RFI C D Integrity Contractors.pdf

Request for Information Medicare Part C & D Integrity Contractors

1. Overview

1.1 Introduction

In Fiscal Year 2025 the Centers for Medicare & Medicaid Services (CMS) intends to procure services to perform audit and fraud, waste, and abuse (FWA) detection, deterrence, and prevention activities for Medicare Part C and Part D. This Request for Information (RFI) seeks vendor feedback on methodology and best practices as it relates to these services.

Please note that this RFI is for informational purposes only, and no contract will be awarded as a result. A firm or organization’s response to the RFI—or lack thereof—will have no impact on the evaluation of responses to any subsequent Request for Proposals (RFP), Request for Quote (RFQ), or Solicitation released. Responses will be used solely for information and planning purposes. No reimbursement will be made for any costs associated with providing information in response to this Request.

1.2 RFI Contact

We have designated the following individuals to serve as the official points of contact for this RFI.

These individuals are the only authorized contact permitted to communicate on behalf of CMS about this RFI.

Contact information for RFI points of contact:

Charlene Barnes, Contract Specialist Office of Acquisition and Grant Management/ CMS Charlene.Barnes@cms.hhs.gov

Jennifer Kuhn, Contracting Officer Office of Acquisition and Grant Management/ CMS Jennifer.Kuhn@cms.hhs.gov

1.3 Submission Details

Please submit your responses to this RFI via email to the RFI points of contact no later than 11 AM EST on August 14, 2024. THIS IS NOT A REQUEST FOR CAPABILITY STATEMENTS. Your response shall not exceed 15-pages and shall be in 11-point font Calibri. Please include a cover page with the following information (not included in page count):

a. Company Name;

mailto:Charlene.Barnes@cms.hhs.gov mailto:Jennifer.Kuhn@cms.hhs.gov

b. Company Address;

c. Unique Entity Identification (UEID) number;

d. Type of Company (i.e., small business, 8(a), woman owned, veteran owned, etc.) as validated via the System for Award Management (SAM); and

e. Company Point of Contact, Phone and Email address.

If you have any questions about this RFI, please direct them to the RFI points of contact.

2. Background Information The CMS has traditionally used two contractors to carryout audit and program integrity work for Medicare Parts C and D, the Investigations Medicare Drug Integrity Contractor (I-MEDIC) and the Plan Program Integrity (PPI) MEDIC. The I-MEDIC is primarily focused on program integrity efforts within Medicare Part C and D, while the PPI-MEDIC is primarily focused on Medicare Part C plan audits and Medicare Part C and D analysis.

This RFI seeks to gain a vendor perspective on best practices and methodology as it relates to the reallocation of the audit and FWA workload in the Medicare programs. Specifically, CMS intends to utilize a Part C Program Integrity Contractor (CPIC) and a Part D Medicare Drug Integrity Contractor (MEDIC) to perform audit and FWA detection, deterrence, and prevention activities for Medicare Part C and Part D, as described in the attached Draft Statements of Work. With this allocation of work, the MEDIC would be focusing primarily on Part D complaint intake, coordination, and response, data analysis; audits of Medicare Advantage Prescription Drug (MA-PD) plans and Part D Plan Sponsors (PDPs); assessing leads from various sources; FWA investigative actions; administrative remedies; and law enforcement and other appropriate referrals. And the CPIC would primarily focus on Part C data analyses, audits, and reviews of Medicare Advantage Organizations (MAOs), assessment of fraud leads from various sources, investigative actions, administrative remedies, and law enforcement and other appropriate referrals.

3. Information Requested Interested Vendors are asked to provide responses to the following questions. Vendors may respond to some or all questions. As well, Vendors may provide any additional feedback they feel would be of benefit to the Government. Please note this is not a request for capability statements.

RFI Questions for CPIC and MEDIC Contracts

1. How does CMS ensure the most efficient/ effective coordination between the CPIC and the

MEDIC?

a. How does CMS ensure the most efficient/effective coordination on investigations and complaints?

b. Are there other CPIC and/or MEDIC tasks that you believe will pose significant coordination challenges? What are they and how does CMS ensure the most efficient/effective coordination in those areas?

c. What methods of evaluation would you recommend when evaluating performance based on CMS’ coordination expectations?

2. Based on the Draft SOW requirements, do you anticipate any duplication in work functions and/or work products between the CPIC and the MEDIC?

RFI Questions for the CPIC Contract

1. What area(s) would you find it critical to have detailed workload assumptions and why? (For example, number of audits, investigations, other tasks referenced in the Draft SOW, etc.)

2. Based on the requirements, how would you define "successful outcomes" for this contract?

3. Do you envision using artificial intelligence for program integrity related activities? If so, please describe how it would be used, included what type of artificial intelligence you anticipate using (e.g., machine learning, large language model, etc.)

4. Are there program integrity activities CMS should focus on through this contract that are not already included?

a. What specific items or services should CMS focus on through the activities in this contract?

5. What would you recommend as an effective strategy for evaluating offeror proposals for this contract.

a. For instance, would you recommend that CMS require offerors to prepare samples of potential work product?

i. If so, which tasks and work products do you think would best highlight an Offeror’s ability to perform the work required of the Draft SOW?

ii. What information would offerors need in order to prepare work samples for these tasks?

RFI Questions for the MEDIC Contract

1. What area(s) would you find it critical to have detailed workload assumptions and why? (For example, number of audits, investigations, other tasks referenced in the Draft SOW, etc.)

2. Based on the requirements, how would you define "successful outcomes" for this contract?

3. Do you envision using artificial intelligence for program integrity related activities? If so, please describe how it would be used, included what type of artificial intelligence you anticipate using (e.g., machine learning, large language model, etc.)

4. Are there program integrity activities CMS should focus on through this contract that are not already included?

a. What specific items or services should CMS focus on through the activities in this contract?

5. What would you recommend as an effective strategy for evaluating offeror proposals for this contract.

a. For instance, would you recommend that CMS require offerors to prepare samples of potential work product?

i. If so, which tasks and work products do you think would best highlight an Offeror’s ability to perform the work required of the Draft SOW?

ii. What information would offerors need in order to prepare work samples for these tasks?

6. How could CMS promote more innovative approaches and higher Return on Investment (ROI) for Medicare Part D audits (Subtask A9)?

7. Does the requirement that all MEDIC Call Center inbound calls be answered within 30 seconds add significant cost to the contract (Subtask B2.1)

a. If so, how would you recommend that CMS structure this requirement so that calls were answered in a timely manner, while ensuring cost efficiency?

4. Attachments

4.1 Draft Medicare Advantage Program Integrity & Plan Oversight Contractor Statement of Work

4.2 Draft Medicare Drug Integrity Contractor Statement of Work