A13_RFP_75040120R00005_00001.pdf

(x)

75040120R00005 x x copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted ; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE

RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR

OFFER. If by virtue of this amendment you desire to change an offer already submitted , such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

x

OS-OIG

Washington DC 20201 5th Floor 330 Independence Ave SW Office of Inspector General

09/03/20200001

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended , by one of the following methods: (a) By completing

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

7. ADMINISTERED BY (If other than Item 6)CODE 6. ISSUED BY

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

09/03/2020

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation data, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

E. IMPORTANT: Contractor is not is required to sign this document and return __________________ copies to the issuing office.

ORDER NO. IN ITEM 10A.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

New Medical Review IDIQ

Period of Performance: Twelves (12) months from the date of award, Plus four

(4) Option Years.

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

NICOLA L. CARMICHAEL

STANDARD FORM 30 (REV. 11/2016)

Prescribed by GSA FAR (48 CFR) 53.243

Previous edition unusable

Except as provided herein, all terms and conditions of the document referenced in Item 9 A or 10A, as heretofore changed, remains unchanged and in full force and effect .

Section C.1 STATEMENT OF OBJECTIVES is deleted in its entirety and replaced with the following:

“C.1 STATEMENT OF OBJECTIVES

1.1 Medical Review of Claims

The resulting contract(s) will require medical review of claims and the supporting medical record documentation as part of audits and less frequently other OIG activities (e.g., evaluations or investigations). Prior to the medical review, the OIG will select the claims for review and in all cases collect the medical documentation. The number of claims and timeframes will vary by review. Claim reviews require, at a minimum, the clinical evaluation of medical records and related documents to determine whether Medicare claims were billed and paid in compliance with Medicare's coding, coverage, billing and payment requirements.

A medical record is the systematic documentation of a single beneficiary's medical history and care across time. Medical record review is the evaluation of the beneficiary's information and medical records to ensure that payment is made only for services that meet all Medicare coverage, coding, and medical necessity requirements. When clinical judgment is needed, a medical record review must be performed by appropriate licensed professionals within the scope of their practice.

The Contractor(s) will perform medical record review of claims that are generated from all fifty (50) States and in six (6) territories. The Contractor(s) shall develop medical record review instruments for each review (e.g., audit) firmly grounded in correct and applicable Medicare criteria. The Contractor(s) shall provide a detailed final review results letter for each sampled claim. The final review results letter must contain an accurate and appropriate summary of all facts needed to support the determination and correctly summarize Medicare requirements. The letter should clearly explain the basis for each decision in a logical, thorough and fact-based manner. The letter should be written in plain English with all medical terminology that would be unfamiliar to a layman defined.

1.2 Consultative Services

Consultative services will consist of oral and written interactions with the OIG during all phases of the audit. Consultative services also will consist of assisting the OIG both orally and in writing in responding to auditee comments and other information received by the OIG pertaining to work previously conducted by the awardee, as well as making available for discussions with the OIG and CMS or an auditee, the professional personnel who performed said work in support of any given audit. In the foregoing instances, consultative services may not necessarily involve a separate task order from the medical review; the OIG looks forward to solutions proposed by Offerors during the Oral Presentations and PWS/QCP and Price Proposal phases of this award.

Consultative Services will also include rebuttal services. OIG deems rebuttal services to be assistance to the OIG in addressing auditee feedback, including disagreement with medical review determinations, that may be expressed at an exit conference with the auditee or in response to a formal draft report from the auditee. Auditee feedback varies and can range from concurrence with all findings and recommendations to total non-concurrence accompanied by voluminous claim-by-claim rebuttals prepared by board-certified physicians retained by an auditee. Rebuttal services include but are not limited to the following major components:

1. Reviewing auditee comments and associated documents (including independent third-party reports based on a review of the medical records).

2. Meeting with the auditee (with OIG staff) to listen to concerns.

3. Assisting the OIG in formulating a formal response to the auditee in the final report.

4. Re-assessing the final review results letters (and underlying medical record documentation) to ensure that they are accurate and adequately supported.

In addition, consultative services will include on an ad hoc basis providing expertise on a wide variety of medical related issues including assistance in assessing risk in designing future oversight activities or in assessing the Medicare program to identify fraud, waste, and abuse vulnerabilities.

1.3 On-board Meetings

OIG anticipates holding multiple meetings over the first 45 days after award to facilitate the on-board process. Teleconference is an acceptable format for these meetings. The Contractor, in coordination with the COR, will schedule these meetings. These meetings will cover various aspects of the On-board process. The Contractor shall coordinate with the COR to prepare an agenda for each meeting. The Contractor shall ensure attendance of the appropriate personnel at each meeting based on the agenda subject matter.

Topics to be covered in these meetings include but are not limited to:

• Classification of review areas into medium/high categories

• Account creation in Kiteworks

• Quality assurance plan

• Period of performance schedule

• Call order process

• Error matrix process/criteria/template used in audits

• Request for additional documentation process

• Determination letter format and content

• Electronic process for submitting medical record documentation and claims, information and other documents

• Invoicing process and template

• Template for monthly status report

• Process for interaction with providers

• Roles and responsibilities/communication protocols”

Section H.2 Physical Security Requirements is deleted in its entirety and replace with the following:

“H.2. Physical Security Requirements

The Contractor shall be responsible for safeguarding all Government equipment, information and property provided for Contractor use. At the close of each work period, government facilities, equipment, and materials shall be secured. Vendors who possess and process HHS OIG information/data must demonstrate the same level of protection of their systems as HHS OIG. For example, if the data is stored on a Moderate system, the vendor must meet the same Moderate FISMA controls found within NIST SP 800-53. Compliance of this system, including any additional systems that are connected to said system, need to be demonstrated through an independent third-party assessment (3PAO) and security documentation.

Security documentation should include, at a minimum, the System Security Plan, contingency plan, incident response plan, Plan of Action and Milestones, and the Security Assessment Report from the third-party independent assessment. The information/data should be segmented from other vendor systems and access limited to only those with a need. All of which will be documented within the System Security Plan.

Upon completion/termination of the contract, all HHS OIG data must be disposed of in accordance with NIST SP 800-88, Guidelines for Media Sanitization.”

Factor 6: Price Proposal is deleted in its entirety and replaced with the following:

“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.

Under the terms of the Solicitation, three activities are outlined: (1) Medical Review, (2) Consultative Services, and (3) On-board Meetings (See Section C above). For your price proposal, OIG is requesting a pricing structure that separates rebuttal services from medical review services and includes them in the consultative portion of the cost estimates. The medical review shall be estimated based on a per claim fixed cost (based on claim intensity) and consultative services shall be reimbursed on a labor hour basis at a fixed hourly rate or multiple hourly rates depending on the credentials of staff involved performing the service. Medical review claims will be based on a 3,000 claim total and shall be split 70% (2100) towards High intensity claims review, and 30% (900) towards Medium intensity claims review. Any low intensity categories must be eliminated. Use 2000 hours as the number for pricing the hours allocated for Consultative Services, inclusive of rebuttal services. Please allocate the 2000 hours amongst your proposed labor categories as you best see fit.

On-board meetings have been added to the requirement. These meetings will be reimbursed at the hourly consultative rate(s) and there is a cap of 50 hours over the 45 days after contract award. Please provide a price as a separate CLIN under the Base Period pricing.”

ALL REMAINING TERMS AND CONDITIONS REMAIN THE SAME.