Medical Review Solicitation Number OIG260145.pdf

Solicitation # OIG260145 WHITE PAPER

Proposal Preparation, Submission and Evaluation

Section 1: The Submittal Process The process is in three (3) phases as follows:

Phase 1, White Paper: Complete a cover page, and White Paper in accordance with the instructions provided in Section 2 below. White Papers will be evaluated against criteria as described in Section 5. White Papers shall describe the effort in sufficient detail to allow evaluation of the concept's technical merit and its potential contribution to the OIG mission.

Offerors whose White Paper receive a favorable evaluation may be invited to participate in

Phase 2 – Oral Presentations. Offerors whose White Paper did not receive a favorable evaluation will be notified by email.

Phase 2, Oral Presentation: Offeror will participate in accordance with the instructions provided in Section 3 below. Oral Presentations will be evaluated against criteria as described in Section 5. (See CONFIDENCE RATING). Offerors whose Oral Presentations receive a favorable evaluation may be invited to participate in Phase 3 –PWS/QCP and Cost Proposal.

Offerors whose Oral Presentation did not receive a favorable evaluation will be notified by email.

Phase 3, PWS/QCP and Price Proposal: Offeror will submit a Performance Work Statement

(PWS) with Quality Control Plan (QCP) and Price Proposal in accordance with the instructions provided in Section 4 below. PWS/QCP and price proposals will be evaluated against criteria as described in Section 5.

Proposal Phases Deadline for Submission Phase 1: White Paper 7/20/2020

Phase 2: Oral Presentation 8/24/2020

Phase 3: PWS/QCP and Cost Proposal 9/14/2020

Section 2: White Paper Preparation Guidance

Interested Offerors shall submit a cover page and White Paper which addresses Section 5.0 – MINIMUM REQUIREMENTS AND QUALIFICATIONS of the attached SOO. The cover page shall contain the following information:

• Solicitation Number;

• Name and Address of Offeror;

• Name and Point of Contact (POC) telephone number and e-mail address for the primary point of contact;

• Team member or subcontractor names, addresses and business size;

• Data Universal Numbering System (DUNS) number;

• Name, title, and signature of the Prime Contractor’s authorized representative (signature authority).

The White Paper shall not to exceed ten (10) pages, not including the cover page. If submissions exceed these limitations, only those pages previously defined will be reviewed. The White

Paper shall address the following technical factors:

Factor 1: Demonstrated Prior Experience The Offeror’s ability to meet the Corporate Experience requirement is very important to the

Government in order to illustrate that the Offeror will be able to successfully perform Medical

Reviews the first day of Task Order award.

The Offeror shall provide a detailed description of up to three (3) recent corporate experience in performing medical reviews for a Government Agency (State or Federal), or for a

Domestic/International Company of a similar size, scope, and responsibilities as HHS OIG.

The Offeror’s response shall identify the contracting Agency Name, Contract Number, Contract

Point of Contact and phone number, or shall describe the Corporate Experience as for a

Domestic/International Company and provide the name of the company for which the work was performed. The Offeror shall also state what the period of performance was and shall categorize its role as a “prime contractor” or “sub-contractor”.

Comparable size, scope, and responsibility is defined as (At least 2,000 health care related claims performed annually with a minimum contract dollar value of $1,000,000). Recent corporate experience is defined as performing a medical review within five (5) years of the RFP release date.

Factor 2: Ability to meet Minimum Requirements and Qualifications The Offeror shall provide a detailed description of their ability to meet and address the minimum requirements and qualifications as described in Section 5.0 of the attached SOO.

Restrictive markings on White Papers: Submissions will be protected from unauthorized disclosure in accordance with FAR Subpart 15.207, applicable law and HHS regulations.

Offeror’s that include in their white papers, data that they do not want disclosed, shall mark their proposal in accordance with the instructions contained FAR 52.215-1(e) ‘Restrictions on disclosure and use of data.’

Each Offeror shall submit an electronic copy of their firm’s White Paper. The White Paper shall be submitted to the Contract Specialist, Christopher Winfield Email Address:

Chris.Winfield@oig.hhs.gov and the Contracting Officer, Nicola L. Carmichael, at email address: Nicola.Carmichael@oig.hhs.gov. Failure to submit Papers via email to both the individuals identified above could be considered non-responsive.

All White Paper submissions are due no later than 12:00 noon, Eastern Time (ET) July 20, 2020.

Include “OIG260145 WHITE PAPER” in the email subject line. White Papers must be submitted in the following format but do not require any special forms:

• Single PDF formatted file as an email attachment

• Page Size: 8 ½ x 11 inches

• Page limit: 10 pages• Margins – 1 inch

• Spacing – Single Font – Arial, 12-point

The file shall not exceed 2 Megabytes of storage space. Movie and sound file attachments, URL

Links, or other additional files, will not be accepted.

Notification to Offerors: All Offerors will receive an email acknowledging receipt of their White Paper submission. Debriefings for White Paper will not be provided; however, feedback may be provided in the response letter from OIG.

Note: Multiple white paper submissions are discouraged.

Section 3: Oral Presentation Guidance Oral Presentations will have 2 elements, a briefing and a scenario. The two elements will be held on the same business day. The briefing shall be one hour in length and documented by an accompanying power point presentation, limited to 20 slides to be mailto:Christopher.Winfield@oig.hhs.gov mailto:Nicola.Carmichael@oig.hhs.gov submitted at the time of the briefing. The scenario will also be one hour. The content of the briefing and the results of the scenario will be used to evaluate the Offeror’s Technical &

Management Capability and their Small Business Participation plan, if applicable. Each

Offeror will be given the same scenario to address.

Please note that the Government evaluators will NOT provide any feedback or comments concerning the Offeror’s performance, presentations, and work products during the oral presentation; however, the Government may ask clarifying questions during the oral presentation and scenario.

The number of slides for the briefing is limited to 20, not inclusive of a cover page and agenda. The offeror shall provide slides that complement and serve as documentation for its presentation. Extraneous information, such as marketing or other information irrelevant to this factor is not desired and will not be considered. Slides in excess of the total will be discarded and not considered.

Since the time for the oral presentation is limited to 2 hours total (1 hour for the briefing, 1 hour for the exercise), the Offeror shall adopt processes to be most effective in the amount of time provided for the presentation and scenario. Each Offeror will receive the same amount of time. The oral presentation will be expected to occur at the Government’s facility in the Washington DC metro area. Other arrangements will be made to accommodate the public health emergency caused by COVID-19. The CO will determine the order in which

Offerors are scheduled through a random selection process after receipt of proposals.

Requests to reschedule will be at the discretion of the CO.

The Offeror may bring a maximum of up to three (3) individuals to perform as a team for the briefing and scenario. The Offeror may bring prime members and teaming partners

(subcontractor) that are expected to make significant contributions to participating in the work proposed and completing the scenario. The Offeror’s team for the oral presentation shall include the Program Manager or Captain as a presenter and be representative of a team that could be proposed and perform work on a task order issued under the IDIQ contract. One additional vendor executive may attend as an observer only, for a total of four (4) vendor representatives (3 presenters, 1 observer).

The time, date, logistical information, scenario, and location of the presentation will be provided by the CO after the closing date of the solicitation.

ELEMENT 1 – Briefing:

Time allotted: one hour

Subfactor A: The Offeror shall demonstrate its knowledge, understanding, and capability to meet all the Objectives as stated in Section 4.0 of the Statement of Objectives (SOO) through a briefing presented to the Government. Through this briefing the Offeror shall provide an efficient methodology for accomplishing the Objectives enumerated in Sections

4.1 and 4.2 of the attached SOO.

Subfactor B: Offerors shall present a small business subcontracting plan in accordance with FAR 52.219-9; and the goals stated below shall be utilized for developing the small business subcontracting plan. In addition, Offerors shall provide a record of previous performance in carrying out the goals of subcontracting plans by providing two (2)

Summary Subcontracting Reports (SF 295) for recent individual contracts. If the Offeror has had no previous contracts requiring a subcontracting plan, include a statement to that effect.

The HHS subcontracting goals for Fiscal Year 2020 are listed below:

SB Category SB Goal

SB 41%

SDB 5%

WOSB 5%

HUBZone 3%

SDVOSB 3%

VOSB 3%

All content presented in the briefing shall be documented in the accompanying power point presentation of no more than 20 slides (excluding the cover page and agenda slide) to be provided the day of the briefing.

ELEMENT 2 – Scenario:

Time allotted: one hour

Offeror will be provided via secure electronic file transfer, two weeks in advance of the Oral

Presentation, with three to five claims and associated medical records of Medicare beneficiaries (with any personally identifiable information removed). Offeror will be required to sign a confidentiality agreement. These records will be for different categories of service billed by providers to Medicare Part A or Part B (e.g., inpatient hospital services, home health agency services, ESRD dialysis services). Offeror will perform a medical review of these records to determine whether these claims were billed and paid in compliance with Medicare coding, coverage, billing and payment requirements. Offeror shall develop a written medical review instrument and prepare a detailed report with the results for each claim reviewed. Performing these medical reviews and providing these documents is the Scenario process.

The Scenario will be presented to the Government Technical Evaluation Panel (TEP) by means of the Offeror’s response to the scenarios. This will occur on the same day as the briefing and will immediately follow. Offeror must be prepared to discuss its methodology, criteria selection, and analysis with the TEP.

Each Offeror will be given the same scenario. As such, it is the responsibility of each Offeror to preserve the integrity of the oral presentation scenario regarding dissemination of the challenge exercise to teaming partners/subcontractors that may participate.

On the day of the Oral Presentation of the Scenario, the Offeror shall bring their own equipment to present and provide its response. The government will provide a list of the equipment it will make available when the scenario is provided to the Offeror.

Within seven days of the Oral Presentation, Offeror will provide written notification to the

Contract Specialist and Contracting Officer certifying that it destroyed all electronic and hard copies of the claims and medical records so provided.

Section 4: PWS/QCP & Price Proposal Preparation Guidance

The PWS/QCP & Price Proposal will consist of Volume 1 – PWS/QCP and Volume 2 – Price

Proposal. There are no page limits to the PWS/QCP & Price Proposal. Volume 1 addresses

Factor 5 and Volume 2 addresses Factor 6.

VOLUME 1: PERFORMANCE WORK STATEMENT (PWS) / QUALITY CONTROL PLAN

(QCP)

PWS

The Statement of Objectives (SOO) describes the objectives, minimum requirements and qualifications to perform medical review of claims and the supporting medical record documentation as part of the development of audits and other OIG activities.

Offerors shall use the SOO with other applicable portions of the solicitation and information gained from the previous Phases as the basis for preparing their PWS. Offerors shall ensure that all aspects of the SOO are thoroughly addressed in the PWS regarding Sections 4.0 and

5.0.

QCP

The contractor is responsible for the quality of all work performed. The contractor measures that quality through the contractor’s own quality control plan (QCP). Quality control is work output, not workers, and therefore includes all work performed under the contract regardless of whether the work is performed by contractor employees or by subcontractors. The contractor’s QCP will set forth the staffing and procedures for self-inspecting the quality, timeliness, responsiveness, customer satisfaction, and other performance requirements in the PWS.

The contractor shall develop and implement a performance management system with processes to assess and report its performance to the designated Government representative.

The contractor’s QCP will set forth the staffing and procedures for self-inspecting the quality, timeliness, responsiveness, customer satisfaction, and other performance requirements in the

PWS. Afterwards, a Quality Assurance Surveillance Plan (QASP) will be developed to enable the Government to take advantage of the contractor’s QCP.

The Government will work in consultation with each Offeror on the development of the PWS and QCP as these documents will be incorporated into the contract. The final version of the

PWS and QCP shall be submitted with the Offerors Price proposal.

PRICE PROPOSAL

The Price Proposal shall consist of Tab A & Tab B.

Tab A shall include the following:

a) The Proposal Cover/Transmittal Letter;

b) Signed copy of the Standard Form (SF) 1449 “Solicitation/Contract/Order for Commercial Items”;

c) Signed copies of the SF30 amendments, if applicable.

Tab B, which addresses Factor 6, Price shall include the following:

Completion of Schedule B: The Government will determine whether the price, inclusive of all options is fair and reasonable, and whether the price of the base period and all option periods

(including the option(s) represented by FAR 52.217-8), in combination with the other evaluation factors specified in the solicitation, represents the best value to the Government. The

Government will use the pricing for Option Period IV to calculate the pricing for the option represented by FAR 52.217-8. The Contractor must also provide a Total Estimated Price for each potential option period (i.e. the sum of all line items within that performance period).

Contractors submitting partial pricing information shall be ineligible for award. The unit price prevails if a discrepancy exists between the unit price and the extended price. The Contractor’s price shall be inclusive of all the Contractor’s direct costs, indirect costs and profit and shall include all costs associated with providing the services described in the Performance Work

Statement, the Exhibits and the Contractor’s technical presentation.

Proposal Validity Period Proposals shall be valid for a minimum of one hundred and twenty (120) days.

Section 5: Evaluation

TECHNICAL FACTORS:

Phase 1: White Paper

• Factor 1: Demonstrated Prior Experience

• Factor 2: Ability to meet Minimum Requirements and Qualifications

Phase 2: Oral Presentation

• Factor 3: Element 1, Briefing o Subfactor A: Technical & Management Approach o Subfactor B: Small Business Participation

• Factor 4: Element 2, Scenario

NON-TECHNICAL FACTOR

Phase 3:

• Factor 5: PWS/QCP

• Factor 6: Price

Within Phase I, Factor 1 and 2 are listed in descending order of importance. Within Phase II, Factor 3 and 4 are listed in descending order of importance. All non-price evaluation factors, when combined, are significantly more important than Factor 6 – Price. When combined, the technical factors are significantly more important than price. All factors will be used in the tradeoff decision for contract award.

THREE PHASE PROCESS

The Government intends to conduct the evaluation and selection process in three (3) Phases:

(1) Phase 1 – White Papers. Factors 1 and 2 will be evaluated in this phase. Each Offeror will receive an Advisory Notification. The Advisory Notification will inform the Offeror of: (i) the basis of the Government advisory notice; and (ii) either that it will be invited to participate in

Phase 2 or, based on the information submitted, that it is unlikely to be a viable competitor with the basis for that opinion. The intent of this distinction is to minimize proposal development costs for those vendors with little or no chance of receiving an award. However, notwithstanding the advice provided by the Government in response to their Phase 1 submissions, all respondents may participate in Phase 2.

Note: The Advisory Notification is the only notice the Government will provide from Phase 1; debriefings will not occur at the end of Phase 1.

(2) Phase 2 – Oral Presentations. Factors 3 and 4 will be evaluated in this phase. Again, each

Offeror will receive an Advisory Notification. The Advisory Notification will inform the Offeror of: (i) the basis of the Government advisory notice; and (ii) either that it will be invited to participate in Phase 3 or, based on the information submitted, that it is unlikely to be a viable competitor with the basis for that opinion. The intent of this distinction is to minimize proposal development costs for those vendors with little or no chance of receiving an award. However, notwithstanding the advice provided by the Government in response to their Phase 2 submissions, all respondents may participate in Phase 3.

Note: The Advisory Notification is the only notice the Government will provide from Phase 2; debriefings will not occur at the end of Phase 2.

(3) Phase 3 – PWS/QCP and Price Proposal. Factors 5 and 6 will be evaluated in this phase.

The selection decision will be a trade-off involving all six factors, according to FAR 15.101-1, Tradeoff Process. Risk assessment will be a part of the overall evaluation.

Participation in Phase 1 is a mandatory part of this acquisition. Failure to participate in Phase

1 or the Oral Presentation in Phase 2 will preclude further consideration of the Offeror’s proposal. Phase 2 submissions will not be accepted from any Offeror who has not completed

Phase 1. Also, Phase 3 submissions will not be accepted from any Offeror who has not completed Phase 2. Results of Phase 1 will be carried over to Phase 2 and results of Phase

2 will be carried over to Phase 3 for the overall evaluation of proposals.

Factor 1: Demonstrated Prior Experience This factor will be evaluated by the Offeror’s ability to provide a detailed description of up to three (3) recent corporate experience in performing medical reviews for a Government Agency

(State or Federal), or for a Domestic/International Company of a similar size, scope, and responsibilities as HHS OIG.

Factor 2: Ability to meet Minimum Requirements and Qualifications This factor will be evaluated by the Offeror’s ability to provide a detailed description of their ability to meet and address the minimum requirements and qualifications as described in

Section 5.0 of the attached SOO.

Factor 3: Element 1 – Briefing Technical & Management Approach: This factor will be evaluated by the Offeror’s ability to demonstrate their knowledge, understanding, and capability to meet all the Objectives as stated in Section 4.0 of the Statement of Objectives (SOO).

Small Business Participation: This factor will be evaluated by the Offeror’s ability to present a small business subcontracting plan in accordance with FAR 52.219-9.

Factor 4: Element 2 – Scenario This factor will be evaluated based on responses to the standard set of management/technical questions related to contract performance and responses to additional questions presented during the Scenario. The Government will evaluate the ability of the Offeror to meet or exceed the requirements of the attached SOO based on an evaluation of the Offeror’s responses to a standard set of questions provided during the oral presentation. Team dynamics of the Key Personnel and the additional participants may also be evaluated during the oral presentation.

Factor 5: PWS/QCP The PWS will be evaluated on how well the Offeror addressed all aspects of the SOO regarding Sections 4.0 and 5.0. The evaluation will include how well the Offeror incorporated other aspects of the solicitation, including prior Phases, into the document.

The QCP will be evaluated on how well the Offeror develops and implements a performance management system with processes to assess and report its performance to the designated Government representative. The Government will consider how well the

Offeror’s QCP set forth the staffing and procedures for self-inspecting the quality, timeliness, responsiveness, customer satisfaction, and other performance requirements in the PWS. The PWS and QCP will not be given a rating.

Factor 6: Price Proposal The Government will establish a “total evaluated price” based on the total of the Base plus

Option Year CLINs. It is anticipated that pricing and award of this acquisition will be based on adequate price competition. The “total evaluated price” will be evaluated for price reasonableness through comparison with other proposed prices and may include other price analysis techniques. The price proposal will not be given a rating.

ADJECTIVAL RATINGS

RATING DEFINITION

High Confidence The Government has high confidence that the Offeror understands the requirement, proposes a sound approach, and will be successful in performing the contract with little or no Government intervention. The risk of unsuccessful contract performance is Low.

Some Confidence The Government has some confidence that the Offeror understands the requirement, proposes a sound approach, and will be successful in performing the contract with some Government intervention. The risk of unsuccessful contract performance is Medium.

Low Confidence The Government has low confidence that the Offeror understands the requirement, proposes a sound approach, or will be successful in performing the contract even with Government intervention. The risk of unsuccessful contract performance is High.

AWARD BASIS

Award shall be made to the Offeror(s) whose proposal conforms to the solicitation and represents the best value to the government. In making its “Best Value” determination, the importance of price as a factor in the final determination will increase with the degree of equality in the overall technical merit of the proposals. The Government may award on the basis of a proposal with superior technical ratings, even though it may result in a higher price to the government.

ATTACHMENT:

Statement of Objectives (SOO) – Dated June 9, 2020