Attachment_J.26_-_RFP_Questions_and_Responses.pdf

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Question Answer/Action

A.2 RFP Section I.1, FAR 52.252-2

Clauses Incorporated by Reference (Feb 1998)

Page 61 FAR 22.1006(c)(1) states, “The contracting officer shall insert the clause at 52.222- 43, Fair Labor Standards Act and Service Contract Labor Standards -- Price Adjustment (Multiple Year and Option Contracts), or another clause which accomplishes the same purpose, in solicitations and contracts if the contract is expected to be a fixed-price, time-and-materials, or labor-hour service contract…” Should FAR 52.222-43, FAIR

LABOR STANDARDS ACT AND

SERVICE CONTRACT ACT —

PRICE ADJUSTMENT

(MULTIPLE YEAR AND

OPTION CONTRACTS) (MAY

2014), be removed from the RFP as this clause only applies to fixed-price, time-and-material, or labor hour service contracts while this RFP is for a cost reimbursement contract?

FAR 52.222-43, FAIR LABOR

STANDARDS ACT AND SERVICE

CONTRACT ACT — PRICE

ADJUSTMENT (MULTIPLE YEAR

AND OPTION CONTRACTS)

(MAY 2014) indicates that this clause is used for Fixed Price.

The J8 RFP has Fixed Price elements, which makes this clause relevant.

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A.4 RFP Section K.2, 52.204-8 Annual Representations and Certifications (Jan 2017), Page 75 and Section

K.11, FAR 52.222-

Representation Regarding Compliance with Labor Laws (Executive Order 13673) (Dec 2016), Page 85

Executive Order 13782, issued March 27, 2017, revoked Executive Order 13673. Should FAR 52.222-57 be removed from the RFP?

FAR Clauses 52.222- 57, 52.222-58, 52.222- 59, 52.222-60 and

52.222.61 will be removed from the RFP, consistent with Executive Order 13782 Issued March 27, 2017.

A.5 SF-33 Solicitation, Offer and Award

Page 1 The SF-33 indicates the solicitation number is

HHSM-500-2017-RFP-

0016. In addition, all of the attachments indicate this same solicitation number. However, in FedBizOpps.gov, the solicitation number is RFP-500-2017-0016. Will the government please clarify the correct RFP number that Offerors should reference in their proposals?

Although CMS uses both solicitation numbers interchangeably, The Offerors should use

HHSM-500-2017-RFP-

0016.

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Question Answer/Action

B.1 RFP Section L.10.g.2, Proposal Submission, Delivery and Organization - Page Size, Typing, Spacing, and Page Numbering

Page 94-95

The RFP states, “So as to allow for more clarity in the numbering of pages; the pages of each separate volume shall be numbered sequentially - from page 1 through the end of the volume. The offeror should not restart numbering the pages in each separate TAB of the particular volume.”

Does CMS expect both print and electronic volumes to be sequentially numbered?

If so, in conjunction with Section L.10.a.i - Delivery Instructions, where it indicates that, “Signed annual reports and corporate policies may be submitted in Adobe Acrobat or PDF format, “is it acceptable for offerors to provide each volume in Adobe PDF format to simplify sequential page numbering?

CMS expects both print and electronic volumes to be sequentially numbered, consistent with the RFP at pages 94-95. The proposal volumes may be submitted in Adobe PDF format to accommodate sequential numbering of each separate volume;

so long as the Cost Templates (Attachment J. 12-J.21) and the BOE (Attachment J.22) remain unprotected and include all spreadsheet formulas as directed in the RFP.

B.2 RFP L.13.5, Volume III, Tabs D through F, Technical Approach Evaluation Factor, Proposal Instructions, Tab E - Staffing Plan

Page

Question 1.a asks, “What was the proposed total number of hours, skill mix and, productivity required to do this work in the past?” Did CMS intend to include “proposed” in this question, or should the question be, “What was the total number of hours, skill mix, and productivity to do this work in the past?”

CMS confirms that the word "proposed" should be removed. Section L.13.5 has been updated.

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B.3 RFP Section L.14, Proposal Instructions:

Volume IV, Business Proposal

Page

The RFP states, “The business proposal narrative should include only business proposal-related content, and shall not include any technical proposal-related content….

Any inconsistency, whether real or apparent, between promised performance and price should be explained in the proposal.” Can CMS clarify what is appropriate/inappropriate to include in the business proposal narrative, as the Contractor to some extent will need to describe what is included in the Cost Estimates, which include key points from the Technical Proposal?

CMS recognizes that the Offeror will, to some extent need to include some technical facts in the business proposal to support its cost estimates. However, CMS does not have an expectation that the Offeror will unnecessarily restate its technical approach in the business proposal.

B.4 RFP Proposal Submission, Delivery and Organization

Page 91 The RFP states, "The Offeror shall submit one (1) original hard copy version of each of the five (5) proposal volumes, Volumes I through V…No hard copies of Volume V are necessary."

Will the government please clarify that an original hard copy of Volume V is required, but no copies of the original are required to be submitted?

As indicated on the chart on page 91 of the solicitation, the Offeror shall submit one original paper Volume V and one

CD- ROM.

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Question Answer/Action

B.6 RFP L.13.4 VOLUME

III, TAB C, Past Performance Evaluation Factor, Proposal Instructions

Page

The instructions for providing Past Performance information state “The below table should be used when providing a summary of the past performance.”

Based on the amount of information required under several of the table columns, is it acceptable for Offerors to provide this information in a foldout or alternatively, can we make each of the CMS column headings individual rows instead – so there is more room to add narrative.

Basically, is an alternative format containing this same information allowed?

CMS confirms that Offerors may use any format that uses the same headers provided that it contains the same information as requested in the RFP page 104 chart, the font size is consistent with the instructions and it is able to fit within the normal size three-ring binder.

B.7 RFP L.13.5 VOLUME

III, TABS D

through F, Technical Approach Evaluation Factor, Proposal Instructions, TAB E, STAFFING

PLAN

INSTRUCTIONS

Page

For the staffing charts required under the Staffing Plan section, would CMS consider having Offerors submit the staffing charts in a soft copy EXCEL spreadsheet only (no hardcopy required) similar to how the BOEs are currently submitted for ease of populating and review? Page count could be adjusted accordingly.

CMS will continue to require offerors to submit hardcopy staffing charts in response to the Staffing Plan requirements.

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B.8 RFP L.13.5 VOLUME

III, TABS D

through F, Technical Approach Evaluation Factor, Proposal Instructions, TAB E, STAFFING

PLAN

INSTRUCTIONS

Page

Under the bullet that states “Identify the total number of FTEs required for CLINs 0002 (Base) and 0003 (Option 1) of the contract across the prime and subcontractor(s)”, can CMS clarify whether the term “prime” includes inter-organizational transfers from affiliates?

CMS confirms that the term "prime" includes inter-organizational transfers from affiliates. It is inclusive of inter-organizational and corporate support. Offerors must identify the total number of FTEs required for CLINs 0002 (Base) and 0003 (Option

1) across the prime and subcontractor(s).

B.9 RFP L.13.5 VOLUME

III, TABS D

through F, Technical Approach Evaluation Factor, Proposal Instructions, TAB E, STAFFING

PLAN

INSTRUCTIONS

Page

Proposal instructions require Offerors to “Identify the number of new hires, required for CLINs 0002 (base year) and 0003 (Option Year 1) of the contract, broken out by labor category and function across the prime and subcontractor(s).” Can CMS confirm that since FTEs at the end of CLIN 0002/beginning of CLIN 0003 are all considered existing staff, the CLIN 0003 new hires would be limited to external hires needed due to annual attrition or slight workload changes?

CMS confirms that Offerors must identify the number of new hires, required for CLIN 0002 (Base Year) and CLIN 0003 (Option Year 1) broken out by labor category and functions across the prime and subcontractor(s).

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B.10 RFP L.13.5 VOLUME

III, TABS D

through F, Technical Approach Evaluation Factor, Proposal Instructions, TAB E, STAFFING

PLAN

INSTRUCTIONS

Page

The requirements for the mission-essential functions (MEFs),“For each mission-essential function listed below in items (A)-(F), the Offeror shall separately provide the staffing information described in items (1) – (3)” appear to duplicate the requirement on the previous page (page

106) in terms of sources of staff, timelines for recruiting and training staff prior to beginning operations. Would CMS consider having Offerors address these requirements only under each MEF rather than in both places?

CMS confirms and acknowledges there is an intentional level of duplication between the two sections.

CMS believes it’s important for offerors to address this issue separately in both sections, as these two sections have different functions during the evaluation of the proposal.

B.11 RFP L.13.5 VOLUME

III, TABS D

through F, Technical Approach Evaluation Factor, Proposal Instructions, TAB E, STAFFING

PLAN

INSTRUCTIONS

Page

In the 3rd bullet at the top of page 107, the instructions state: “Provide a detailed timeline for recruiting and training staff prior to beginning operations. The timelines should be broken out by business function and should indicate timeframes associated with each stage of recruiting and training staff for each business function.” We interpret “business functions” to be the mission-essential SOW areas described in A-F on page 107. Please confirm.

CMS confirms "business functions" are the mission-essential SOW areas described in Tab E, A-F on page 107.

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B.12 RFP Staffing Plan - Sources of Staff

Page

RFP asks offerors to "Describe the experience of the proposed staff for the function, by labor category.

In describing this experience: ... Describe the type of experience such as performed the same Medicare work, performed different Medicare work, performed different non- Medicare work, etc. and years of Medicare experience or other non- Medicare experience." This requirement asks for the years of experience, by labor category. However, "years of experience" doesn't make sense at the labor category level as many employees will be included in each labor category. It will be quite difficult and time consuming for offerors to compile this information for current employees as it would require offerors to obtain information about years of experience for every person expected to work on the J8 contract.

Offerors will no doubt struggle with communicating this information in an efficient manner given the page constraints of the proposal. Most important, it is questionable how accurate this would be as the operational start date is more than one year away. Most offerors will have some staff turnover

CMS continues to believe it is important for Offerors to describe years of Medicare experience or other non- Medicare experience.

Therefore we are maintaining the requirement that Offerors provide this information.

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In addition, such experience information would not be obtainable for new hires (who won't be hired until much closer to the operational start date) nor to incumbent staff that might be hired (as they won't be identifiable until post-award). Will CMS revise this section to remove the requirement for "years of Medicare experience or other non-Medicare experience"?

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C.1 Section C.5.7.3.5, Provider

Internet Portal

SOW Page 80 The SOW indicates that portal transactions are at the discretion of the contractor. However, CMS recently published multiple Change Requests that mandate specific data be provided in addition to

Health Insurance

Portability and

Accountability Act

(HIPAA)-compliant data.

Please identify specifically what data is required in the portal beyond basic claim status and 270/271 eligibility data.

CMS confirms the current requirements for portals are located in the Portal Handbook section 1.2. Which states the following: The portal should be offered to access various healthcare transactions. Portal content may include, but is not limited to the following high-level functionalities:

• Claims related transactions

• Eligibility inquiries

• Remittance advice (includes the ability to view and/or print remittances)

• Reopenings

• 1st level appeals

(Redeterminations)

• Secure messaging/mailbox

CMS is currently working on additional requirements, e.g.

CR 10069 that requires incorporation of a Medicare

Beneficiary Identifier look up tool in portals. These additional activities will be addressed in future Change

Requests. For proposal purposes, Offerors shall only propose to current portal requirements.

C.2 C.5.26.6

Recovery Audit

Prepayment

Review

Demonstration

SOW Page 140 We understand that this demonstration project ended in December of

2015. Please clarify if the inclusion of this demonstration within the

SOW is appropriate.

CMS confirms that the

Recovery Audit Prepayment

Review Demonstration ended in

December 2015. Offerors shall prepare their proposal based on the understanding that no additional workload is expected and the SOW will be updated to that effect upon contract award.

C.3 SOW: C.5.4.1.4:

Compliance

Officer; and

J.24: Key

Personnel

Attestations

SOW SOW

Page 46;

J.24 Page

SOW Section C.5.4.1.4

Compliance Officer states, "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

CMS confirms that as stated in

SOW section 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 or Federal Agency Contracts).

See revised Attestation

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"Shall not be responsible for other private business lines." Please confirm that a MAC Compliance

Officer can also serve as a

Compliance Officer for (a) other Federal agency contracts; or (b) at a minimum, other HHS or

CMS contracts not supporting Medicare Title

XVIII or the MAC program.

document (Attachment J.24).

Question Answer/Action

C.4 SOW SOW:

C.5.4.1.4:

Compliance

Officer;

and J.24:

Key

Personnel

Attestations

SOW

Page 46;

J.24

The CMS answer to question C.3 states, "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 or

Federal Agency

Contracts)". Please confirm that other

"Federal Agency

Contracts does not include

HHS or CMS.

The Compliance Officer’s activities shall be focused on the Medicare fee-for-service program. Accordingly, the

Compliance Officer’s scope of activity shall be limited to ensuring compliance with the requirements of one or multiple A/B and/or DME

MAC contracts for which the organization is under contract with CMS to administer. The

Compliance Officer’s scope of activity may also include any other Medicare fee-for-service-related contract for which the organization is under contract with CMS to administer.

Conversely, the Compliance

Officer shall not simultaneously be engaged in Compliance Officer-related activities that pertain to Medicare functions not affiliated with

Medicare fee-for-service lines of business (e.g., Medicare Advantage, Medicare Part D, Accountable Care

Organization) nor shall the

Compliance Officer be simultaneously engaged in

Compliance-Officer-related activities for other Federal or private lines of business.

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Question Answer/Action

D.1 J.01.G Provider

Enrollment

4 In attachment J.01.G

Performance Standards Final, it appears CMS has omitted a standard, C.5.5.1 Process

Initial and Revalidation

Enrollment Applications -

(Web-based), which requires

"98 percent of such applications are processed in accordance with all of the instructions in IOM Pub. 100-

08". Is it CMS' intent to omit this standard for J8?

No. CMS confirms that the

98% accuracy standard for

Web-based Initial and

Revalidation Enrollment

Applications is a current requirement in the Internet

Only Manual (IOM). This

Standard is applicable to J8.

D.2 J.03 Small Business

Subcontracting

Plan

Is the provided Small and

Disadvantaged Business

Utilization Small Business

Subcontracting Plan template the current version to be utilized or should contractors utilize the 20 Apr 17 version released from the Small

Business Office?

The Offeror should use the

April 20, 2017 version of the

Small and Disadvantaged

Business Utilization Small

Business Subcontracting Plan template.

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F.1 Base, OY1-6 &

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 the volumes in Investigated

Bills/Claims should be used. 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, The contractor is assuming that those volumes are not included in the Investigated

Bills/Claims. Are the volumes for provider adjustment bills located somewhere else in 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.2 Base, OY1-6 &

Instructions Tab

Can CMS clarify what inquiries are included in the J.22 “Provider

Inquiries Part A & Part B” RFP volume? Does this volume represent just answered and IVR-handled volume noted in the description, or does it also include

Internet portal self-service interactions as is noted in the J.22 instructions tab description of

Provider Telephone Inquiries?

CMS confirms that the Provider

Inquiries Part A and Part B volume includes Calls Answered by CSRs and

Calls Handled by IVR.

F.3 Base, OY1-6 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 directs Offerors to use their historical experience in determining the workload split of non-RAC and

RAC-related redeterminations.

F.6 Base Year and

Option Years 1-

6, Provider

Enrollment Part

B, Lines 96-99

Based on our experience and the numbers of Part B providers identified in the Jurisdiction 8

RFP, we would expect the workloads for Initial Applications and Changes of

Information/CHOWs to be much higher. Please evaluate and confirm the following workloads:

• Initial Applications – Paper

(received)

• Initial Applications – Web

(received)

• Changes of Information and

CHOWs – Paper (received)

• Changes of Information and

CHOWs – Web (received)

CMS confirms all Provider Enrollment workload numbers are accurate with the exception of the Part A Changes of

Information and CHOWs - Paper workload number. CMS is providing an updated BOE with several corrections noted via strikethrough and red font. See revised BOE

(Attachment J.22).

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F.7 Base Year, Line

142 - Wage

Index Reviews

The Base Year reflects a total of 91

Wage Index reviews. The Base

Year for Part A (CLIN 0002) starts

December 8, 2018, and ends July

31, 2019. The completion of the

Wage Index workload is a cyclical process which can’t start until the provider submission timeframe has elapsed, which is typically very early in September. The MACs then have approximately 2.5 months to complete the Wage

Index desk reviews on a full year of cost reports, with the due date for the completion of these desk reviews in mid-November. Since the wage index timeline falls outside the Base Year period, we believe there should not be any

Wage Index workload assigned in the Base Year. Will CMS please confirm the workload for wage index in the Base Year?

CMS confirms the workload number of 91 Wage Index Reviews. For proposal purposes, the Offeror should presume that during Round 2

(February-March) some of the Wage

Index Reviews will require research and review based on CMS direction.

F.8 Estimated

Annual

Workloads, Table 9 - Cost

Report

Acceptance

Table 9, Line 58 indicates a total workload of 1,887, which includes

128 Outpatient Physical Therapy providers (FISS Type 48, STAR type 17, Line 30). These providers, however, are not required to submit cost reports because of the fee-based payments they receive.

We believe the Total Number of

Cost Report Accepts should be reduced by 128, for a total of 1,759.

Will CMS please confirm that the

Cost Report Acceptance workload should be reduced by 128?

CMS confirms the workload number of 1,887 for Cost Report Acceptances.

Outpatient Physical Therapy (OPT) providers are not required to submit cost reports but still have the option to submit cost reports. For proposal purposes the Offeror should assume

OPTs file cost reports.

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F.9 Estimated

Annual

Workloads, Table 11 - Full

Desk Reviews

Table 11, Line 89 reflects 101 Full

Desk Reviews for End Stage Renal

Disease (ESRD) providers, and

Table 12, Line 109 reflects 284

Limited Desk Reviews for ESRD providers. This results in a total of

385 desk reviews for ESRD providers.

The Facilities by Type sheet, Table

4, Line 30 indicates that there are

278 Independent ESRD Facilities, while Table 4, Line 29 and Table 6, Line 48 indicate 18 total Hospital-

Based ESRDs. This results in a total of 296 ESRD facilities.

Based on the number of providers identified on the Facility

Population Tables 4 and 6, the total number of desk reviews (both

Limited and Full) should be close in proximity to the total number of providers; however, it is not. We believe the Limited Desk Review number of 284 (on Table 12) may be overstated, and should be reduced by the number of Full

Desk Reviews of 101 (on Table 11), resulting in a total number of limited desk reviews of 183 (284-

101=183). This new Limited Desk

Review number of 183, plus the 101

Full Desk Reviews, would be 284, which more closely approximates the total number of ESRD providers (296) and would match the original Limited Desk Review count for ESRDs. Will CMS please confirm this information and adjust the ESRD Limited Desk

Review accordingly?

CMS confirms the correct number of

ESRD Full Desk Reviews is 98 and the correct number of ESRD Limited Desk

Reviews is 198. CMS is providing an updated BOE with several corrections noted via strikethrough and red font.

See revised BOE (Attachment J.22).

F.10 Estimated

Annual

Workloads, Table 11 - Full

Desk Reviews

The BOE for Option Years (OY) 1-

6, Line 144 indicates a workload of

93 ESRD Special Audits per OY.

However, there is no corresponding workload information in the

Facilities by Type Facility

Populations tables (Tables 3-6).

The Estimated Annual Workloads sheet - Table 11, Lines 89 and 91 indicates that there are 101 Full

ESRD Desk Reviews and 2 Full

Desk Reviews ESRD Special

Audits. Can CMS please clarify the number of ESRD Special Audits and if a Special Audit should be completed in conjunction with the

Full ESRD Desk Reviews?

CMS confirms the number of ESRD

Special Audits should be completed in conjunction with the Full ESRD Desk

Review. The correct workload number of ESRD Special Audits is 98. CMS is providing an updated BOE with several corrections noted via strikethrough and red font. See revised BOE (Attachment J.22).

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F.11 Estimated

Workloads, Table 18 - Cost

Report

Reopenings

Table 18 indicates a total number of 1,400 (OY 1-6), broken down by individual provider type. Of the total number, 1,142 relate to Short

Term facilities (PPS Hospitals). We note that there are only 137 Short

Term Facilities listed on Facility

Population Table 3. The reopening number of 1,142 is over eight times the number of Short Term facilities in the contract. Will CMS please clarify the workload for

Reopenings of 1,400 for all OY 1-6, as it appears to be unreasonably high, due to the fact there are 137

Short Term Facilities and the reopening number associated with that population is 1,142?

CMS confirms 933 Cost Report

Reopening Requests in the Base Year and 1,400 Cost Report Reopening

Requests in Option Years 1-6 are the total number of reopenings in the historical baseline. For proposal purposes, the Offeror should compute the number to be completed during the

Base and Option Years. A provider can have numerous reopenings for one fiscal year end (FYE) in addition to having reopenings for various FYEs.

It is not uncommon for a provider to have eight or more “open” reopenings relating to various FYEs.

F.12 Estimated

Annual

Workloads, Table 19 - Cost

Report Appeals

Table 19, Line 224 indicates a workload of 111 for Preliminary

Position Papers due PRRB. Should the Contractor expect to complete the same number of Final Position

Papers due PRRB?

CMS confirms that for proposal purposes, Offerors should assume completion of 111 Final Position

Papers due to the PRRB.

F.13 Estimated

Annual

Workloads, Table 19 - Cost

Report Appeals

Table 19, Line 226 indicates a workload of 254 for Lead MAC on

Group Appeals (Review Schedule of Providers). Should the

Contractor expect to complete workloads on individual cost report appeals as well?

CMS confirms Offers should anticipate

254 Lead MAC on Group Appeals and approximately 311 other types of appeals.

F.14 Estimated

Annual

Workloads, Table 19 - Cost

Report Appeals

Please verify the workload of 179 for Jurisdictional Challenges (Line

227), as the workload appears higher than expected in comparison to the Total Hospitals of 293 reflected in Table 3 of the

Facilities by Type sheet.

CMS confirms the workload number of 179 for Jurisdictional Challenges as stated in the BOE.

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F.15 Estimated

Workloads, Table 21 - Wage

Index

Table 21 - Wage Index, Line 243 indicates 137 for the Total Number of PPS Hospitals, which matches the number of Short Term Facility-

PPS Hospitals (FISS Type 00) reported on the Facilities by Type sheet, Table 3 - Hospitals, Line 12.

However, Table 3 also reflects:

• 14 Rural Referral Center-PPS

Hospital (FISS Type 07, Line 17)

• 11 Re-based Sole Community

Hospital-PPS Hospital (FISS Type

16, Line 20)

• 8 Re-based Sole Community

Hospital/Referral Center-PPS

Hospital (FISS Type 17, Line 21)

We believe that these three additional PPS Hospital types should be added to the total number of Wage Index reviews.

The addition of these three provider types (14 + 11+ 8 = 33) would result in a new Wage Index review number of 170 (137 +33).

Will CMS please confirm these additional PPS hospitals should be added to the wage index workload?

CMS confirms the number for wage index workload should have been 170.

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

F.16 Estimated

Annual

Workloads, Table 22 -

HITECH

Please clarify the inclusion of

HITECH Audits for Acute and

Critical Access Hospital (CAH) providers in Table 22 for the BY and OYs 1-6. It is our understanding that by the time this contract is awarded around August

2018, the HITECH Audits should already have been completed for both Critical Access and Acute

Hospitals. Any given hospital can only be eligible for the HITECH incentive payment for a consecutive four-year window. The first potential Federal Fiscal Year

(FFY) that could be selected was

10/01/2010 - 09/30/2011. Each hospital would report the incentive on the cost reporting period beginning in that FFY. Acute Care

Hospitals had a six-year range within which they could select their four-year window for the EHR incentive; CAHs only had a five-year window to choose from. There have already been five years’ worth of HITECH audits performed under the current J8 contract, including cost reporting periods beginning in FFYs between

10/01/2010 - 09/30/2015. If CMS were to assign a sixth year of audits

CMS confirms that the number of

HITECH audits are as stated in the

BOE. Hospitals were paid a HITECH incentive for four consecutive years.

However, all of the hospital HITECH payments were paid as initial/preliminary payments using the most current cost report data available at the MAC and must be adjusted to calculate the final HITECH payment of record. The final HITECH payment

(or payment of record) is based on the cost report that began during the year in which the provider attested for

HITECH (meaningful use). Due to the natural cost report processing life cycle, MAC’s may be performing

HITECH reviews through January

2020.

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(for the Acute Care Hospitals with

FYYs between 10/01/2015 -

09/30/2016), these would be completed before the new J8 contract is awarded around August

2018. Will CMS please verify the number of HITECH audits for the

BY and OYs 1-6?

F.17 Estimated

Annual

Workloads, Table 23 -

Special Payment

Status

Table 23 in the Estimated Annual

Workloads sheet reflects a workload of zero for Special

Payment Status (Lines 256-57);

however, the BOE for Option

Years 1-6 indicates a Special

Payment Status workload of 25 per

OY (Line 145). Can CMS please clarify the workload required for

Special Payment Status?

CMS confirms that 25 is the correct workload number for Special Payment

Status. CMS is providing an updated

BOE with several corrections noted via strikethrough and red font. See revised BOE (Attachment J.22).

F.18 Base, OY1-6 Row 181 The change request workload for the base period is the same as the option years even though the duration of the base period is approximately 6 months (Part B) to

7 months (Part A). Should the base period change request workload be pro-rated relative to the length of the base period?

CMS confirms that the Base Year should have been prorated for the change request workloads. CMS is providing an updated BOE with several corrections noted via strikethrough and red font. See revised BOE (Attachment J.22).

F.19 Instructions Tab Row 38 On the Instructions tab of the

BOE, the instructions for Column

E state that "JF is not an

HH+H...". Should the reference to a MAC be to J8?

CMS confirms the reference should state J8. CMS is providing an updated

BOE with several corrections noted via strikethrough and red font. See revised BOE (Attachment J.22).

PROCUREMENT SENSITIVE INFORMATION – In accordance with FAR 2.101 and 3.104, the information contained in this email is source

F.20 Base, OY1-6 Column

E, rows 20

The Part B claims workloads

(electronic and paper, both) decrease by approximately 0.4% each option year, while most other workloads either increase or remain steady. For example, total Part A claims increase by 2.3% each option year while Part B investigated claims increase by about 0.9% each option year. Can CMS confirm the Part B claims workloads?

CMS confirms the workload numbers for both Part B Claims - Electronic and Part B Claims - Paper. The Part

A & Part B workloads have different and distinct trends that are commensurate with Jurisdiction 8.

F.21 Base, OY1-6 Column

E, row 115

The telephone inquiries workload for J8 is much less than that of the recently released JF and JJ RFPs, relative to the number of claims. For example, in

JJ, telephone inquiries were 1.49% of claims while in JF telephone inquiries were 1.99% of claims. The government provided telephone inquiries for J8 are 0.76% of claim. Can CMS confirm the workload for telephone inquiries?

CMS confirms the telephone inquiries workload number in the BOE as stated.

F.23 Base, OY1-6 Are offerors allowed to add the

Excel function IFERROR to the predefined formulas to enhance the readability of the document by removing Excel calculation errors?

CMS confirms that Offerors shall not add functionality to the BOE spreadsheet.

F.24 Base, OY1-6 The J.22 Basis of Estimate is sorted by workload, which is more complex to manage as the form is filled with historic and proposed data. Is it possible to allow the

Offeror to complete the form sorted by SOW WBS Crosswalk as opposed to workload order?

CMS confirms that Offerors may not reorder the BOE and that Offerors may not sort by SOW WBS Crosswalk.

PROCUREMENT SENSITIVE INFORMATION – In accordance with FAR 2.101 and 3.104, the information contained in this email is source

F.25 Base, OY1-6 Where an offeror utilizes other than historical hours and productivity data as proposed productivity, are the

History/Baseline columns in the

J.22 to be populated with historic hours and productivity? With the other than historical data being explained.

CMS confirms the purpose and instructions for the History/Baseline column, as stated on the Instructions tab of the BOE:

PURPOSE: The purpose of this column is to demonstrate workload differences between the proposed workload and the Offerors historic workload (12 month baseline) so CMS can understand potential impacts of the history on the level of effort proposed. CMS may verify the

Offerors stated historic workloads against historic data available to CMS.

INSTRUCTIONS: The Offeror shall identify the historic workload (12 month baseline) for the respective labor subcategory that impacted its proposed productivity and level of effort. The Offeror shall leave this column blank for a row relating to

“Non-Workload Estimating Factor” (a non-productive labor category).

F.26 Base, OY1-6 Are the History/Baseline columns on the J.22 intended to always represent 12 months of historic hours, historic workload, and historic productivity?

CMS confirms where an Offeror uses historical hours and production data as a basis of estimate, the Offeror should use a historical data baseline that is based on at a minimum twelve consecutive months of the Offeror’s most recent performance. If the

Offeror chooses to use a productivity baseline period of less than twelve months duration, the Offeror should provide detailed rationale to support the use of the shorter baseline period, for its proposed productivity metrics.

Moreover, when electing a shorter baseline period, the Offeror should still provide its historic month-by-month hours and production performance for the full twelve consecutive months’ time span, highlighting the months actually used by the Offeror for the basis of estimate, so that CMS may view the proposed limited historic baseline in the context of a full twelve consecutive months’ worth of performance.

F.27 Estimated

Annual

Workloads

Table 18, Cost Report Reopenings, has each line labeled as “reopening requests”. Is the workload being tracked by the number of reopening requests received or the number of reopenings completed?

CMS confirms that Table 18 reflects

Cost Report Reopening Requests received.

PROCUREMENT SENSITIVE INFORMATION – In accordance with FAR 2.101 and 3.104, the information contained in this email is source

ID Section Page

Question Answer/Action

G.1 Section 23 Page 11 High Risk Fraud & Abuse Areas

(SOW C.7.19) indicates that for proposal purposes, the workloads are included in the MIP Benefit Integrity

ZPIC/UPIC Support workloads in the

BOE (Attachment J.22).

1) Which workload are the volumes included in, Non Law Enforcement or

Law Enforcement?

2) What percentage of this volume is for normal ZPIC/UPIC workloads and what percentage is for the High Risk

Fraud & Abuse Areas? There are separate SOWs and would need to be proposed accordingly.

For proposal purposes, CMS directs

Offerors to report cost for the jurisdiction specific C.7.19 in WBS C.5.13 as the workload is combined in the BOE.

The C.7.19 workloads are included in the

Law Enforcement workloads. For proposal purposes, offerors shall develop proposals with the expectation that the

High Risk Fraud and Abuse, C.7.19 activities equate to 20% of the Law

Enforcement workload.

G.2 Section 2 1 CMS states in section 2.

Implementation Cutover Date that it regards each individual CICS region as an individual segment, with a reference to a table showing two segments. Are offerors to assume that there are only 2 CICS regions, one for Part A and one for

Part B?

There is one CICS region for MI Part A and one CICS region for MI Part B.

There are two UAT regions for MI, one for Part A and one for Part B. There is one CICS region for IN Part A and one

CICS region for IN Part B. There are two UAT CICS regions for IN, one for

Part A and one for Part B.

G.3 RFP Attachment 23, Government

Provided Proposal Assumptions

(GPPA), Contract Award Date, page

1. Can CMS please clarify and confirm the changes made to RFP

Amendment 23, the Government

Provided Proposal Assumptions

(GPPA)? CMS updated the award date to August 31, 2018 and contract start date to September 1, 2018 in this paragraph but did not update the contract effective dates in the rest of the GPPA document. Accordingly, the implementation period of performance listed still begins on August 1, 2018, which is before the estimated contract award date.

Attachment J.23 has been updated to reflect the correct Award and Effective date.