RFP Questions and Responses JM RFP 75FCMC22R0001.xlsx

XLSX spreadsheet 55 KB Posted Jan 19, 2022

Attached to: Part A/B Medicare Administrative Contractor (MAC) Jurisdiction M (JM) RFP
Solicitation number: 75FCMC22R0001
Issued by: Department of Health and Human Services Centers for Medicare and Medicaid Services

About this file

Written by GovTribe AI · Dec 27, 2023

This document contains questions and responses related to a Request for Proposal (RFP) for a Part A/Part B Medicare Administrative Contractor (MAC) for Jurisdiction M. The RFP seeks a contractor to provide specified health insurance benefit administration services, including Medicare claims processing and payment services, in support of the traditional Medicare fee-for-service program for the states of North Carolina, South Carolina, Virginia, and West Virginia. The contractor will also be responsible for processing Medicare Home Health and Hospice billings in 16 additional states. The document addresses questions from potential offerors regarding workload assumptions, proposal submission requirements, and other solicitation details. It provides the Centers for Medicare and Medicaid Services' responses to clarify expectations and amend the RFP where needed.

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Other files

File	Type	Posted
RFP Amendment 0001.pdf	PDF	Jan 26, 2022
Amendment 0001 Revised RFP Questions and Responses -- JM RFP 75FCMC22R0001.xlsx	XLSX spreadsheet	Jan 26, 2022
75FCMC22R0001 FINAL RFP with SF33.pdf	PDF	Jan 26, 2022
JM Final RFP Attachments.zip	ZIP file	Jan 19, 2022
FINAL RFP.pdf	PDF	Jan 19, 2022

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A. Section B-K

Question ID	Document	Section	Page #	Question	CMS Answer/Action
A.1	RFP	Section I.1	64	The RFP states "May be impacted by Executive Order 14026, "Increasing the Minimum Wage for Federal Contractors." Please clarify if offerors should assume Executive Order 14026 is in effect at the start of , and for the life of, this contract.	CMS confirms Offerors shall assume Executive Order 14026 will be in effect for the life of the contract.
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B. Section L-M

	Question ID	Document	Section	Page #	Question	CMS Answer/Action
	B.1	RFP	L.14.4.b Past Performance Instructions	108	As long as all of the required data is included, may the past performance template be changed to a different (vertical) table format?	Offerors shall use the past perfromance template provided. The template format may not be changed.
	B.2	RFP	L.11.a Delivery Instructions	95 and 96	On page 95, the instructions indicate that only Volume III be submitted in Word and PDF, while all other files be submitted in only PDF. However, on page 96, item 1 indicates that all files be "compatible with Microsoft Office 2013 or newer versions."
Can CMS clarify whether Volumes I, II, IV, V, and VI be submitted in only PDF or should they be submitted in both Word/ Excel and PDF.	CMS confirms the RFP direction in section L.11.a is updated to note that all Word and Excel files must be submitted with Microsoft Office 2013 or newer versions. Further, CMS confirms all other diretion as provided.

RFP has been updated.

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C. Section J.1 SOW

Question ID	Entity	Point of Contact (POC)	Date of Email Submission	Document	Section	Page #	Question	CMS Answer/Action
C.1	Palmetto GBA	Kathy Brannon	12/14/21	RCD SOW	RFP Questions		The RCD SOW indicates that the demonstration will last until May 31, 2024. Is it CMS' expectation that no work will be proposed after this date or should offers propose the annual workload provided in Attachment J.23 - Government Provided Proposal Assumptions (GPPA) within the Cost Proposal Templates?	CMS confirms that although the RCD is currently scheduled to end in May 2024, Offerors shall propose for all periods of performance (POPs) on contract based on the workload provided in Attachment J.23.
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D. Sections J.1-J.11

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E. Section J.22 BOE

Question ID	Document	Section	Page #	Question	CMS Answer/Action
E.1	BOE	C.5.11.10 - PM Credit Balance Forms Received Part A	All OY	Please confirm the the Credit Balance Count for HHH.	CMS confirms the workload numbers in the BOE, Attachment J.22, include HH&H workloads as JM is a HH&H jurisdiction. A separate workload number will not be provided for HH&H Credit Balance Reports.
E.2	BOE	C.5.14 - MIP MSP Prepay Part A	All OY	Please confirm the number of Hospital Audits - Outside of the Jurisdiction.	CMS confirms the BOE, Attachment J.22, On-site Hospital Reviews/Audits - (Out-of-Jurisdiction Providers serviced by JM) workload is updated to 0.

Update to BOE

E.3	BOE	C.5.10 - Appeals Part A and Part B of A	N/A	Can CMS please confirm that the workload volumes listed for each of the following are correct?: Redeterminations (Adjudicated Claims Cleared) (Includes Pt A and B of A RAC) Redeterminations (Dismissed Claims Cleared) (Includes Pt a and B f A RAC)	CMS confirms the accuracy of the workload volumes listed for Redeterminations (Adjudicated Claims Cleared) (Includes Pt A and B of A and RAC) and Redeterminations (Dismissed Claims Cleared) (Includes Pt A and B of A and RAC) in the BOE, Attachment J.22.
E.4	BOE	N/A

Section C.5.27 - Support and Coordination with the SMRC Operations All OY 161-164

SOW Section C.5.27 includes the requirements for the MAC support and coordination with the SMRC and provides the IOM information that the MAC shall comply regarding SMRC work. However, the BOE does not include SOW C.5.27, SMRC specific work. Should the offers assume that the SMRC workloads are included in the BOE workloads for other applicable SOW codes?	Offerors shall include the costs for C.5.27 based on the SOW requirements. As stated in section L.13 of the Request for Proposal (RFP), "The BOE, Attachment J.22, provides workloads for a significant portion of the SOW/WBS structure but not all. Offerors are instructed to use their business judgment to determine workloads and/or level of effort for the SOW/WBS workloads not provided in the BOE. Offerors shall use the determined workloads when completing cost templates. The Offeror shall document in the Offeror Assumptions section of its proposal a description of the forecasting methodology used to determine workloads and/or level of effort for the SOW/WBS workloads not provided in the BOE."
E.5	BOE	C.5.12 - MIP Medical Review (MR) Part A

17 ALJ Heardings Participation/Support All OY

BOE C.5.12 includes Defending MR Decisions at ALJ Hearings workload volumes for Part A of 80, HHH of 166 and Part B of 30. However, Number 17, ALJ Heardings Participation/Support on page 10, states: "The Offeror shall provide the assumptions used to allocate the workload volume between Part A and Part B Administrative Law Judge (ALJ) Hearings Participation/Support in Proposal Volume II, TAB C, Offeror Proposal Assumptions." Please clarify if offerors should use the workloads furnished in the BOE or if they should furnish their own assumptions. CMS confirms Offerors shall use the workload breakouts provided in the BOE, Attachment J.22, for Defending MR Decisions at ALJ Hearings and complete the BOE in full as required. The Government Provided Proposal Assumptions (GPPA), Attachment J.23, has been updated to remove item number 17.

Update to GPPA

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F. Section J.23 GPPA

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G. Section J.23.A-J.32

Question ID	Document	Section	Page #	Question	CMS Answer/Action	Responsibility	Lead Analyst	Amendment 1?	Amendment #
G.1	J.23.A GPPA A&R Tables	Estimated Annual Workloads	4 and 8	The ESRD Special Audits (BBA 1/3 Audits) requirement is satisfied with the completion of a Full Desk Review. Exhibit J.23.A GPPA Audit & Reimbursement Tables includes 167 ESRD Full Desk Reviews (Table 11) and 167 ESRD Special Audits (Table 24). Is CMS’ expectation that both workload units include the same cost reports or does CMS expect there will be two separate populations of 167 ESRDs?	CMS confirms the ESRD Special Audits (BBA 1/3 Audits) requirement is satisfied with the completion of a Full Desk Review, both workloads include the same 167 ESRD facility-related cost reports.	MCMG
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H. Section J.33-J.49

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I. Cost Realism

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File details come from the government source that posted it. Updated May 14, 2026.