULE OF SUPPLIES/SERVICES

CPAF

CREDITS

CLIN 0001*** –IMPLEMENTATION

Date: TBD

CLIN 0002** – AB MAC SERVICES

BASE YEAR OPERATIONS

0002AA

Program Management

0002AB

Medicare Integrity Program

0002AC

Recovery Audit Contractor

TOTAL CLIN 0002 – AB MAC SERVICES

BASE YEAR OPERATIONS

CLIN 0003** – AB MAC SERVICES OPTION YEAR 1 OPERATIONS

0003AA

0003AB

Medicare Integrity Program

0003AC

Recovery Audit Contractor

TOTAL CLIN 0003 – AB MAC SERVICES

OPTION YEAR 1

CLIN 0004** – AB MAC SERVICES OPTION YEAR 2 OPERATIONS

0004AA

0004AB

Medicare Integrity Program

0004AC

Recovery Audit Contractor

TOTAL CLIN 0004 – AB MAC SERVICES

OPTION YEAR 2

CLIN 0005** – AB MAC SERVICES OPTION YEAR 3 OPERATIONS

0005AA

0005AB

Medicare Integrity Program

0005AC

Recovery Audit Contractor

TOTAL CLIN 0005 – AB MAC SERVICES

OPTION YEAR 3

CLIN 0006** – AB MAC SERVICES OPTION YEAR 4 OPERATIONS

0006AA

0006AB

Medicare Integrity Program

0006AC

Recovery Audit Contractor

TOTAL CLIN 0006-AB MAC SERVICES

OPTION YEAR 4

CLIN 0007** -AB MAC SERVICES OPTION YEAR 5 OPERATIONS

0007AA

0007AB

Medicare Integrity Program

0007AC

Recovery Audit Contractor

TOTAL CLIN 0007-AB MAC SERVICES

OPTION YEAR 5

CLIN 0008** -AB MAC SERVICES OPTION YEAR 6 OPERATIONS

0008AA

0008AB

Medicare Integrity Program

0008AC

Recovery Audit Contractor

TOTAL CLIN 0008 – AB MAC SERVICES

OPTION YEAR 6

CLIN 0009** -AB MAC SERVICES OPTION YEAR 7 OPERATIONS

0009AA

0009AB

Medicare Integrity Program

0009AC

Recovery Audit Contractor

TOTAL CLIN 0009 – AB MAC SERVICES

OPTION YEAR 7

CLIN 0010** -AB MAC SERVICES OPTION YEAR 8 OPERATIONS

0010AA

0010AB

Medicare Integrity Program

0010AC

Recovery Audit Contractor

TOTAL CLIN 0010 – AB MAC SERVICES

OPTION YEAR 8

CLIN 0011*** - Outgoing Contractor Workload Transition Activities

CONTRACT LINE ITEM NUMBER

CLIN 0012*** – Prior Authorization for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) BASE YEAR Date: TBD

CLIN 0013*** – RSNAT OPTION YEAR 1

CLIN 0014*** – RSNAT OPTION YEAR 2

CLIN 0015*** – RSNAT OPTION YEAR 3

CLIN 0016*** – RSNAT OPTION YEAR 4

CLIN 0017*** – RSNAT OPTION YEAR 5

CLIN 0018*** – RSNAT OPTION YEAR 6

CLIN 0019*** – RSNAT OPTION YEAR 7

CLIN 0020*** – RSNAT OPTION YEAR 8

CLIN 0021*** - BASE YEAR

Medical Review for Therapy Claims KX Modifier (KX MODIFIER)

DATE: TBD

CLIN 0022*** - KX MODIFIER

OPTION YEAR 1

DATE: TBD

CLIN 0023*** - KX MODIFIER

OPTION YEAR 2

DATE: TBD

CLIN 0024*** - KX MODIFIER

OPTION YEAR 3

DATE: TBD

CLIN 0025***- KX MODIFIER OPTION YEAR 4

DATE: TBD

CLIN 0026*** – KX MODIFIER OPTION YEAR 5

DATE: TBD

CLIN 0027*** - KX MODIFIER

OPTION YEAR 6

DATE: TBD

CLIN 0028*** - KX MODIFIER

OPTION YEAR 7

DATE: TBD

CLIN 0029*** - KX MODIFIER

OPTION YEAR 8

DATE: TBD

CLIN 0030*** - BASE YEAR

Medicare Cost Report Workload Initiative (MCRWI)

DATE: TBD

CLIN 0031*** – MCRWI

OPTION YEAR 1

DATE: TBD

CLIN 0032*** – MCRWI

OPTION YEAR 2

DATE: TBD

*Refer to section G.15, Complementary Credits.

**Cost-Plus Award Fee (CPAF) CLIN/SLIN ***Cost-Plus Fixed Fee (CPFF) CLIN/SLIN (CLIN 0001 – IMPLEMENTATION and CLIN 0011 – Outgoing Contractor Workload Transition Activities and all other CLINS, except CLINs 0002-0010 are CPFF. CLINs 0002-0010 are CPAF.)

(NOTE: 1. For Incremental Funding Table, per HHSAR 332.703-72, refer to Section H.25 – Limitation of Funds)

(END OF SECTION B)

SECTION C - DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

C.1 STATEMENT OF WORK

The Statement of Work (SOW) is provided in Section J as Attachment J.01 and shall be made a part of the contract. The SOW takes precedence over the Internet Only Manuals and Paper-Based Manuals unless otherwise specified.

(END OF SECTION C)

SECTION D - PACKAGING AND MARKING

D.1 PACKAGING AND MARKING

All deliverables required pursuant to the terms of the contract must be shipped and marked in accordance with Section F.3 Deliverables and any other requirements as set forth in Attachment J.02.

(END OF SECTION D)

SECTION E - INSPECTION AND ACCEPTANCE

E.1 FAR 52.252-2 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: https://www.acquisition.gov/far/

Federal Acquisition Regulation (FAR) Clauses:

52.246-5 INSPECTION OF SERVICES – COST REIMBURSEMENT (APR 1984)

E.2 APPROVALS BY THE CONTRACTING OFFICER REPRESENTATIVE

All services or supplies to be delivered to the Contracting Officer Representative (COR) will be deemed to have been accepted 30 calendar days after date of delivery, except as otherwise specified in this contract, if written approval or disapproval has not been provided within such period. The COR's approval or revision to the services or supplies delivered shall be within the general scope of work stated in the contract.

E.3 INSPECTION OF SERVICES –COST-REIMBURSEMENT

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

b) The Government's COR is a duly authorized representative of the Government and is responsible for inspection and acceptance of all items required to be delivered by this contract.

c) Inspection and acceptance of the Contractor's performance shall be in accordance with FAR Clause 52.246- 5, Inspection of Services-Cost Reimbursement.

(END OF SECTION E)

SECTION F - DELIVERIES OR PERFORMANCE

F.1 FAR 52.252-2 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: https://www.acquisition.gov/far/

Federal Acquisition Regulation (FAR) Clauses:

52.242-15 STOP WORK ORDER, ALTERNATE I (APR 1984)

F.2 PERIOD OF PERFORMANCE (JAN 2014)

The period of performance for completion of all work included in this contract shall be from the effective date of contract award through 12 months, plus eight (8) one (1) year options as follows:

Date of contract award – 6 months for Part B*

*Cutover from Implementation – 6 months for Part B*

*CLIN 0001 and CLIN 0002 may be overlapping periods of performance.

**This option may be exercised approximately 6 months prior to the expiration of the current year of performance.

(NOTE: 1. The option periods delineated above are subject to the FAR option clauses incorporated in Section I of the contract.

2. For Incremental Funding Table, per HHSAR 332.703-72, refer to Section H.25 - Limitation of Funds.)

F.3 DELIVERABLES

a) The Deliverable Schedule is provided under Section J as Attachment J.02 and shall be made a part of this contract.

b) The Contractor shall submit all required deliverables and reports in accordance with the attached schedule. Reports submitted under the contract shall reference and cite the contract number and identify CMS as the sponsoring agency.

c) Deliverables shall be submitted to the MAC/CMS Data Exchange (MDX) MAC Deliverables Tracking (MDT) module.

d) If unable to upload deliverables electronically to MDT, contact CMS.

e) Hardcopy Implementation deliverables should be sent to the J8 Implementation Lead. Refer to JSM Number 10337 for further instructions.

f) Satisfactory performance under the contract shall be deemed to occur upon delivery and acceptance by the Contracting Officer, or the duly authorized representative, of the items in the attached Deliverable Schedule (Attachment J.02). Reports submitted under the contract shall reference and cite the contract number and identify CMS as the sponsoring agency. The following abbreviations apply to Attachment J.02:

Note: Additional deliverables may be assigned as part of the project planning process. Individual projects may be released, as necessary by the direction of the Contracting Officer. Addressees:

· CONTRACTING OFFICER’S REPRESENTATIVE (COR): Please refer to Section G.8, Government Representatives and Responsibilities

· CONTRACTING OFFICER (CO): Please refer to Section G.8, Government Representatives and Responsibilities

· CONTRACT SPECIALIST (CS): Please refer to Section G.8, Government Representatives and Responsibilities

All electronic files shall be submitted in a format compatible with Microsoft Office PC-based software. As this requirement is subject to change, the contractor shall be able to adapt to any new CMS standard in order to submit deliverables. Unless specifically denoted as “workday(s),” all timeframes are in calendar days, calendar weeks, calendar months, etc. after the effective date of the contract.

(END OF SECTION F)

SECTION G - CONTRACT ADMINISTRATION DATA

G.1 ACCOUNTING AND APPROPRIATION DATA

G.2 PAYMENT, SELECTED ITEMS OF COST REIMBURSEMENT CONTRACTS

a) Travel Costs (Including Foreign Travel)

The Contractor shall be reimbursed for travel costs in accordance with FAR 31.205-46 Travel Costs.

b) Per Diem

Expenses for subsistence and lodging shall be reimbursed to the Contractor only to the extent where overnight stay is necessary for performance under this contract. Incurred costs shall be considered to be reasonable and allowable only to the extent that they do not exceed, on a daily basis, the maximum per diem rates in effect at the time of travel as set forth in the Federal Travel Regulations in accordance with FAR 31.205-46(2).

c) Cost of Materials

The cost of materials furnished or used under this contract shall be reimbursed in accordance with FAR 52.216-7 Allowable Cost and Payment, Reimbursing costs for cost reimbursement contracts. Expendable material costs for items such as office supplies, report paper, etc., and tools of the trade shall be priced in accordance with the Contractor’s approved accounting practices or standards, as applicable. The Contractor shall be required to support all material costs claimed.

d) Relocation Costs

In accordance with FAR 31.205-35, Relocation costs, either direct charged or included in the contractor's indirect cost pools, associated with an individual not completing a term of service equal to one (1) year working under this contract shall be an unallowable cost under this contract.

G.3 DISSEMINATION, PUBLICATION & 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 stipulated. 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 FAR 52.233.1 Disputes.

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 is requested pursuant to the Federal Freedom of Information Act (FOIA).

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 projects funded, 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 acknowledgment substantially, as follows:

"The analyses upon which this publication is based were performed under Contract Number ___TBD____entitled, A/B MAC Jurisdiction 8. Sponsored by the Centers for Medicare & Medicaid Services, U.S. Department of Health & Human Services."

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

Solicitation Number 75FCMC27R0001 A/B MAC Jurisdiction 8

G.4 SUBCONTRACTING REPORTING

The Contractor shall report all subcontract awards to small, small disadvantaged, women-owned, HUBZones, veteran-owned and service-disabled veteran-owned small business concerns. The reports shall be submitted in SAM.gov.v The Individual Subcontracting Report (ISR), formerly SF 294, and the Summary Subcontracting Report (SSR), formerly SF 295, shall be submitted as detailed in the chart below.

G.5 SUBCONTRACTING PROGRAM

Contractors are to submit Small Business Subcontracting Plans per FAR 52.219-9, Small Business Subcontracting Plan. In accordance with FAR 19.109 and 302, the subcontracting plan shall be submitted using the U.S. Department of Health and Human Services (HHS) Small Business Customer Experience (SBCX) system. The plan shall cover the entire contract period of performance, and the Contractor shall strive to achieve the HHS small business utilization goals outlined in section L.12.6 when developing its small business subcontracting plan. Offerors are directed to https://osdbu.hhs.gov/customer/subk-create/e51b67f8-0eea-47a8-8425-84fac649a383 for this submission.

The contractor hereby agrees to implement the conditions of the subcontracting plan submitted and approved by the Contracting Officer for this contract.

G.6 SUBCONTRACT CONSENT

a) To facilitate the review of a proposed subcontract by the COR and the Contracting Officer, the Contractor shall submit the information required by FAR Clause 52.244-2, Subcontracts (Jun 2020) to the Contracting Officer. The Contracting Officer shall review the request for subcontract approval as well as the COR's recommendation and advise the Contractor of his/her decision to consent or object to the proposed subcontract, in writing.

b) Consent is hereby given to issue the following subcontract(s): (To be completed at time of award, if applicable).

G.7 SERVICE OF CONSULTANTS/SUBCONTRACTORS

a. For the purposes of this contract, consultants are considered subcontractors. The Contractor shall follow the procedures established in FAR Clause 52.244-2, Subcontracts.

b. The Contractor shall be reimbursed at the rates(s) set forth below for services provided by consultants/subcontractors in connection with this contract:

(To be completed at time of award, if applicable)

G.8 GOVERNMENT REPRESENTATIVES AND RESPONSIBILITIES (NOV 2024)

Following are the Government Representatives and their respective roles and responsibilities on this contract:

a. Contracting Officer

As defined in Federal Acquisition Regulation (FAR) 2.101, Definitions, and in accordance with FAR 1.602- 1, Authority, “Contracting officers have authority to enter into, administer, and/or terminate contracts and make related determinations and findings.” There is no other authorized representative, or any other Administrative Contracting Officer assigned to this contract to carry out a Contracting Officer’s duties, except for technical direction assigned to the Contracting Officer’s Representative, if applicable.

The Contracting Officer is:

Centers for Medicare & Medicaid Services Office of Acquisition & Grants Management Medicare Support Contracts Group Division of Fee-for-Service Contracts ATTN: Mark Smolenski 7500 Security Blvd.

Baltimore, MD 21244-1850 Phone: 410-786-0175 Email Address: Mark.Smolenski@cms.hhs.gov

b. Contract Specialist

Notwithstanding any of the other provisions of this Contract, the Contract Specialist will assist the Contracting Officer with his/her responsibilities as defined in the FAR.

The Contract Specialist is:

Office of Acquisition & Grants Management Medicare Support Contracts Group Division of Fee-for-Service Contracts ATTN: Alyssa Jones 7500 Security Blvd. Baltimore, MD 21244-1850 Phone: 410-786-1535 Email Address: Alyssa.Jones@cms.hhs.gov

c. Contracting Officer’s Representative The Contracting Officer’s Representative (COR), as defined in FAR 2.101, Definitions, is:

Centers for Medicare & Medicaid Services Medicare Contractor Management Group ATTN: Christopher Kerr 7500 Security Blvd., Mail-stop: S1-14-17 Baltimore, MD 21244-1850 Phone: 617-565-1217 Email Address: Christopher.Kerr@cms.hhs.gov

In accordance with FAR 1.602-2(d), Responsibilities, the COR’s delegated responsibilities are identified in the Contracting Officer’s appointment memorandum, a copy of which will be furnished to the contractor.

The COR will serve as the primary liaison between the Contractor and the Contracting Officer and perform duties within the limitations of the COR’s responsibilities in accordance with FAR 1.602-2(d).

Technical direction must be within the general scope of the work stated in the contract. The term "technical direction" is defined to include, without limitation, the following:

(1) Directions to the Contractor which direct 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 technical requirements as identified in the Statement of Work or Performance Work Statement; or

(2) Provision of information to the Contractor, which assists in the interpretation of drawings, specifications, or technical portions of the work description.

Technical direction within the scope of the contract, shall be “in writing” whenever possible and routed through the CO prior to release to the Contractor. If technical direction is verbally communicated, the COR must immediately confirm its direction in writing. Where doubt exists as to whether proposed technical direction is within or outside the scope of the contract, the CO shall be contacted.

If, in the opinion of the Contractor, any instruction or direction issued by a Government representative constitutes a change to the contract or constitutes a “Change Order” as defined in FAR 2.101, Definitions, the Contractor shall follow the instructions identified in FAR 52.243-7 Notification of Changes.

The COR “has no authority to make any commitments or changes that affect price, quality, quantity, delivery, or other terms and conditions of the contract nor in any way direct the contractor or its subcontractors to operate in conflict with the contract terms and conditions.” See FAR 1.602-2(d)(5). The COR’s authority is not re-delegable and the COR may be personally liable for unauthorized acts in accordance with FAR 1.602-(d)(7)(iv) and (v). For example, the COR does not have the authority to:

1. Make changes to contract terms and conditions;

2. Direct the contractor to perform work or make deliveries not specifically required under the contract;

3. Waive or relax the Government’s rights with regard to the Contractor’s compliance with the specifications, price, delivery or any other terms or conditions of the contract;

4. Make any commitments or approve any actions that would create any financial obligation on the part of the Government; or

5. Issue direction that constitutes a “change” as defined in:

FAR 52.243-1, Changes – Fixed Price;

FAR 52.243-2, Changes – Cost-Reimbursement;

FAR 52.243-3, Changes – Time-and-Materials or Labor-Hours;

FAR 52.243-4, Changes; or, FAR 52.243-5, Changes and Changed Conditions.

In addition to the above responsibilities, the COR and/or Contractor shall immediately notify the Contracting Officer of any contractual concerns related to the following:

1. Personal Services: FAR 37.104(a) provides that, “[a] personal services contract is characterized by the employer- employee relationship it creates between the Government and the contractor’s personnel. The Government is normally required to obtain its employees by direct hire under competitive appointment or other procedures required by the civil service laws. Obtaining personal services by contract, rather than by direct hire, circumvents those laws unless Congress has specifically authorized acquisition of the services by contract.”

Under this contract, the services to be performed do not require the Contractor or the Contractor’s personnel to exercise personal judgement and discretion on behalf of the Government. Rather, the Contractor’s personnel will act and exercise personal judgement and discretion on behalf of the Contractor. The services to be performed under this contract are not for personal services as defined by FAR 37.104.

Both the Government and the Contractor have a responsibility to monitor contract activities. The CO must be notified immediately if at any time during contract performance the interaction between the Government representative and Contractor personnel constitutes or is perceived to constitute personal services. Both the Government and Contractor personnel must exercise caution to ensure that service contracts not personal in nature avoid even the appearance of a personal services contract.

2. Inherently Governmental Functions: The agency shall not use contractors for the performance of inherently governmental functions unless issued under statutory authority See FAR 7.5 Inherently Governmental Functions. As defined in FAR 2.101, “Inherently Governmental Function” means, as a matter of policy, a function that is so intimately related to the public interest as to mandate performance by Government employees. An inherently governmental function includes activities that require either the exercise of discretion in applying Government authority, or the making of value judgments in making decisions for the Government. Inherently governmental functions DO NOT normally include gathering information for or providing advice, opinions, recommendations, or ideas to Government officials.

FAR 7.503(c) provides a list of examples of functions considered to be inherently governmental functions or which shall be treated as such.

To this effect, during contract performance, care should be taken to ensure that any change or expansion in scope of the requirement does not include inherently governmental functions. Further, due to the nature of a given requirement, there is a potential for close working relationships to develop between Government and Contractor personnel; however, care should be taken to ensure that any familiarity established between the Government and Contractor personnel never promotes or fosters an environment that allows for the assignment of inherently governmental functions to contractor employee(s).

3. Unauthorized Commitments: In carrying out your duties, you are reminded that in accordance with FAR 1.602- 2(d)(5), the COR “[h]as no authority to make any commitments or changes that affect price, quality, quantity, delivery, or other terms and conditions of the contract, or in any way direct the Contractor, or its Subcontractors, to operate in conflict with the contract terms and conditions.” Doing so constitutes an “unauthorized commitment.” The Contracting Officer is the only individual with the authority to enter into an agreement on behalf of the Government. An unauthorized commitment is defined as “an agreement that is not binding solely because the Government representative who made it lacked the authority to enter into that agreement on behalf of the Government.” FAR 1-602-3(a). Examples of unauthorized commitments include, but are not limited to, the following:

· Orders placed with a Contractor without a valid contractual instrument in place.

· Directing any Contractor to do additional work, in excess of the contract value, or work beyond the Period of Performance.

· Authorize new work to a contract without notifying the Contracting Officer (CO) or Contract Specialist (CS) and having a modification in place for the new work.

· Directing the Contractor, in any way that could change the terms and conditions of the contractual instrument or be deemed outside the Scope of the Statement of Work.

Unauthorized commitments are a serious matter and may result in personal liability on the part of the employee who committed the unauthorized commitment. Ratification, is “the act of approving an unauthorized commitment by an official who has the authority to do so.” FAR 1.602-3(a).

G.9 CONTRACT PROPERTY ADMINISTRATION

(a) Contractor agrees to furnish information regarding Government Property to the Contract Property Administrator in the manner and to the extent required by the Contract Property Administrator, his duly designated successors, and in accordance with FAR Part 45 – GOVERNMENT PROPERTY and Appendix Q of the U.S. Department of Health & Human Services (HHS) Contracting Guide for Contract of Government Property, (April 2009) which is provided as Attachment J.04 to this solicitation.

(b) The Contractor is responsible for an annual physical inventory accounting for all government property under this contract. The inventory must be conducted by September 30th and the Standard Form 1428 Inventory Schedule, (or other form designated by the Contract Property Administrator), submitted by October 31st of each year.

(c) The inventory report shall include all items acquired, furnished, rented or leased under the contract. Employees who conduct the inventories should not be the same individuals who maintain the property records. The contractor must complete an HHS-342, Report of Survey, for any Government Furnished Equipment/Government Furnished Property inventory damages or shortages upon the direction of the Contract Property Administrator. Following the physical inventory, the Contractor shall prepare an inventory report and submit the report to the CMS Contract Property Administrator at the following address:

Centers for Medicare & Medicaid Services Office of Operations Management Administrative Services Group Division of Printing, Mail, and Logistics Attn: Piljun Kim 7500 Security Boulevard, M/S SL-13-12 Baltimore, Maryland 21244-1850

(410) 786-0239

AND

Email the Contract Specialist (Refer to Section G.8 for contact information).

(d) Commercially leased software is subject to these reporting requirements.

(e) The Contractor shall submit a consolidated report of all accountable government property under this contract, including subcontractor inventory information.

(f) The final inventory report shall indicate that all items required for continued contract performance are acceptable and free from contamination. Property that is no longer usable or required shall be reported and disposition requested from the Contract Property Administrator at least 60 days prior to contract expiration. The final inventory report shall be submitted upon the date of contract expiration.

G.10 GOVERNMENT FURNISHED PROPERTY

Pursuant to FAR Part 45 – Government Property and FAR Clause 52.245-1, Government Property, of this contract, the Government will furnish for performance of the work required herein a list of accessible government systems, which is provided under Attachment J.05 and is hereby made part of this contract.

G.11 CONTRACTOR FURNISHED PROPERTY

A list of Contractor Furnished Property is incorporated as Attachment J.06 (To be completed at time of award).

G.12 PAYMENTS – INVOICES – (SEPT 2024)

a. GENERAL: Effective August 31, 2020, the Contractor/Vendor shall create an invoice within the Invoice Processing Platform (IPP), a secure Web-based service for federal agencies and their vendors to manage government invoicing from purchase order (PO) through payment notification. Note: All invoice terms and conditions are contract specific and may vary from contract to contract.

b. CONTENT OF INVOICE: FAR 32.905 Payment Documentation and Process, provides the required content for a proper invoice. In addition to the requirements of FAR 32.905, the following items shall also be included on the invoice to be considered proper:

· Line item number (i.e. CLIN/SLIN as applicable);

· Contractor/Vendor’s Unique Entity Identifier (UEI) Number;

· Period of Performance (POP) or delivery date of goods or services provided;

· Attachments and applicable support documentation requested by the CO;

· The first page of the PDF invoice or PDF SF-1034 shall include:

1. Contractor/Vendor name and address;

2. Bill to: CMS, P.O. Box 7520, Baltimore, MD 21207;

3. Full CMS contract number and task order number;

4. Summary of charges by CLIN/SLIN (if applicable) with a grand total. CLIN/SLIN(S) on the PDF shall be identical to what is entered in IPP;

5. Invoice number shall be identical to what is entered in IPP. Each Contractor/Vendor invoice number must be unique across all CMS contracts awarded to the Contractor/Vendor. For example, If Contractor/Vendor A has 5 CMS contracts, Contractor/Vendor A cannot use the same invoice number on any of the 5 contracts they have with CMS. If using a dash in IPP then the dash must be used on the PDF. IPP does not allow any special characters (i.e.*, #);

6. Within IPP, the “Bill Period Start” and “Bill Period End” dates should align with the “Service From” and “Service To” dates (this is not the entire POP dates);

7. Date of Delivery or Service dates shown on the PDF should: (i) Fall within the contract POP (unless contract indicates otherwise) (ii) Align with the “Bill Period Start” and “Bill Period End” dates and “Service From” and “Service To” dates, and (iii) Note when the work was performed;

8. Date invoice was prepared;

9. The total invoice amount on the first page of the invoice or SF-1034 must be a debit. A credit may be shown on the first page of the invoice or SF-1034 if the credit falls within the Period of Performance and is for the same CLIN as the debit. CMS does not accept credit vouchers or process refunds in IPP or the Invoice Submission Box. Credits in excess of $5.01 must be submitted via Pay.gov (For questions surrounding Pay.gov, contact pay.gov.clev@clev.frb.org or 1-800-624-1373 (Option 2)). Credits sent to Pay.gov shall be copied to the CO, CS and COR. Credits valued at or less than $5.01 must be submitted via Credit Gateway; however, it is preferred that the Contractor/Vendor wait until a dollar amount is accumulated in order to submit the refund through Pay.gov (For questions surrounding Credit Gateway, contact customer.care@usbank.com or 1-877-815-1206);

· When an invoice has been resubmitted, an “R” should be added after the invoice number on the PDF and in IPP; this will ensure that the original invoice number is not duplicated in IPP. If a resubmitted invoice is rejected again, each subsequent resubmission requires an additional “R” added after the invoice number (i.e. “RR”);

· The “final” designation should only be used when the contract is being closed out by OAGM. Do not use for the end of POP or Option Year;

· Contractor/Vendor must maintain active registration in SAM.gov. If your SAM account is about to expire, wait until it is updated before submitting your invoice; and,

· Banking or address changes must be submitted via email to CCRchanges@cms.hhs.gov.

c. INVOICE SUBMISSION: The contractor/vendor shall create an invoice from the Purchase Order (PO)/ Contract via the IPP website http://www.ipp.gov/. For questions, call IPP Customer Support at (866) 973-3131 or email the IPP Customer Support at IPPCustomerSupport@fiscal.treasury.gov. Only one PDF invoice per submission is allowed in IPP.

d. PAYMENTS: The Government shall make payment of all proper invoices in accordance with the following clauses, as applicable and included in the respective TO/PO/contract:

· FAR 52.232-33 Payments by Electronic Funds Transfer – System for Award Management,

· FAR 52.232-1 Payments

· FAR 52.212-4 Contract Terms and Conditions – Commercial Items (If applicable)

· FAR 52.216-7 Allowable Cost and Payment

· FAR 52.232-7 Payments under Time-and-Materials and Labor-Hour Contracts

Payment shall be made 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 no later than 30 calendar days after receipt of a proper invoice from the Contractor requested at the paying office designated above. Contracts with a 15-day payment term are not subject to interest payments until after day 30.

e. 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 a proper invoice in IPP.

Determinations of interest due will be made in accordance with the provisions of the Prompt Payment Act and 5 CFR 1315.

G.13 SEPARATION OF MEDICARE INTEGRITY PROGRAM AND PROGRAM MANAGEMENT FUNDING

Funding for Medicare Integrity Program activities under Section 1893 of the Social Security Act is derived from a different source than funding for the other functions (called “Program Management functions”) which the Contractor performs pursuant to the authority of Section 1874A of the Social Security Act. Therefore, separate accounts shall be designated for Medicare Integrity Program activities and the Program Management functions which the Contractor performs pursuant to the authority of Section 1874A. The Contractor shall separately account for costs incurred to perform Medicare Integrity Program activities and its Program Management functions under this contract. In no event shall the Contractor apply funding which is designated for Medicare Integrity Program activities to costs incurred in performing its Program Management functions authorized by Section 1874A; similarly, the Contractor shall not apply funding designated for costs incurred in performing its Program Management functions under Section 1874A to Medicare Integrity Program activities.

G.14 SEPARATION OF TRUST FUND EXPENDITURES/ACCOUNTING FROM ADMINISTRATIVE EXPENDITURES/ACCOUNTING

Any costs which are properly chargeable by a provider of services, physician, or supplier as benefit costs in accordance with Title XVIII of the Social Security Act, its implementing regulations and this contract, shall not be chargeable to this contract as administrative costs (i.e., either Medicare Integrity Program or Program Management costs). The Contractor shall separately account for benefit payments made by it from costs incurred to perform its Medicare Integrity Program activities and its Program Management functions under this contract.

G.15 COMPLEMENTARY CREDITS

The contractor shall separately account for complementary credits and reflect the current and cumulative totals on their monthly invoice. The estimated amounts for complementary credits shall be shown as a reduction to the total costs amount (i.e., after application of any fees) within each applicable CLIN. Complementary Credits for crossover claims will be accounted for on a cash basis.

G.16 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 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 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 and assigning consecutive numbers (serial numbers to permit accountability), as illustrated below:

EXAMPLE: Contract No. – 75FCMCXXXX Sequence # - XX (YEAR) – XXXX Subject - Request for Subcontract Consent

G.17 DATA TO BE DELIVERED

Any working papers, interim reports, data provided 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.

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.18 AWARD FEE EVALUATION PLAN

A sample Performance Evaluation Award Fee Plan and Self-Assessment Template upon which the determination of award fee is based is identified herein as Attachment J.07. The award fee plan contains details with respect to how the Contractor will be evaluated periodically for its performance. The general criteria upon which the Contractor will be evaluated on can be found in the aforementioned Attachment J.07. Award fee evaluations will not be applied to contract period of 6 months or less.

The Contractor may submit self-evaluations of performance for each period under consideration. The Performance Evaluation Board in reaching its determination will consider these self- evaluations.

A sample Performance Evaluation Award Fee Plan is provided. The final award fee plan will be provided at time of contract award.

G.19 INDIRECT COST RATES (MAY 2021)

Paragraphs 1 and 2 below apply only to contractors where the Department of Human Health and Services (HHS), or one of its Operating Divisions (e.g., CMS), is recognized as the Cognizant Federal Agency (CFA) as defined in FAR 42.003.

If an Agency other than HHS (or one of HHS’ Operating Divisions) is identified as the CFA (e.g., Defense Contract Management Agency), paragraphs 1 and 2 below do not apply. Rather, the contractor must provide a copy of all applicable and executed provisional billing rate agreements, forward pricing rate agreements, and final indirect cost rate agreements to the CMS Acquisition Division of Financial Services mailbox: AcquisitionDFSIncurredCostSubmission@cms.hhs.gov.

1. Provisional Billing Rates

a. Formation

1. Until final indirect cost rates are established pursuant to FAR 52.216-7(d), the Government will reimburse the contractor’s incurred indirect costs temporarily using the provisional billing rates established in the Provisional Billing Rate Agreement as described below.

2. In accordance with FAR 52.216-7(e), FAR Subpart 42.707, and HHSAR Subpart 342.705, the…