RAC Region 1 Solicitation Questions and Responses.pdf

E.2 Questions and Answers (QAs)

Questions and Answers – 75FCMC2021R0001

REQUEST FOR PROPOSAL QUESTIONS (RFP):

Question # 1

Section/ Page Number: Section B – Continuation of SF 1449, B.1 Continuation of Blocks 19-24/ Page 3 of 83. Section E, E.8 Evaluation of Business Proposal/Page 61 of 83. Attachment E.1 – Proposed Firm Fixed Contingency Fee Template/Exhibit E.1 – Proposed Contingency Fee.

Question: Would the Government consider proposals that offer alternative pricing models?

CMS Answer: No.

Question # 2

Section/ Page Number: Section B – Continuation of SF 1449, B.1 Continuation of Blocks 19-24/ Page 3 of 83. New Process.

Question: The Government indicates that funding will be included at the time of award to be compliant with CMS systems.

• Will CMS consider deleting this requirement, since the source of funding for payments to the contract is recovered amounts attributable to the Medicare Trust Funds as opposed to fiscal year appropriations?

CMS Answer: CMS is considering multiple options regarding its approach to funding future Recovery Audit Contracts (RAC), including approaches not used under previous contracts. Whether using the same approach as used in the past or an entirely different approach, CMS will ensure payment of viable invoices are made timely. Should CMS use the approach of obligating funds in advance of recoveries, offerors shall assume that the amount obligated is not intended to establish a limit on the amount of contingency fee earned as contingency fee payments will continue to be based on amounts recovered. Therefore, the approach to funding the RACs should not have an impact on the contractor.

• If not, what amount of funds does CMS intend to obligate to the RAC Region 1 contract?

CMS Answer: If funding is obligated at award, the initial obligation will be an estimate based off historical RAC earned contingency fees. CMS will then continue to fund, as needed. Therefore, there is no definitive amount.

Question # 3

Section/ Page Number: Section B – Continuation of SF 1449, B.1 Continuation of Blocks 19-24/ Page 4 of 83. CLIN Table.

Question: The Government indicates that the Base Period will include 8.5 years of active recovery auditing, but also that this may change and will be finalized when answers to questions are provided. Can CMS confirm the period of performance will be an 8.5 year base period with

1.5 year administrative period?

CMS Answer: The Solicitation has been revised.

Question # 4

Section/ Page Number: Section E.6 Proposal Organization, D. Section 508 Compliance Proposal Instructions (Volume IV)/Page 44 of 83.

Question: The instructions for Volume IV refer to Factor 5 of the technical proposal requirement.

Can CMS confirm the information for Section 508 compliance will only be submitted in Volume

IV?

CMS Answer: Correct.

Question # 5

Section/ Page Number: Section E.6 Proposal Organization/Page 44 of 83.

Question: The Proposal Organization instructions require each volume to be signed by an official authorized to bind the offeror’s organization. Is it acceptable to include the signature and contact information on a transmittal letter included with each volume?

CMS Answer: Yes.

Question # 6

Section/Page Number: Section E.6, Proposal Organization (page 44)

Question: This section indicates Section 508 Compliance should be submitted as Volume IV;

however, Section 508 Compliance is also listed as Factor 5 in Volume I (Technical Proposal).

Please clarify whether offerors should provide Section 508 Compliance information in Volume 1 OR Volume IV OR both.

CMS Answer: Volume IV only. However, 508 Compliance will be reviewed as part of the technical evaluation for the apparent awardee only.

Question # 7

Section/ Page Number: Section E.6 Proposal Organization, A. Technical Proposal Instructions, Factor 3 – Technical Approach for Identifying Improper Payments:, Key Personnel and Staffing Plan/Page 48 of 83. Statement of Work: IV. Personnel Requirements/Page 8.

Question: The Government indicates that the organization chart should be sufficient to provide an understanding of the roles and responsibilities and placement of proposed personnel, limited to one page. Will the Government clarify if and how the organization chart will be used to evaluate roles, responsibilities, and placement of key personnel only, or those of all staff (including medical review staff and other staff)?

CMS Answer: The Offeror will be evaluated on how well the organizational chart evidences placement of proposed personnel and understanding of the roles and responsibilities.

Question # 8

Section/ Page Number: Section E.6 Proposal Organization, A. Technical Proposal Instructions, Factor 3 – Technical Approach for Identifying Improper Payments:, Key Personnel and Staffing Plan/Page 48 of 83. Section E.7 52.212-2 – Evaluation – Commercial Items (OCT 2014), Five- Phased Approach:, Phase 3 – Factor 3: Technical Approach for Identifying Improper Payments:/Page 57 of 83.

Question: The Government indicates that the Offeror provide a Staffing Plan inclusive of the rationale for the labor categories and a chart identifying Labor Category, full-time equivalent (FTE) count, hours, location, identification of Prime or Subcontractor (if Subcontractor, provide company name), rationale for labor category and proposed duties. As part of determining Best Value, this Staffing Plan is indicated in the Phase 3 evaluation for Technical Approach for Identifying Improper Payments. Since this is a Firm Fixed Contingency Fee Commercial Items Contract award, will the Government consider removing the requirement for “hours, location, and identification of Prime or Subcontractor”?

CMS Answer: The Government is agreeable to removing both hours and location but the Offeror should still include a Staffing Plan inclusive of the rationale for the labor categories and a chart for the prime, and any subcontractor(s).

Question # 9

Section/ Page Number: Section/ Page Number: Section/ Page Number: Section E.6 Proposal Organization, B. Business Proposal Instructions, (c) Financial Capability:/ Page 53 of 83. E.8 Evaluation of Business Proposal/Page 61 of 83

Question: The Government indicates that the Offeror’s Business Proposal must also demonstrate that the offeror has adequate financial resources to sustain operations without any payment from CMS during the initial phases of the contract (at least one year) or for any period of work stoppage, and to provide a “Statement on the Offeror’s Financial Capability”. Can the Government clarify what factors will be considered, and whether this evaluation will include factors such as stock price performance (for publically traded companies), debt ratio (ratio of total debt to assets), cash flow to debt ratio (cash flow from operation to total debt), working capital (minimum measure) or other industry standard financial capability measures?

CMS Answer: An Offeror must demonstrate that they have adequate financial resources to sustain operations without any payment from CMS during the initial phase(s) of the contract.

This can be a statement from a bank indicating/confirming whether an offeror has the necessary financial capability, working capital, and other resources to perform the contract without assistance from any outside source.

Question # 10

Section/ Page Number: Section E.6 Proposal Organization, B. Business Proposal Instructions, (b) The following items from Section D:/ Page 53 of 83. E.8 Evaluation of Business Proposal/Page

Question: The Government indicates that Attachment D.4 Responsibility Questionnaire is to be completed and included in the submitted Business Proposal.

• Can the Government clarify how the Responsibility Questionnaire will be evaluated, and will this be evaluated as part of the Business Proposal evaluation prior to a Best Value determination?

CMS Answer: As stated in Attachment D.4 Responsibility Questionnaire, in order to facilitate the Contracting Officer’s determination of responsibility as required in accordance with FAR 9.104-3(a), the Government will review responses provided to the questions in Attachment D.4 to determine overall best value to the Government.

• Will an Offeror evaluated as not meeting the Responsibility Questionnaire requirement be removed from further consideration?

CMS Answer: An offeror determined not be to be responsible based on the review of Attachment D.4 will not be able to receive award unless it is corrected/addressed in discussions.

Please refer to FAR 9.103.

Question # 11

Section/ Page Number: Section/ Page Number: Section/ Page Number: Section E.6 Proposal Organization, B. Business Proposal Instructions, (c) Financial Capability:/ Page 53 of 83. E.8 Evaluation of Business Proposal/Page 61 of 83

Question: Given the statement to sustain operations without any payment from CMS “for any period of work stoppage”, and given the recent work stoppage during the current Public Health Emergency, can the Government provide further clarification as to whether it will consider the multi-region risk and/or financial capability associated with an Offeror that has already been awarded two RAC regions?

CMS Answer: There is no limit on how many RAC Regions an offeror may have for this solicitation.

Question # 12

Section/ Page Number: Section E.7, 52.212-2 – Evaluation – Commercial items, Five-Phased Approach/Page 54-55 of 83.

Question: This section provides that “The Government intends to conduct the evaluation and selection process in five phases.” It further provides an overview of each phase. For each phase, CMS intends to notify each offeror who does not receive a rating of “Some Confidence” that it has been removed from further consideration. What factors, criteria, measures, or other considerations will be applied for determining a rating of “Some Confidence” for each of the five phases of the evaluation and selection process?

CMS Answer: Some Confidence is that the Offeror's technical proposal gives the Government some measure of confidence that the Offeror will successfully perform the contract requirements.

The proposal meets the Government's requirements; some benefits and/or weakness may exist but overall the Offeror's approach should acceptably accomplish the Government's requirements.

Risk of unsuccessful performance is low to moderate. In order to achieve some confidence rating, the proposal must not contain deficiencies.

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.

Question # 13

Section/ Page Number: Section E.7 52.212-2 – Evaluation – Commercial Items (OCT 2014), Five-Phased Approach:, Phase 1:/Page 54 of 83

Question: Can the Government provide the full rating scale, including ratings above and below “some confidence”?

CMS Answer: High Confidence, Some Confidence or Low Confidence.

Question # 14

Section/ Page Number: Section E.7 52.212-2 – Evaluation – Commercial Items (OCT 2014)/Page 54 of 83.

Question: In the previous RAC procurement, CMS specified that an Offeror would be limited to being awarded a maximum of two regions. Since the previous RAC contracts which resulted from the prior procurement (HHSM-500-2016-RFP-003) remain active contracts, does CMS consider that the two region maximum limitation would still apply to a previously successful Offeror, currently performing under contract for CMS as a RAC for two regions?

CMS Answer: No, the two region maximum limitation does not apply to this RAC Region 1 procurement.

Question # 15

Section/ Page Number: Section E.7 52.212-2 – Evaluation – Commercial Items (OCT 2014)/Page 54 of 83.

Question: Will CMS consider awarding this contact to an Offeror that currently performs under contract for CMS as a RAC for two regions?

CMS Answer: Yes.

Question # 16

Section/Page Number: Section E.7, 52.212 – Evaluation – Commercial items (OCT 2014) (pages 54-61)

Question: CMS does not indicate any restriction on the number of regions for which a RAC is eligible for award. Does CMS intend to impose any such restriction?

CMS Answer: No.

Question # 17

Section/Page Number: Section E.7, 52.212-2 – Evaluation – Commercial items (OCT 2014) (page 54)

Question: What are the relative percentage weights or point values CMS will use when evaluating each of the factors 1 to 4?

CMS Answer: CMS will use the High Confidence, Some Confidence or Low Confidence rather than percentage weights or point values in the multi-phase evaluation.

Question # 18

Section/ Page Number: Section E.7 52.212-2 – Evaluation – Commercial Items (OCT 2014), Five-Phased Approach:, Phase 2:/Page 57 of 83, Phase 3:/Page 59 of 83, Factor 4:/Page 60 of 83.

Question: The Government indicates under the evaluation for Phase 2, Phase 3, and Phase 4 that “However, if there is not enough competition, Offerors with a rating below “Some Confidence” may be considered. Can the Government clarify what would constitute “not enough competition”?

CMS Answer: If none of the offerors receive a rating of Some Confidence or High Confidence.

• Can the Government clarify how a rating below “Some Confidence” in one phase will be evaluated in a subsequent phase(s) for an Offeror determined to be no longer considered for award and how this will be evaluated in determining a Best Value decision with ratings from all five phases?

CMS Answer: Offerors who do not receive a rating of “Some Confidence” or above will no longer be considered for award and will be notified via-e-mail that they have been removed from further consideration. However, if all offerors receive a rating below “Some Confidence” the Government will consider including them in the next phase. If necessary, the Government may open it up for discussions.

Question # 19

Section/ Page Number: Section E.6 Proposal Organization, A. Technical Proposal Instructions, Factor 3 – Technical Approach for Identifying Improper Payments:, Developing and maintaining a Secure Web-Based Application for a Provider Portal and Communications Plan:/Page 58 of 83.

Section E.7 52.212-2 – Evaluation – Commercial Items (OCT 2014), Five-Phased Approach:, Factor 5 – Section 508 Compliance (For awardee only) -/Page 60 of 83.

Question: Can CMS confirm that Section 504 is applicable to the General Website, Approved Review Website, and Provider Portal?

CMS Answer: Yes.

Question # 20

Section/ Page Number: Section E.6 Proposal Organization, A. Technical Proposal Instructions, Factor 3 – Technical Approach for Identifying Improper Payments:, Developing and maintaining a Secure Web-Based Application for a Provider Portal and Communications Plan:/Page 58 of 83.

Section E.7 52.212-2 – Evaluation – Commercial Items (OCT 2014), Five-Phased Approach:, Factor 5 – Section 508 Compliance (For awardee only) -/Page 60 of 83.

Question: The Government indicates the Offeror’s technical approach will be evaluated for development and maintenance of a secure web-based application to serve as a provider portal both 504 and 508 Compliant as described in RAC SOW, Section V, Task 7 (Website and Provider Portal);. Can the Government clarify that this evaluation for compliance will be based upon the submission of the Product Accessibility Template (PAT)?

CMS Answer: Yes.

Question # 21

Section/ Page Number: E.7 52.212-2 – Evaluation – Commercial items, Five-Phased Approach, Phase 4-Factor 4: Past Performance/Pages 59-60 of 83.

Question: With respect to the determination of “Some Confidence” for “Phase 4-Factor 4: Past Performance”, will it be possible for an offeror that has less than a Satisfactory CPAR rating for any past performance evaluation factor on a current RAC contract, or other relevant contract, to receive a rating of “Some Confidence”?

CMS Answer: Please refer to Phase 4 – Factor 4: Past Performance under Section E.7 that explains how an offeror will be evaluated for Past Performance.

• If so, what are the circumstances or conditions that would permit a contractor with a less than Satisfactory CPAR rating to be rated as “Some Confidence”?

CMS Answer: Please refer to the first answer provided under question # 21. Some Confidence is that the Offeror's technical proposal gives the Government some measure of confidence that the Offeror will successfully perform the contract requirements. The proposal meets the Government's requirements; some benefits and/or weakness may exist but overall the Offeror's approach should acceptably accomplish the Government's requirements. Risk of unsuccessful performance is low to moderate. In order to achieve some confidence rating, the proposal must not contain deficiencies.

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.

Question # 22

Section/Page Number: Section E.10, 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS – COMMERCIAL ITEMS (AUG 2020) (page 61)

Question: In which volume of the response should offerors include the relevant representations and certifications?

CMS Answer: They should be included in Volume II. Please refer to the Business Proposal Instructions.

Question # 23

Section/ Page Number: Section/ Page Number: Section/ Page Number: Section E.8 Evaluation of Business Proposal/Page 61 of 83

Question: Can the Government provide clarification as to how the Offerors Financial Capability will be evaluated and will this be evaluated as part of the Business Proposal evaluation prior to a Best Value determination?

CMS Answer: Please refer to the answer provided for question # 9.

• Will an Offeror considered to not meet the Financial Capability requirement be removed from further consideration?

CMS Answer: Yes, that would put the Government at risk for not having a financially capable offeror.

Question # 24

Section/ Page Number: Section E, E.8 Evaluation of Business Proposal/Page 61 of 83.

Question: The Government indicates that Attachment E.1 – Pricing Worksheet is “explained in Section B.3 of this solicitation”. Section B.3 Continuation of Block 11 is Deliverables. Can the Government confirm this reference should be B.1, or clarify if it is another section?

CMS Answer: Correct, the solicitation has been updated to reflect Section B.1.

Question # 25

Section/page Number: Section E.11, 52.209-7 Information Regarding Responsibility Matters (Jul 2013) (pages 82-83)

Question: In which volume of the response should offerors include responses to this section?

CMS Answer: The solicitation has been updated under Business Proposal Instructions.

MISCELLANEOUS:

Question # 26

Section/ Page Number: N/A

Question: Can you share the previous RFP bid tabulation sheet that shows how much the winning bid percentage was the last round this RFP was issued?

CMS Answer: No.

STATEMENT OF WORK QUESTIONS (SOW):

Question # 27

Section/Page Number: Section IV, Personnel Requirements, paragraph 2 (page 8)

Question: Is the HSPD background investigation required for all RAC personnel OR only for those personnel who need/have a 4-digit CMS User ID to access CMS systems? Under the current SOW, this is required only for those personnel who need a CMS User ID. Moreover, this is a lengthy process, which takes more than a year for personnel to obtain PIV. Is CMS forecasting changes to streamline the turnaround time under the new contract?

CMS Answer: HSPD background investigation is required for personnel who need/have a CMS User ID to access CMS systems. (See: https://www.cms.gov/About-CMS/Contracting-With- CMS/ContractingGeneralInformation/Contracting-Policy-and-Resources.html for turnaround time).

Question # 28

Section/Page Number: Section IV (ii), Other Clinicians, paragraph 2 (page 12)

Question: Will CMS permit years of medical record review experience and years of current and/or relevant clinical experience to run concurrently?

CMS Answer: The Government will review the overall experience from multiple relevant experience.

Question # 29

Section/ Page Number: V.iv.A / page 19

Question: For facilities that utilize an Electronic Health Record (EHR), is EHR integration a possibility with the providers for easier transfer of documents? Integrating our technology with whichever EHR they use to store medical records.

CMS Answer: CMS will review offeror’s relevant Electronic Health Record proposal.

Question # 30

Section/ Page Number: V.iv.A / page 19

Question: The URL provided for the ADR limits is broken and does not bring up a site. Can you provide limit numbers for this or an updated URL?

CMS Answer: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring- Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Resources (Space and period removed).

Question # 31

Section/Page Number: Section V(iv)(A), Additional Documentation Request Limits, paragraph 4 (page 20)

Question: Is there a specified number of days the RAC should wait before denying the claim?

CMS Answer: Per the Medicare Program Integrity Manual (PIM), Pub. 100-08 Chapter 3 §3.2.3.2, “When requesting documentation for postpayment review, the MAC, CERT and RAC shall notify providers that the requested documents are to be submitted within 45 calendar days https://www.cms.gov/About-CMS/Contracting-With-CMS/ContractingGeneralInformation/Contracting-Policy-and-Resources.html https://www.cms.gov/About-CMS/Contracting-With-CMS/ContractingGeneralInformation/Contracting-Policy-and-Resources.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Resources https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Resources of the request.” CMS reserves the right to require the RAC to grant additional extensions to this timeframe.

Question # 32

Section/Page Number: Section V(v)(A)(2), Staff Performing Complex Coverage/Coding Reviews, paragraph 6 (page 23)

Question: While clinical validation is prohibited in all RAC reviews, as per page 23, we would like to clarify that medical necessity review is allowed as per NCD/LCD and as approved by CMS on issues.

CMS Answer: Yes.

Question # 33

Section/ Page Number: V.v.C.1 / page 26

Question: Will CMS provide access to archived NCCI edit files? For performing audits for claim years in the past where NCCI edit files have been removed from CMS website.

CMS Answer: No. Per SOW, page 6, paragraph 5, CMS will provide approximately three years of historical claims data divided by provider type to each RAC region.

Question # 34

Section/Page Number: Section V(xvi), Task 16: Administrative Period (Contract Closeout and Reconciliation) (page 53)

Question: Will CMS provide notification to the RAC within a minimum number of days before activating the Administrative Period? If so, what is the minimum number of days prior that CMS will provide notification?

CMS Answer: The SOW has been revised and the period of performance for each option and/or admin period will be included in the contract. Notification will be provided in accordance with the options clause.

Question # 35

Section/ Page Number: Statement of Work: VI. Administrative and Miscellaneous Issues, J.

Remedies for Unsatisfactory Performance or Non-Compliance/Page 57

Question: The Government indicates all actions deemed necessary will be taken to remedy unsatisfactory performance or non-compliance with any requirements in the SOW. Can the Government clarify what period(s) of time for unsatisfactory performance will be considered before the Government may take action for remedies?

CMS Answer: The Government will act to remedy any unsatisfactory performance or non-compliance with the SOW immediately.

Question # 36

Section/Page Number: Not applicable

Question: Periodic Interim Payment (PIP) provider reviews are not mentioned in the 2020 SOW.

Can RAC review claims from PIP providers under the new contract?

CMS Answer: Hospitals receiving Periodic Interim Payments (PIP) are not excluded from review, however CMS reserves the right to exclude PIP providers from review, at any time.

Question # 37

Section/Page Number: Not applicable

Question: Prepayment review is not mentioned in the 2020 SOW, but is included in the current Region 1 SOW. Are prepayment reviews no longer being considered for potential RAC scope?

CMS Answer: Prepayment review by the RAC can only be done, as it was previously, under demonstration authority, which CMS does not currently have; therefore, it was removed from the

2020 RAC SOW.