Final RFPOIG260145 Questions and Answers.pdf

RFP #OIG260145

Questions and Responses Date: September 16, 2020

Page # Section # Section Title Question and Answers 1 Page 3 Section A.3 Scope Is the term “claim” defined as a unique claim line item on a CMS claim form or all claim line items on a single CMS claim form (e.g., CMS-1450 or

CMS-1500)?

Definition of claim will vary by the review being conducted. Typically, the term “claim” refers to a claim for institutional or professional services submitted using HIPAA mandated transaction ASC 12 837 or paper Form CMS-1450 and CMS- 155 and includes all claim lines on the electronic or paper claim. Occasionally, the term “claim” refers to a unique claim line. See OIG web site for examples of audit reports and specific definition of claims and sampled items in those reviews.

2 Page 3 Section A.5 Contract Type It states the contract type as “Firm Fixed Price, Time and Materials, IDIQ.” Will each claim review be priced differently since a Firm Fixed Price contract and Time and Materials contract are two different contract types (fixed price vs.

cost-reimbursable)? The contract type will be dependent upon the offers proposed approach(s). The OIG does not expect the Offerors to present their technical solution until Phase 2 - Oral Presentations

3 Page 4 Section C.1 Statement of Objectives,

1.1 Medical Review of

Claims

Can you please confirm that the OIG is asking for one final review results letter per claim?

The Contractor will provide one final review results letter for each sampled claim.

4 Page 4 Section C.1 Statement of Objectives,

1.1 Medical Review of

Claims

Besides the facts, are there any other elements the final review results letter must contain?

“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.”

5 Page 4 Section C.1 Statement of Objectives,

1.1 Medical Review of

Claims

What are the OIG’s expectations of the Contractor regarding the final report process?

There is a distinction between a final review results letter and a summary report of a set of claims/final audit report. The RFP does not outline any obligations associated with a formal report per audit (“audit” is defined in Section A.3 to be 100-200 claims).

The contractor is to provide a written assessment of each sampled item/claim. No overall summary of groupings of claims is typically requested. OIG audit teams are responsible for writing the actual audit reports and rely on the contractor determinations when addressing issues associated with medical necessity and similar issues. Per the Solicitation, contractors may be asked to assist in addressing provider concerns associated with the contractor’s work.

6 Page 4 Section C.1 Statement of Objectives Does any work provided by a contractor under this contract need to comply with GAGAS?

No. The work done by the contractor does not need to meet GAGAS standards. However, the OIG will be following GAGAS as they perform their work and use the contractor’s product and/or input consistent with GAGAS standard, related to using the work of Specialists and others. Please refer to Yellow Book standards 2018 revision, Application Guidance: Specialists and Using the Work of Others.

7 Page 4 Section C.1 Statement of Objectives,

1.2 Consultative Services

What are the annual workload assumptions, in labor hours, for the consultative services (e.g., standard and ad hoc services)?

We do not have an estimate in labor hours.

Under the terms of the contract, we anticipate that the vast majority of the work will be claims review and a smaller portion will be consultative services.

8 Page 5 Section C.4 Government Hours of Operation

The Section states, “The Contractor is responsible for performing between the hours of 8:30 a.m. and 5:00 p.m. Monday through Friday….” What time zone(s) pertain to the hours listed? Eastern Standard Time

9 Page 13 Section H.8 Government Furnished

Property, Items and Services

Section H.8. states “the Government will provide the Contractor with dedicated office space, basic equipment and property (e.g., laptops and/or desktops).” Section C.3. states that the place of performance is the contractor's designated facilities. Can you please confirm that the intended place of performance is offsite at the contractor’s facilities and that the work does not have to be performed onsite in OIG dedicated office space?

H.8 has been removed from the solicitation.

10 Page 16-17

Section I.3 and Section 4

Contract Clauses Incorporated in Full text 52.215-70 - Key Personnel, if applicable to this contract

PWS/QCP & Price Proposal Preparation Guidance

Besides the Board-certified physicians listed under C.2, the cited sections suggest other Key Personnel will be required under this solicitation.

What are the key positions along with their qualifications required under this solicitation?

The Solicitation is written in such a way as to give Offerors maximum flexibility in defining key personnel and their qualifications in order to best provide the services under the OIG contract.

11 Page 21 Section L.1 Submission of Questions Will we be allowed to ask questions later under each phase, since certain information (e.g., scenario, pricing table, etc.) will be provided after Phase 1 and Phase 2? Yes

12 Page 26 Section L.2, Section 4

Proposal Preparation, Submission and Evaluation, PWS/QCP & Price Proposal Preparation Guidance

The Section states, “Tab B, which addresses Factor 6, Price shall include the following:

Completion of Schedule B:…” What is Schedule B? Schedule B is only referenced here. OIG expects Scheduled B to be developed during Phase 3-PWS/Pricing Proposal.

13 Page 13 Section H.7 Organizational Conflict of Interest

Is the contractor required to include potential OCI and a Mitigation Plan with the White Paper?

No plan required unless the offeror identifies a potential OCI.

14 Page 13 H.8 H Special Contract requirements/Guidance(s)

This section indicates that the government will provide equipment. Is this a change from the current contract?

See question and answer #9

15 Page 13 H.11, Paragraph 1

H Special Contract requirements/Guidance(s)

Is the intent of the New Contractor Training for key personnel or all personnel working on the project? Training is reserved ONLY for personnel cleared to work on OIG Systems.

16 Page 13 L.2, Section 1, Element 1

L. Instructions, Conditions and Notices to Offeror

Would the government please confirm that the lowest percentage for the subcontracting goal is

(Briefing) Subfactor B

52%. The total SB (Small Business) goal for this acquisition is 33%.

17 Page 13 H.11, paragraph 1

H Special Contract requirements/Guidance(s)

Is the intent of the New Contractor Training for key personnel or all personnel working on the project?

See question and answer #15

18 Page 23 Section 2:

Phase 1, White Paper Preparation Guidance

L. Instructions, Conditions and Notices to Offeror

The RFP states: “Spacing – Single Font – Arial, 12-point” – Can the government let us know what the instructions/font size for Tables and Graphics is?

Offerors may use the font of their choice (e.g., Arial, Times New Roman) for any part of their White Paper. Offerors are not limited to 12-point typeface for Tables and Graphics. Material should be readable and professional and adequately convey whatever point is being made.

19 General General Please confirm that “Questions and Responses Industry Day “document released on July 14, 2020 is still accurate. Yes.

20 Page 1 RFP Cover page The RFP identifies this as an IDIQ opportunity.

How many contract awardees does OIG anticipate? The OIG anticipates two awards however, OIG reserves the right to make a single award.

21 Page 3 RFP A.3: Scope What is the expected level of annual medical record reviews?

“Based on prior experience, the resulting contract(s) will require medical review of approximately 100-200 claims and associated medical records per audit and approximately 2,000-3,000 claims and associated medical records per annum, but actual workload under the resulting contract(s) could fluctuate based on potential future changes in OIG’s budget, shifts in OIG’s priorities, and other factors.”

22 Page 5 RFP C.2: Minimum Requirements and Qualifications

Please confirm that "bi-weekly" is defined in the RFP as every other week.

Yes.

23 Page 24 RFP L.2: Proposal Preparation, Submission and Evaluation/Section 3: Oral Presentation

Will the small business subcontracting plan be expected to be included within the slide presentation (and count against the 20-slide limit)? Yes

Guidance/Element 1- Briefing/Subfactor B

24 Page 25 RFP L.2: Proposal Preparation, Submission and Evaluation/Section 3: Oral Presentation Guidance/Element 1- Briefing/Subfactor B

This section of the RFP requests that bidders provide two Summary Subcontracting Reports (SF 295) for recent individual contracts. Please define “recent” for purposes of this requirement.

Within the past three years from the posting of the solicitation.

25 Page 26 RFP L.2: Proposal Preparation, Submission and Evaluation/Section 3: Oral Presentation Guidance/Element 1- Briefing/Subfactor B

This section of the RFP requests that bidders provide two Summary Subcontracting Reports (SF 295) for recent individual contracts. Will these reports be expected to be included within the slide presentation (and count against the 20-slide limit)?

See question and answer #23

26 Page 25 RFP L.2: Proposal Preparation, Submission and Evaluation/Section 3: Oral Presentation Guidance/Element 2 - Scenario

Will the scenario require the expertise of a board-certified specialist?

“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 (consistent with the specifications contained in paragraph C.1 of this solicitation) to be presented via Microsoft Teams. Performing these medical reviews and providing these documents is the Scenario process.” Moreover, as stated in paragraph C.1 of the Solicitation, “When clinical judgment is needed, a medical record review must be performed by appropriate licensed professionals within the scope of their practice.” And, as stated in paragraph C.2 of the Solicitation, “The Contractor must have professional staff (medical and coding) with thorough knowledge of and extensive expertise in applying requirements for providing and billing services to Medicare beneficiaries. The Contractor must employ or contract with Board certified physicians in all relevant fields of medicine and surgery in order to evaluate the medical necessity of any and all Medicare services.” Offerors are expected to exercise good judgment in selecting personnel for performing the Scenario, which should be equivalent to the personnel they would assign to perform like review if awarded the Contract.

There is no requirement regarding who presents the analysis during the oral phase of the contracting process. That person should be prepared to answer questions if asked.

27 Can you please expand upon the COI details and/or potential mitigation plans for OCI?

It is the responsibility of the Offeror to identify possible CIOs and propose mitigation plans.

28 Are COI’s relative to specific task orders or as a global designation as a Medical Review IDIQ?

Conflicts of interest are multifactorial and involve the interplay of tasks, personnel, and entities. Offerors should be sophisticated enough to identity potential conflicts of interest and propose plans to mitigate them.

29 Dependent upon the circumstances, is a firewall for key personnel sufficient to mitigate a potential COI?

Conflicts of interest are multifactorial and involve the interplay of tasks, personnel, and entities. Offerors should be sophisticated enough to identity potential conflicts of interest and propose plans to mitigate them.

30 How many vendors or IDIQ designees do you plan on awarding?

See question and answer #20

31 General General As this is listed as an IDIQ (Medical Review IDIQ), does OIG still anticipate selecting one vendor?

See question and answer #20

32 General Can OIG provide the annual contract value for the past five years for these services, and could they please break it down by funds spent on fixed fee services (or per audit claim costs) and cost plus services?

Maximus Federal Services Inc, is the Incumbent per Contract #HHSP233201500023B.

OIG encourages Offerors to search and review publicly available websites (i.e.

https://www.usaspending.gov/) for any additional funding information.

33 Page 24 of RFP and Attached subcontracting plan

Within the bid, there are subbing goals. Does OIG view these as just goals, or will contractors need to use someone in some capacity. How will OIG determine whether large primes actually make a good faith effort to utilize small business (e.g. FAR 52.219-9)? OIG intends to ensure Other Than Small Business compliance by requiring the submission of periodic reports so that the Government can determine the extent of compliance by the Offeror with the subcontracting plan; and requiring offeors to submit the Individual Subcontract Report (ISR) and/or the Summary Subcontract Report (SSR) using the Electronic Subcontracting Reporting System (eSRS) at http://www.esrs.gov.

34 Page 10 Section H.1 The security is Public Trust-Moderate Risk.

Would each vendor employee attain this prior or upon contract award?

Contractor personnel will not receive their final security clearance until after contract award.

35 Page 13 Section H.8 Does this read that the government will supply all necessary computer hardware to perform the work? Does this include a secure, HIPAA FTP site/portal for file transfer.

See question and answer #9

36 Pages 21-22 Section L.2 Must a prime include any proposed sub on the white paper submission on the Cover Letter? Can a prime subsequently add a sub after the white paper or as part of the oral presentation or PWS response?

White Papers shall address Offerors’ ability to meet minimum requirements and qualifications and demonstrated prior experience. Offerors should identify subcontractors if they want that information considered for such purposes.

37 Pages 4-5 Section C.2 Regarding staffing, does OIG envision physicians reviewing every audited claim, or alternatively the aggregate audit of an auditee and providing a recommendation/conclusion? The former seems cost prohibitive.

Offerors are expected to evaluate individual claims. Offerors should outline their proposed use of medical professionals and OIG will evaluate them. Please refer to Yellow Book standards 2018 revision, Application Guidance:

Specialists and Using the Work of Others.

38 Page 4 Section C.1. When OIG states a “medical record review must be performed by appropriate licensed professionals within their scope of practice”, what type of professionals does OIG mean?

http://www.esrs.gov/

The type of professional will vary depending on what type of claim is reviewed. “The Contractor must have professional staff (medical and coding) with thorough knowledge of and extensive expertise in applying requirements for providing and billing services to Medicare beneficiaries. The Contractor must employ or contract with Board certified physicians in all relevant fields of medicine and surgery in order to evaluate the medical necessity of any and all Medicare services.”

39 Page 25 L.2. “Element 2 – Scenario”

Can OIG clarify whether the scenario would be provided to contractors prior to the oral presentation (and after a signed confidentiality agreement), at which the offeror would present their findings at the oral presentation?

Alternatively, will the Offeror receive the scenario for review at the oral presentation and subsequently complete its review during the second part of the oral presentation?

Offerors who receive an Advisory Notification that they are invited to participate in Phase 2 will be sent a confidentially agreement at the same time. OIG intends to issue Advisory Notifications based on Phase 1 by October 14, 2020. OIG will send the Scenario to Offerors upon receipt of a signed confidentiality agreement. Offerors that notify the OIG within two business days from the date of notification that they have little or no chance of receiving an award that they elect to continue to Phase 2 will be sent a confidentiality agreement and will be sent the Scenario upon its return.

40 Page 5 RFP C.2 Minimum Requirements and Qualifications, Bullet 4

The RFP states, “The Contractor must have professional staff (medical and coding) with thorough knowledge of and extensive expertise in applying requirements for providing and billing services to Medicare beneficiaries. The Contractor must employ or contract with Board certified physicians in all relevant fields of medicine and surgery in order to evaluate the medical necessity of any and all Medicare services.”

Question: What are the relevant fields of medicine and surgery required for Board-certified physicians?

It depends on the claims being reviewed. The field of the reviewer needs to be consistent with the field of the provider who performed the service that was reimbursed by Medicare.

41 Page 5 RFP C.2 Minimum Requirements and Qualifications

The RFP states, “All contractor personnel will be required to work offsite at the contractor's designated facilities or as directed.” And H.9.

Work at Home – Page 13 States, “Allowed in coordination with COR.”

Question: Can the contractor's designated facility be a work from home environment for the personnel working on this contract as long as the contractor complies with the H.1 Security Requirements, H.2 Physical Security Requirements and coordinates with the COR?

Yes. The contractor’s designated facility can be defined by the contractor subject to meeting the terms of the contract.

42 Page 22 RFP L.2 Proposal Preparation, Submission and Evaluation Factor 2: Demonstrated Prior Experience

The RFP States, “The Offeror shall provide a detailed description of no less than three (3) recent corporate experiences in performing medical reviews, of the type described in paragraph C.1, 1.1-Medical Review of Claims and Paragraph C.1.”

Question: If the contractor is proposing using subcontractors, can a subcontractor’s prior experience be used for one or more of the recent corporate experiences?

Yes

43 Page 23 RFP L.2 Proposal Preparation, Submission and Evaluation

The RFP states,” Spacing – Single Font – Arial, 12-point.”

Question: Please confirm there should be a comma between single and font (i.e. Spacing – Single, Font – Arial) Yes Question: Please consider changing the font from Arial to Times New Roman as generally, characters in Arial are thicker and take more space than those in Times New Roman. The font is changed to Times New Roman

44 Page 28 RFP L.2 Proposal Preparation, Submission and Evaluation

The RFP states, “the HHS OIG’s evaluation of offerors’ price proposals will include a review of price reasonableness “and may include other price analysis techniques.”

Question: Would HHS OIG confirm whether it intends to, or whether it reserves the right to, conduct a price realism analysis on offerors’ proposed prices? The Government reserves the right to perform a price realism analysis.

45 Page 13 RFP H.7 Organizational Conflict of Interest

The RFP states, “Contractor and subcontractor personnel performing work under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational Conflict of Interests (OCI) as defined in FAR Subpart 9.5.”

Question: Please provide additional information on the types of proprietary or source selection information and other procurements or programs the offeror may receive (or have access to) in order to better evaluate potential OCIs and to develop an appropriate mitigation strategy in performing work on behalf of the HHS OIG? Offerors are required to sign Non-disclosure Agreements upon award.

46 Page 13 RFP H.7 Organizational Conflict of Interest

Question: Does HHS OIG believe that it would be a conflict of interest for a Medicare Administrative Contractor (MAC) to conduct medical review activities under this contract as a subcontractor? If so, would any conflict be effectively avoided or mitigated by ensuring the prime contractor or another subcontractor performed all medical review tasks involving claims from the MAC’s jurisdiction, such that the MAC would have no involvement in any medical review tasks involving claims from the MAC’s jurisdiction?

It would appear to be a conflict of interest for a MAC to review a claim that it paid and Offerors that may have such a conflict should present a plan to mitigate it. OIG is not prepared to provide feedback on possible mitigation strategies at this stage of the contracting process.

47 Page 13 RFP H.8. Government Furnished Property, Items and Services

The RFP states, “The Government will provide the Contractor with dedicated office space, basic equipment and property (e.g., laptops and/or desktops). The Government will also provide access to OIG tools and applications as needed to support this effort.”

Question: Will the Government actually provide the contractor with the laptops and/or desktops?

Or should the cost of the laptops and/or desktops be included in the pricing proposal to the Government? See question and answer #9.

48 Does a subcontractor need to be present for orals?

That is within the discretion of the Offeror.

49 What assumptions should we make regarding staff testifying?

CMS is the action official on OIG recommendations and as such are responsible for any judicial or administrative action that follows. OIG staff and contracted personnel are typically not involved.

50 Can slides be used (in addition to written material) to accompany the scenario portion of the oral presentation? If so, is there a limit on the number of slides for this portion of the presentation?

Yes. No limit on slides but Offerors are expected to adhere to time allocations.

51 Audits can lead to recoupments and litigation.

Are the costs of depositions, hearings, and other legal proceedings to be priced into this proposal?

No. During the last five (5) years, the number of litigations that have involved OIG or its contractor personnel is “Zero”.

52 Are large business allowed to bid as it states it is a NOT a small business set-aside.

Yes I think what can be confusing sometimes is the interpretation of the NAICS codes. The NAICS website provides the clarification which says “A size standard is the largest that a concern can be and still qualify as a small business for Federal Government programs.

Please clarify as to the acquisition?

The acquisition Strategy is Full and Open.