Attachment_J.26_JF_RFP_Questions_and_Responses_Revision_1.pdf

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Attached to: Part A/B Medicare Administrative Contractor, Jurisdiction F
Solicitation number: RFP-500-2017-0005
Issued by: Department of Health and Human Services Centers for Medicare and Medicaid Services

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Amendment 2 Attachment J.26 RFP Questions and Responses

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ID Section Page number

Question CMS Response

A.1 I.1 FAR

52.252-2 Clauses Incorporated by Reference

Page 58 FAR Subpart 22.21—Establishing Paid Sick Leave for Federal Contractors, prescribes policies and procedures to implement Executive Order 13706, Establishing Paid Sick Leave for Federal Contractors, dated September 7, 2015, and Department of Labor implementing regulations at 29 CFR part 13. The Federal Acquisition Regulation, at FAR 22.2110, requires inserting the sick leave clause, FAR 52.222-62, in solicitations and contracts that incorporate the SCA clause (FAR 52.222-41) for work to be performed at least in part in the United States. It appears this FAR clause is applicable to covered contracts for which the solicitation has been issued on or after January 1, 2017. To ensure offerors include all expected costs in their proposals, can CMS confirm that the clause in FAR 52.222-62 will be included in the new contract awarded under this solicitation?

CMS confirms clause FAR 52.222-62 will be included in the new contract awarded under this solicitation. See Amendment #1, revised solicitation section I.1 FAR 52.252-2 Clauses Incorporated by Reference (FEB 1998).

A.2 H.20 Page 48 While contractors have submitted estimated costs to CMS under CR 9645, the actual costs of implementing a PIV system are unclear at this time. Please verify that you require offerors to include estimated costs to implement a PIV system.

CR 9645 is irrelevant to this solicitation. Offerors are required to include estimated costs to comply with solicitation section H.20 CMS Security Clause

(APR 2016).

A.3 I.2 Page 62 HHSAR clause 352.231-70 is included therein. Paragraph (a) of the HHSAR provision does not permit the contractor to use contract funds to pay the direct salary of an individual at a rate more than the Federal Executive Schedule Level II. In as much as SOW C.5.4.1.11 requires two full time equivalent Contractor Medical Directors with credentials that include, but not limited to, board certified Doctor of Medicine or Doctor of Osteopathy in a specialty recognized by the American Board of Medical Specialties, board certified for at least 3 years, current licensure, and prior clinical experience as an attending physician, etc. How are we to employ these types of individuals and stay within the boundaries of HHSAR 352.231-70? Is there a way that CMS can grant exemption given the experiential and academic requirements required by these two positions?

CMS confirms there will be no exemption given to HHSAR clause 352.231-70.

The salary rate limitation does not restrict the salary that an organization may pay an individual working under a HHS contract or order; it merely limits the portion of that salary that may be paid with contract funds. For further information, please see “Salary Rate Limitation Questions and Answers” document appended to APM 2012-03 and available at https://www.hhs.gov/grants/contracts/contract-policies-regulations/salary-rate-limitation/index.html

A.4 H.1 Pages 29-

37, SOW

Pages 69- 70, J.02 Pages 5-6

Throughout RFP section H.1, there is mention of the compliance program and FAR 52.203-13 Contractor Code of Business Ethics and Conduct, which details the requirements of a compliance program. SOW Section C.5.4.11 is specific to the Compliance Program and includes a list of required compliance program elements. The Deliverable Schedule rows for RFP/SOW WPS # C.5.4.11 require the Contractor to submit Compliance Program documents to CMS upon award and annually thereafter.

- RFP Section H.1.e, mentions an audit of the "Mitigation Strategy." Additionally, H.1.e.5(b) states, "Although not all inclusive, the auditor may also want to consider the following...(vii) The audit will also examine the Contractor's records to verify that all of the requirements specified in FAR 52.203-13(c)(2)(ii), Contractor Code of Business Ethics and Conduct, are met." It appears that if the Contractor obtains the services of an external/independent auditor to conduct an audit that would include elements of the Contractor's compliance program, this would be a duplication of efforts given that the Contractor is already submitting compliance program documentation according to the Deliverable Schedule to CMS for review.

- (1) Would CMS please confirm that the independent audit discussed in H.1.e is only of the "Mitigation Strategy" and conflict of interest program? (2) Would CMS please confirm that an audit of the Contractor's compliance program (e.g. the requirements specified in FAR 52.203- 13(c)(2)(ii)) is not a required element of the independent audit of the "Mitigation Strategy"?

A.5 H.1.e Pages 36-

In H.1.e.5(b) it states, "Although not all inclusive, the auditor may also want to consider the following...(vii) The audit will also examine the Contractor's records to verify that all of the requirements specified in FAR 52.203-13(c)(2)(ii), Contractor Code of Business Ethics and Conduct, are met." If the Contractor's compliance program is reviewed by an independent auditor under a separate CMS contract, would CMS accept the results of that other audit, as opposed to requiring another audit of the Contractor's compliance program?

The "independent audit" referenced in section H.1.e.5 is contract specific and is required when a mitigation plan is submitted. CMS will not accept the results of another audit under any other separate CMS contract.

A.6 H.3 Page 37 Section H lists "Unified Program Integrity Contractor (UPIC)/Zone Program Integrity Contractor (ZPIC)Liaison" as key personnel. The SOW (pg. 55, Section C.5.4.1.5) lists "C.5.4.1.5 Program Safeguard Contractor/Zone Program Integrity Contractor Liaison" as key personnel. Will CMS please clarify which title contractors should propose?

CMS confirms the Key Personnel requirements for Program Safeguard Contractor/Zone Program Integrity Contractor Liaison in the SOW are accurate. The title of this Key Personnel is transitioning. Upon award, the JF SOW will be updated with the latest UPIC nomenclature. Offerors should use the term PSC/ZPIC Contractor Liaison for proposal purposes.

05/19/2017 Jurisdiction F

B. Section L-M 2

ID Section Page number Question CMS Response

B.1 L.10 Proposal Submission, Delivery and Organization

Page 91 The RFP states "In addition to the originals, offerors shall submit four (3) hard copies (12 total) of Volumes I through IV." The table on page 91 indicates that three copies of volumes I through IV be submitted as does the numeral in the text, however the wording in the text indicated "four" copies. Please clarify.

CMS confirms this was an error and the sentence should read "In addition to the originals, offerors shall submit three (3) hard copies…..". Amendment 1 to section L.10 corrects this error.

B.2 L.5 FAR

52.216-1, Type of Contract & B.2 Contract Type

Page 89 Section L5 states "The Government contemplates award of a Cost Plus Award Fee contract resulting from this solicitation. However, in accordance with FAR

16.102 (b) Policies, 'Contracts negotiated under Part 15 may be of any type or combination of types that will promote the Government’s interest, except as restricted in this part (see 10 U.S.C. 2306(a) and 41 U.S.C. 254(a))'”. In the draft RFP released with the Request for Information titled "Medicare Program: Request for Information Regarding Procuring Medicare Administrative Contractor (MAC) Contracts" dated August 5, 2016, Section L.5 of the draft RFP simply stated “The Government contemplates award of a Cost Plus Award Fee contract resulting from this solicitation.” The text of section L.5 from the draft RFP has been unchanged in MAC RFPs in recent years. Although it appears clear from the business proposal instructions CMS is directing offerors to submit cost proposals, is it CMS' intent to permit offerors to submit proposals for a contract "of any type or combination of types " such as firm fixed price?

CMS confirms that it is NOT CMS' intent to permit offerors to submit proposals for a contract "of any type or combination of types" such as firm fixed price.

CMS anticipates award of a Cost-Plus-Award-Fee (CPAF) type contract based on the pricing arrangement for the preponderance of the work. However, specific functions will be obtained on a Cost-Plus-Fixed-Fee (CPFF) basis resulting from this solicitation. Refer to Section B.6 Schedule of Supplies and Services for clarification on the contract type applicable to each SLIN. See Amendment 1, revised section L.5 FAR 52.216-1, TYPE OF CONTRACT, APR 1984 and Section B.2 Contract Type.

B.3 L.14.2 Page 117 “The Offeror shall complete the Other Direct Cost (ODC) and Travel spreadsheets for each CLIN, (Implementation period, Base and Option Years 1-6).” However, in RFP Section L.14.3, pg. 119: it states:

Offerors that propose more than $250,000 in direct travel costs cumulatively per CLIN (each period of performance) must, at a minimum, provide a breakdown of travel costs inclusive of: number of trips, origin and destination, number of personnel traveling, method of travel (i.e. plane, train, etc.) associated travel prices and mileage estimates. two different directions, both when travel costs exceed $250,000.

And further:

For proposed direct travel costs exceeding $250,000 per CLIN, the Offeror shall complete the travel worksheets located within the Cost Template spreadsheets, Attachments J.12 through J.21.

Please clarify when the Travel spreadsheets should be completed.

The travel spreadsheets should be completed and submitted with proposals when the travel costs exceed $250,000 per CLIN. See amendment to Section L.14.2.

B.4 L.12.2 Volume II, Tab B BOE L.13.5 Volume III, Tabs D through F

CMS states: “Any instance where productivity of a given productive labor category, in performing a given workload, is proposed to increase by more than four (4) percent . . . “ while on page 109

1.c first bullet, CMS states: “focus its detailed explanation of productivity changes on any proposed increase of 4% or more . . . “

Please clarify if these sections should be consistent and both be “more than 4%” or “4% or more”.

CMS confirms these sections should read "more than 4%". See Amendment 1, revised section L.13.5 VOLUME III, TABS D through F, Technical Approach Evaluation Factor, VOLUME III, TAB E, STAFFING PLAN, Proposal Instructions, 1. Total Staff, Section c.

B. Section L-M 3

ID Section Page number Question CMS Response

B.5 L.13.5 Volume III Tabs D-F M.5

Page 115 Within this paragraph, CMS states “The Government will evaluate the extent to which the 0fferor’s approach to the jurisdiction implementation (F.1) demonstrates a superior understanding of the challenges and a superior capability to expeditiously resolve unforeseen difficulties and achieve a successful implementation. The Government will also evaluate the extent to which the Offeror’s approach to performance of the other MAC mission-essential functions (F.2 thru F.7) demonstrates an understanding of the requirements of the MAC mission-essential functions, the mission-essential workload requirements specific to the solicited jurisdiction, and the likelihood that its approach will result in quality and value-added performance throughout the duration of the contract.”

Please define the terms “superior understanding,” “superior capability” and “value-added performance” and clarify how each is determined.

The terms "superior understanding", "superior capability" are used to communicate the agency's objective of obtaining high quality proposals. The term value-added performance has been removed in Section M.5, Mission- Essential Functions, Evaluation Criteria and has been replaced with the term "high quality".

B.6 L.10 Page 91 The RFP states "The Offeror shall submit one original of each proposal volume (5 total) listed in the table above and three (3) copies (13 total) and CD-ROMs (5 total) as stated above (Volume V only needs to be submitted as an Original copy) in Microsoft Office Word or Excel, version 2010." Is Microsoft Office Word or Excel, version 2013 acceptable?

CMS confirms Microsoft Office Word or Excel, version 2013 is acceptable.

See amendment to Section L.10.

B.7 L.10 Page 91 The table in Section L.10 indicates the Offeror shall provide 1 Original Paper/Hard Copy of Volume V, Conflict of Interest. However, the paragraph that immediately follows the table states “No hard copies of Volume V are necessary.” Can CMS please clarify that only 1 Original is required for Volume V and no additional hard copies are required.

CMS confirms that one hard copy of Volume V, Conflict of Interest, is required.

See amendment to Section L.10 removing the phrase "No hard copies of Volume V are necessary".

B.8 Volume III, Tab C

Pages 104-105 The RFP states "The Offeror and all its significant subcontractor(s) identified in the proposal are required to provide a summary to disclose all of the following for the past performance information with a period of performance end date within the last three (3) years of the initial posting date of this solicitation:" Item 8 - Additional Info: "If performance is less than satisfactory, the Offeror shall provide a summary of the identified issues...." Will CMS please clarify the length of time of look back a “less than satisfactory” result should be reported with the knowledge of varying contract lengths across CMS?

As stated in Section L.13.4(b), "The Offeror and all its significant subcontractor(s) identified in the proposal are required to provide a summary to disclose all of the following for the past performance information with a period of performance end date within the last three (3) years of the initial posting date of this solicitation..."

B.9 Volume III, Tab F

Page 111 The RFP states "Proposed approach to IT infrastructure for the implementation (3) the Offeror’s assessment of system identity management issues, for internal users and external users/submitters, that may arise during the implementation, and its proposed approach to resolving these issues" Is this RFP requirement only specific to Electronic Data Interchange (EDI) Submitter IDs or does it also relate to provider portal IDs and/or Direct Data Entry (DDE)?

CMS confirms the request for information is not limited to Electronic Data Interchange (EDI) submitters.

ID Document Section Page number Question CMS Response

C.1 Attachment J.01 Statement Of Work

C.7.4 Rural Community Hospital Demonstratio n

Page 148 The link in the first paragraph is not valid:

http://www.cms.gov/DemoProjectsEvalRpts/downloads/RCH_Summary.pdf

Will CMS provide a corrected link?

The correct website address is: https://innovation.cms.gov/initiatives/Rural- Community-Hospital/

CMS is confirming, upon award the SOW section C.7.4 will be removed.

Please note, this workload was scheduled to end in December 2016. For proposal purposes, Offerors are requested not to propose workload and any associated costs with this SOW section.

C.2 Attachment J.01 Statement Of Work

C.7.29 Page 153-154 In regard to the Medicare Essential Hospital Payment Program (MEHPP), the SOW indicates the contractor shall draw funds from a separate account and that the payments for Regional Preferred Provider Organizations’ (RPPO) claims is not to be commingled with the fee for service payments. Will there be a dedicated HIGLAS org established for this account to handle the fund disbursement, overpayments and the corresponding financial reporting?

CMS is confirming that all MEHPP activities, including funding disbursement and overpayments are handled outside of HIGLAS. A spreadsheet of all financial activities is maintained for payment tracking and financial reporting.

C.3 Attachment J.01 Statement Of Work

C.7.41 Page 161 The first paragraph, and throughout this section, states that Noridian will be performing this work. Should offerors include a level of effort for C.7.41 in their bid?

Under the JF contract, Noridian shall perform Medicare payment and reporting functions for this demonstration project as specified in CMS Change Request 9165, dated April 7, 2016. Noridian will conduct activities related to the specified Medicare payment changes in conjunction with CMS and the ten selected Critical Access Hospitals (CAHs). In addition, Noridian shall conduct reporting functions with the other CMS contractors participating in the demonstration.

Amendment 1 of the solicitation revises Attachment J.01 Statement Of Work to remove "Noridian" and replace it with "the MAC." Offerors are directed to include a level of effort for C.7.41. Workload specific information is located in the Government Provided Proposal Assumptions PPA), Attachment J.23.

C.4 Attachment J.01 Statement Of Work

C.7 Page 148 In order to respond to Jurisdiction specific items, please provide the structure, processes, specific provider groups participating, and systems being used within each jurisdiction specific activity.

information located in the Government Provided Proposal Assumptions (GPPA), Attachment J.23, to develop the JF proposal. CMS is confirming the use of MCS, FISS, CWF and locally designed systems for claims processing associated with jurisdictions specific activities. Details and requirements will be provided at award.

C.5 Attachment J.01 Statement Of Work

C.7.29

MEHPP

Page 104 Please confirm if the banking relation for this program is part of the tripartite agreement established at C.5.11.2 Banking Relations or is a separate tripartite agreement is required?

CMS is confirming one tri-partite agreement covers all commercial banking services for the JF MAC.

C.6 Attachment J.01 Statement Of Work

C.7.39 PSAVE Task

There is a reference in the SOW that the pilot will start with lab providers and services and other types of providers may be explored. Noridians website has a reference that any specialty is eligible and there is no reference to Part A providers. Please clarify are all Part B specialties are eligible and if PSAVE is limited to Part B providers.

CMS is confirming all Part B specialties are eligible for PSAVE at the discretion of CMS and the MAC. PSAVE is limited to Part B services at this time.

C.7 Attachment J.01 Statement Of Work

C.7.24 EHHPP Libby Project

Please provide clarification around the following questions on the Environmental Health Hazards Pilot Project (EHHPP): How many beneficiaries are currently enrolled in the pilot? How many claims are anticipated?

CMS is confirming the number of beneficiaries currently enrolled in in EHHPP Project is 1,302. Further, the number of claims processed per year for proposal purposes is 7,006 as stated in the Government Provided Proposal Assumptions (GPPA), Attachment J.23.

C.8 Attachment J.01 Statement Of Work

C.7.24 EHHPP Libby Project

SOW C.7.24 states that HHS awarded a grant to the Lincoln County Health Department to screen and treat those affected by asbestos related diseases (ARD) and that a third party administrator, New West, currently processes claims for screening and treatment. How do the Lincoln County Health Department/New West and its benefits coordinate with the Medicare benefits allowed under the Environmental Health Hazards Pilot Project? The SOW indicates that Medicare is secondary to the liability of W.R. Grace Company but can CMS explain if Medicare is secondary to benefits administered under the Lincoln County Health Department/New West?

CMS is confirming covered services under the pilot are services not traditionally paid by Medicare. Screening and treatment of diseases are often covered under traditional Medicare coverage; and, therefore, not pilot-related benefits.

C.9 Attachment J.01 Statement Of Work

C.7.24 EHHPP Libby Project

Noridian’s website indicates Medicare providers may submit claims on behalf of beneficiaries and certified Medicare providers, under special circumstances, may receive reimbursement from the pilot program. Can CMS explain under what special circumstances and what certified Medicare providers may receive payment under the pilot?

CMS is confirming covered services under the pilot are services not traditionally paid by Medicare. Therefore, most benefits under this pilot program are provided by non-Medicare providers.

A Medicare DME supplier who provides an oxygen concentrator to a pilot participant, is an example of when a Medicare provider could receive a

C.10 Attachment J.01 Statement Of Work

C.7.24 EHHPP Libby Project

With regard to the EHHPP pilot, provide information related to claims processing system, the platform the system uses, if and how the system integrates with CMS’ existing systems including CWF, FISS and MCS, and how the incoming contractor will receive training on the system.

CMS is confirming that detailed information and requirements related to the claims processing of pilot-related claims will be discussed upon award.

C.11 Attachment J.01 Statement Of Work

C.7.24 EHHPP Libby Project

The SOW indicates that beneficiaries eligible under this ACA regulation receive covered Medicare services that are billed and processed by all A/B MACs. The Environmental Health Hazards Pilot only covers services and items not currently covered under Medicare but that are reasonable and necessary in the medical treatment and life functioning of the pilot beneficiary with ARD. These claims are submitted to the JF MAC under this SOW. The SOW states that the contractor must maintain a list of pilot benefits and fee schedule. Can CMS provide a current list of Environmental Health Hazards Pilot benefits and their associated fee schedule?

CMS is confirming a list of covered services and a fee schedule will be provided at award.

C.12 Attachment J.01 Statement Of Work

C.7.24 EHHPP Libby Project

In item c for SOW C.7.24 CMS appears to indicate an expectation that the contractor has onsite case management staff located in Libby, MT. Can CMS confirm this is the intent? This section of the SOW states that “for the time period” the contractor will work with the CARD clinic in Libby, Montana to coordinate care for patients who utilize services at the clinic. Can CMS define what is meant by “for the time period”?

CMS is confirming the intent that the MAC have an onsite case management presence located in Libby, MT. The statement, "for the time period" is defined as the length of the pilot, meaning, the MAC will work with the CARD clinic to coordinate patient care for the life of the pilot.

C.13 Attachment J.01 Statement Of Work

C.7.24 EHHPP Libby Project

Item d for SOW C.7.24 seems to indicate prior authorization and pre and/or postpayment medical review of claims will be required for pilot claims. Can CMS confirm if prior authorization is part of the SOW? Can CMS confirm if pre and/or postpayment medical review is part of the SOW? If yes, can CMS provide the applicable workloads for the past several years?

CMS is confirming the requirement to perform medical review of claims and prior authorization. In most instances it is prepayment review, however; in certain circumstances, post-pay medical review may be required.

C.14 Attachment J.01 Statement Of Work

C.7.24 EHHPP Libby Project

In relation to item f for SOW C.7.24, as this is a very specialized pilot, can CMS provide information related to existing coordinating organizations and software required to support this project?

CMS is confirming that detailed information and requirements related to the claims processing of pilot-related claims will be provided upon award.

C.15 Attachment J.01 Statement Of Work

C.5.4.3.4, C.5.4.10.4, C.5.11.9.2, DS and GPPA Item 18.

SOW TOC, Pages 52, 67-69, 114, DS Page 5, GPPA

The SOW, Deliverable Schedule, and GPPA refer to SSAE 16 audits. Will CMS please clarify that this should be SSAE 18 instead?

CMS is confirming that the American Institute of Certified Public Accountants’ (AICPA) Statement on Standards for Attestation Engagements (SSAE) 16 has been updated and superseded by SSAE 18 with respect to Reporting on Controls at Service Providers. As this transition is currently underway, the JF SOW references to SSAE 16 will be updated upon award to include the requirements and SSAE 18 nomenclature. Offerors should use the existing SSAE 18 title/requirements for proposal purposes.

C.16 Attachment J.01 Statement Of Work

C.5.4.1.4 and J.24: 1.

Pages 45 and J.24: 2

SOW Section C.5.4.1.4, Compliance Officer, provides as follows: “The Compliance Officer is not required to be fully dedicated to the A/B MAC contract (i.e. the Compliance Officer may be responsible for the Medicare Title XVIII and MAC lines of business, but not responsible for other private business lines).” In contrast, the J. 24 attestation states only that the compliance officer shall not be responsible for other private (non-Medicare Fee-For-Service) business lines. Will CMS please confirm that the Compliance Officer may support other Federal contracts and, in particular, CMS contracts that are operationally separate from other business lines?

CMS is confirming that per the SOW language C.5.4.1.4 Compliance Officer:

The Compliance Officer is not required to be fully dedicated to the A/B MAC contract (i.e. the Compliance Officer may be responsible for the Medicare Title XVIII and MAC lines of business, but not responsible for other private business lines). The J.24 Attestation document has been updated to reflect this language. Please note the revised language on Page 2 of the J.24 Attestation document.

C.17 Attachment J.01 Statement Of Work

C.7.24

MPPARD

Page 149 Please clarify how the estimated telephone inquiries from Beneficiaries (749) will be received at the MAC? Will this work be transmitted from the Beneficiary Contact Center (1-800-Medicare) through NGD to the MAC or will the MAC be required to setup a unique communication path for beneficiaries? If CMS plans on the contractor answering the calls, will CMS provide the infrastructure needed to answer these phone calls?

CMS is confirming that telephone inquiries will not be transmitted from the Contact Center Operations (CCO), formerly the BCC. For proposal purposes only, Offerors are to assume the use of CMS contracted toll free telephone line.

F. Section J.22 BOE 7

ID Document Section Page number Question CMS Response

F.1 Attachment J.22 Basis Of Estimate

Base, OY1-6 For the Workload Category PM Provider Reimbursement and Audit, Workload Subcategory Reopening’s, should the correct Workload Category be MIP Provider Reimbursement and Audit?

CMS is confirming the workload category should be MIP Provider Reimbursement and Audit Reopenings. CMS is providing an updated BOE with several corrections noted via strikethrough and/or red font. See revised BOE

F.2 Attachment J.22 Basis Of Estimate

Base, OY1-6 For the Workload Category MIP Medical Review (MR) Hospice (if applicable), Workload Sub-Category Prepay Complex Reviews – Provider Specific, should the correct workload category be MIP Medical Review (MR) Part B?

CMS is confirming the workload category is MIP Medicare Review (MR) Part B.

CMS is providing an updated BOE with several corrections noted via strikethrough and/or red font. See revised BOE (Attachment J.22).

F.3 Attachment J.22 Basis Of Estimate

Workload Category - Appeals

Base Year Tab Do the stated RFP Workload volumes include all pending work that can be expected at the time of cutover or are these workloads only reflective of the number of months stated, respectively? Part A - 8 months, Part B - 6 months?

Can CMS provide the pending workload for each workload subcategory identified separately? A full understanding of the pending volumes will be especially important for all sub-categories of appeals to assure next-level appeal rights are not adversely affected and that case file requests can be completed timely for the QIC.

Pending volumes would be beneficial for all workload subcategories.

CMS is confirming that for proposal purposes offerors should assume any pending workloads are included in the workloads provided in the BOE.

F.4 Attachment J.22 Basis Of Estimate

RAC

Adjustments Part A (Claims) -

SLIN 000X A

RAC

Adjustment Part B (Claims) -

SLIN 000X AC

RAC Adjustments - Part A and Part B

The RAC adjustment workload volumes included in the BOE for Part A and Part B are significantly (nearly 1/12) lower than the CMS RAC workload limits for the new RAC contracts provided in TDL-170210. Given the TDL stated workloads, should the offeror use the RAC workload volumes provided in the TDL?

In addition, can CMS please clarify if workload tracking and cost reporting for RAC Appeals will be changed from the current SLIN AG/AH that requires separate tracking and reporting for RAC Appeals? If not, can CMS please provide the specific Part A and B RAC Redetermination workloads for this jurisdiction?

CMS is confirming that offerors should use the workload numbers provided in the BOE. CMS will not be changing the current SLIN AG/AH tracking and reporting of all RAC costs. CMS is also confirming that the Part A Redeterminations workload and Part B Redeterminations workload include both non-RAC and RAC-related Redeterminations workloads. CMS directs offerors to use their historical experience in determining the workload split of non-RAC and RAC-related redeterminations.

F.5 Attachment J.22 Basis Of Estimate

Workload Category- MIP Medical Review (MR) Part B, Probe Review - Prepay and Postpay Complex - Provider Specific & Probe

Rows 301-302 The workloads listed for the BY for "Probe Reviews - Prepay and Postpay Complex - Provider Specific" (row 301) and "Probe Reviews - Prepay and Postpay Complex - Service Specific" (row 302) appear to be incorrect. Because the Part B BY period of performance is 6 months, it would be expected that these workloads would be 50% of the workload for OY1 through OY6. However, the BY workload for these two types of probe reviews are disproportionately high at 67% of the annual workload in OY1 through OY6. Can CMS confirm the correct BY workload for Probe Reviews - Prepay and Postpay Complex - Provider Specific and Probe Reviews - Prepay and Postpay Complex - Service Specific?

CMS is confirming that the workload number for Base Year Part B Probe Review - Prepay and Postpay Complex - Provider Specific and Base Year Part B Probe Reviews - Prepay and Postpay Complex - Service Specific were incorrect. CMS is providing an updated BOE with several corrections noted via strikethrough and red font. See revised BOE (Attachment J.22).

F.6 Attachment J.22 Basis Of Estimate

Workload Category - Provider Inquiries Part A & Part B Congressional s (Received)

Row 117 It appears the workload for Provider Inquiries Part A & Part B Congressionals (Received) may not include the Congressionals inquiries labeled as “beneficiary” in PIES as typically there are many more beneficiary inquiries than provider inquiries for Congressionals and one would expect a MAC jurisdiction of this size to have a higher number of Congressionals than this. Can CMS confirm the Provider Inquiries Part A & Part B Congressionals (Received) workload for the BY and OY1 through

OY6?

CMS is confirming that the Provider Inquiries Part A and Part B Congressional workload value includes provider-related Congressionals only.

F.7 Attachment J.22 Basis Of Estimate

Workload Category - ALJ Hearing Participation/S upport MIP Medical Review (MR) Part A, MIP Medical Review (MR) Part B, Part A & Part B ALJ

Rows 69, 245 and

In attachment J.22 Basis of Estimate Final, it appears likely that the workloads in row 69 (77 for BY and 154 for OY1-OY6) for Part A & Part B ALJ Hearing Participation/Support represent the overall, rolled up workload for this activity and that the workloads in rows 245 and 246 (134 and 20) represent the separate workloads for this activity for Part A and Part B, respectively. Is this correct and if so, is it correct that offerors should not propose a level of effort for row 69? In addition, do the workload numbers indicate the number of hearings participated in or the number of hearings for which offerors can expect to receive a notice of hearing?

CMS is confirming that Row 69 of the BOE is the combined A&B workload, roll up of Part A (Row 245) and Part B (Row 296). Further, this workload number is the number of hearings participated in, it is not the number of hearing notices received.

F. Section J.22 BOE 8

ID Document Section Page number Question CMS Response

F.8 Attachment J.22 Basis Of Estimate

Workload Category - Provider Enrollment Part B, Initial Applications - Paper (Received), Initial Applications - Web

Rows 96-101 The JF Part B provider enrollment workloads appear lower than expected. Based on CMS' data for the number of providers in JF it would be reasonable to expect the Part B enrollment workloads to be substantially higher. To ensure all offerors have the most accurate information possible and that CMS receive accurate cost estimates from all offerors, could CMS confirm the JF Part B enrollment workloads?

CMS confirms the workload numbers provided for the Part B Provider Enrollment lines are in the BOE, Attachment J.22.

F.9 Attachment J.22 Basis Of Estimate

Non-Workload Estimating Factor

Please confirm that the hours reflected in the BOE should only be the direct hours that are being proposed. Hours for employees that are part of a contractor’s overhead rate (ex. Managers) should not be included in the BOE file.

CMS is confirming that the hours reflected in the BOE are for the direct hours that are being proposed. However, if the Offeror accounts for significant amounts of management time and effort in the Overhead rate (or anywhere other than direct labor hours, such as indirect costs), CMS recommends the Offeror clarify this in the technical proposal, Tabs E, to facilitate the

F.10 Attachment J.22 Basis Of Estimate

Instructions Tab

Under Column F, Total Proposed/Derived Workload, the instructions for Claims Processing have changed to read that suspended claim volumes are not to be entered by the Offeror but instead we should use the volumes in Investigated Bills/Claims. It further states that Investigated Bills/Claims are suspended initial bills/claims. For Part A, providers can initiate their own adjustment bills which may then suspend for manual intervention. Based on this instruction, CGS is assuming that those volumes are not included in the Investigated Bills/Claims. Are the volumes for provider adjustment bills located somewhere else on the Basis of Estimate, or should Offerors calculate those?

CMS is providing the projected number of initial bills/claims received, in the BOE. Of those initial bills/claims, CMS is providing the projected number of investigated claims. The investigated claims workload is the number of initial bills/claims that require some level of investigation. The offeror should provide the costs associated with the investigations of these initial bills/claims. These costs should be provided on the Investigated Electronic/Paper Claims lines. All other claims processing costs, including non-investigation-related costs for investigated initial bills/claims; and investigation costs for adjustment bills/claims, should be included on the Electronic/Paper Claims lines.

F.11 Attachment J.22 Basis Of Estimate

CMS reflects workload for Appeals Part A : QIC Requests Supported (Case Files Forwarded). The contractors no longer do this function for Part A with the implementation of MAS. Please confirm the offeror will be responsible for this workload.

CMS is confirming the workload provided for Part A QIC Requests Supported.

MAS implementation has significantly decreased, however there are instances when the MAC must provide support to the QIC.

F.12 Attachment J.22 Basis Of Estimate

CMS includes a combined workload for Appeals Part A and RAC Part A, and Appeals Part B and RAC Part B. Will CMS provide the workload split for purposes of the Cost Templates since these are separate SLINs?

CMS is directing offerors to use their historical experience in determining the workload split of non-RAC and RAC-related redeterminations.

F.13 Attachment J.22 Basis Of Estimate

The JF proposal does not include HH+H workload. Yet, on the J.22, Workload Category – MIP Medical Review (MR) Hospice (if applicable), Workload Subcategory – Prepay Complex Reviews – Provider Specific, it includes RFP workload in Base Year, and each Option Year. Please confirm if this workload to be included in the JF response.

CMS is confirming the workload category is MIP Medicare Review (MR) Part B.

CMS is providing an updated BOE with several corrections noted via strikethrough and red font. See revised BOE (Attachment J.22).

F.14 Attachment J.22 Basis Of Estimate

Please clarify if CMS wants the contractor to report a derived workload in column F for Part A and Part B claims because investigated claims does not fully represent all claims that will be worked by an examiner?

As indicated in the instructions, proposed workload and assumptions shall be included in column N, however, the example provided shows a derived workload in column F that appears to be a suspended claims volume based on the assumption example in column N. For claims processing, does CMS want the suspended claims volumes reported in column F?

CMS is confirming the Offer should not derive the workload for Part A and Part B claims. Use the Investigated Paper/Electronic Claims workload provided in the BOE (and Government Proposed Proposal Assumptions) and provide the costs associated with the investigations of the investigated initial claims on those specific rows.

G. Section J.23 GPPA 9

ID Document Section Page number Question CMS Response

G.1 Attachment J.23 Government Provided Proposal Assumptions

3. Jurisdiction F - Facilities Population by Type

Page 7 In the table titled "Jurisdiction Facilities by State (counts do not include distinct part units)" on page 7 of attachment J.23 there appears to be an error. The count of 1 in the "EACH" column for South Dakota is not included in the total in the rightmost column of that row. The total for the entire table also appears to be off by 1 as a result. It appears the total for South Dakota should be 173 and the total for the entire table should be 1,873.

CMS is confirming that there were incorrect numbers on this table. CMS is providing an updated Government Provided Proposal Assumptions document with several corrections noted via strikethrough and red font. See revised GPPA (Attachment J.23).

G.2 Attachment J.23 Government Provided Proposal Assumptions