AttachmentB-ZPIC-Pre-Proposal-slidesAmendment1.ppt

ZONE PROGRAM INTEGRITY CONTRACTOR

(ZPIC)

CYCLE ONE

ZONES 4, 5, AND 7

Pre-Proposal Conference

October 17, 2007

Troy Barsky Acting Deputy Director, Program Integrity Group

WELCOME

Theresa Schultz Contracting Officer, Office of Acquisition and Grants Management

PURPOSE OF PRE-PROPOSAL CONFERENCE, OVERVIEW AND GROUND RULES

PURPOSE

To clarify CMS direction The purpose of this conference is to allow prospective offerors the opportunity to gain a better understanding of the objectives of the acquisition. In addition, it also offers CMS an opportunity to stress the importance of significant elements of the Request for Proposal (RFP).

GROUND RULES

Speakers will go through agenda items.

CMS will post responses to questions in an amendment under the Federal Business Opportunities (FedBizOpps) database.

Reminder: Please turn off cell phones and pagers.

We will break for ten minutes after we have completed the agenda

We are asking that you use the index cards located in your conference folder to submit written questions.

Questions should be dropped in the box located on the registration table at the beginning of the break

The index cards are color-coded to expedite the response process.

After the break, CMS will try to respond to as many questions as possible. Responses to questions will include both the ones submitted today and any questions we received prior to today.

All responses provided today will be posted to FEDBIZOPPS in accordance with L.10 of the solicitation.

GROUND RULES (con’t) Remarks and explanations provided today do not qualify the terms of the solicitation.

The information provided at this conference is considered supplemental guidance and does not override the terms of the RFP and specifications.

For any ambiguities and/or conflicting information the offerors shall refer to the RFP.

Any required changes to the RFP will be accomplished through a formal amendment.

OVERVIEW

On October 10, 2007, CMS released the first RFP for the Cycle One Zone Program Integrity Contractor (ZPIC) procurement.

Three (3) separate ZPIC contracts will be awarded to detect, deter and prevent fraud, waste and abuse in the Medicare and Medicaid Programs for Zones 4, 5 and 7.

ZPIC ZONES

Zone 4 is comprised of the following states: Colorado, New Mexico, Oklahoma, and Texas.

Zone 5 is comprised of the following states: Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and West Virginia.

Zone 7 is comprised of the state of Florida and two U.S. territories: Puerto Rico and the US Virgin Islands.

ZPIC ZONES (con’t)

PR

WA

OR

CA

NV

AK

ID

UT

AZ

NM

CO

WY

MT

ND

NE

KS

OK

TX

LA

AR

MO

IA

WI

IL

IN

KY

TN

MS

AL

GA

SC

NC

VA

OH

MI

WV

PA

NY

SD

M``N

Current Program Integrity Environment

Home Health + Hospice Program Integrity Medicare Parts A and B Program Integrity Medicare DMEPOS Program Integrity Program Safeguard Contractor

MEDICS

Part D Program Integrity Medicare-Medicaid (Medi-Medi) Program Integrity

Part C Program Integrity

ZPIC FUTURE ENVIRONMENT

ZPIC

Medicare Parts A & B

DMEPOS

Home Health & Hospice Medi-Medi Part C & D

RFP OVERVIEW

Gina Romano Contract Specialist

ZPIC CYCLE ONE

PROCUREMENT TIMELINE

10/10/07 RFP Posted on FedBizOpps

10/17/07 Pre-Proposal Conference

10/24/07 Questions Due from Offerors

11/02/07 Answers Posted on FedBizOpps

11/13/07 Intent to Bid Due – Zone 4

11/27/07 Proposals Due - Zone 4

12/04/07 Intent to Bid Due – Zone 7

12/18/07 Proposals Due – Zone 7

01/09/08 Intent to Bid Due – Zone 5

01/23/08 Proposals Due – Zone 5

ZPIC CYCLE ONE

PROCUREMENT TIMELINE

04/30/08 Award of IDIQ, Task Order 0001 and 0002 – Zone 4

05/15/08 Award of IDIQ, Task Order 0001 and 0002 – Zone 7

05/31/08 Award of IDIQ, Task Order 0001 and 0002 – Zone 5

(Dates are estimated)

RFP OVERVIEW – SECTION G (CONTRACT ADMINISTRATION DATA)

Contracting Officer – Theresa Schultz

Contract Specialist – Gina Romano

Project Officer – Susan Oken

Project Officer – Stephanie Blaydes-Kaisler

RFP OVERVIEW – GENERAL

CONTRACT INFORMATION

Federal Acquisition Regulations (FAR) - www.arnet.gov

Health and Human Services Acquisition Regulation (HHSAR) www.hhs.gov/oamp/dap/hhsar.html

RFP OVERVIEW – GENERAL

CONTRACT INFORMATION (con’t) Any inconsistency in the solicitation or

The Schedule (excluding the specifications) : Part I of the Solicitation, Sections A-H including the SOW under Section C Representations and other instructions – Sections K, L, & M Contract Clauses – Section I Other documents, exhibits and attachments – Section J The specifications Order of Precedence – Uniform Contract Format (UCF) – FAR 52.215-8

RFP OVERVIEW – FEDBIZOPPS

Office : Centers for Medicare & Medicaid Services Location : Office of Acquisition and Grants Management Solicitation number : RFP-CMS-2007-0027 Title : R – Zone Program Integrity Contractor (ZPIC) Synopsis - Posted on September 18, 2007 Solicitation - Posted on October 10, 2007 View List of Interested Vendors

Register to Receive Notification Register as Interested Vendor Department of Health and Human Services Business Opportunities

RFP OVERVIEW –

FEDBIZOPPS (con’t)

VENDOR NOTIFICATION SERVICE

Allows vendors to register to receive e-mails notifying the vendor of all notices from a particular solicitation.

The FedBizOpps system includes the capability to join and view a published list of vendors interested in a particular solicitation.

RFP OVERVIEW – SECTION B (SUPPLIES

OR SERVICES AND PRICES/COST)

Contract Type

Indefinite Delivery Indefinite Quantity (single) – one IDIQ for each Zone will be awarded. CMS will not be competing task orders among the ZPICs or Zones.

Cost Reimbursable (includes T&M) Task Orders Fixed Price Task Orders Task Order 0001 and 0002 - Cost-Plus-Award- Fee (CPAF)

Contract Line Item Number (CLIN) – each contract period or year is segregated by a CLIN.

Sub Line Item Number (SLIN)

For example, established to separate the funds associated with the States under Task Order 0002

RFP OVERVIEW – SECTION F

(CLAUSE F.2 PERIOD OF PERFORMANCE)

IDIQ

12 months (Base Year), plus four one year option periods H.1 Contract Renewal – MIP Authority:Pursuant to 42 CFR 400 and 421, “Medicare Integrity Program” if this contract is funded by Medicare Integrity Program appropriated funding, the Contracting Officer may renew this contract annually by giving the Contractor written notice, within 90 days of the expiration date of this contract (after exercise of all option or renewal years), of its intent to do so.

Task Order 0001

CLIN 0001

SubCLIN 0001AA – Transition (date of award – October 31, 2008) SubCLIN 0001AB – Fully Operational (November 1, 2008 – October 31, 2009) Plus four one year option periods H.1 Contract Renewal

RFP OVERVIEW – SECTION F

(CLAUSE F.2 PERIOD OF PERFORMANCE)

Task Order 0002 (Zone 4 Example)

CLIN 0001 – Base Year including transition/implementation period, plus four one year option periods CLIN 0001AA – Texas (Base Year: Transition: date of award – September 30, 2008; Fully Operational: October 1, 2008 – April 30, 2009) CLIN 0001AB – New Mexico (May 1, 2010) CLIN 0001AC – Colorado (Base Year: Implementation: date of award – September 30, 2008; Fully Operational: October 1, 2008 – April 30, 2009) CLIN 0001AD – Oklahoma (Base Year: Implementation: date of award – September 30, 2008; Fully Operational: October 1, 2008 – April 30, 2009) H.1 Contract Renewal

RFP OVERVIEW - SECTION G – CONTRACT ADMINISTRATION DATA

RFP OVERVIEW - SECTION H – SPECIAL CONTRACT REQUIREMENTS

Clause H.24 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 BUSINESS ASSOCIATE PROVISION II

SECURITY CLAUSE – BACKGROUND INVESTIGATIONS FOR CONTRACTOR PERSONNEL

RFP OVERVIEW - SECTION K –

REPRESENTATIONS, CERTIFICATIONS, AND

OTHER STATEMENTS OF OFFERORS OR QUOTERS

Registration Required (must to be awarded a contract):

Online Representations and Certifications Applications (ORCA): http://orca.bpn.gov

Central Contractor Registration (CCR): www.ccr.gov

Additional fill-in information required

RFP OVERVIEW – SECTION C

STATEMENT OF WORK

Kim Downin, Technical Advisor, Division of Benefit Integrity Management Operations

ZPIC USOW

Seven zones were created for the ZPICs based on the newly established MAC jurisdictions.

Oklahoma Texas

Zone 5 includes the following states:

North Carolina

Zone 7 includes the following:

The purpose of the USOW is twofold:

Decrease the submission of abusive and fraudulent Medicare and Medicaid claims.

Recommend appropriate administrative action to CMS as necessary IAW Medicare and Medicaid laws and regulations.

2) Establishes the fundamental activities that may be awarded by individual Task Orders under the ZPIC umbrella SOW.

Program Integrity Manual (PIM):

USOW Chapter 2: ZPICs perform BI work IAW the PIM for Medicare Parts A, B, DME, HH +H, and Medi-Medi PIM Chapter 2 – Data Analysis PIM Chapter 3 – Overpayments, Suspensions of Payment, Consent Settlements, Statistical Sampling for Overpayment Estimation

PIM Chapter 4 – All other BI requirements (e.g., referrals to LE, MR for BI, administrative actions, IRP, Fraud Alerts, designation of high risk areas, and JOAs)

Susan Oken, Project Officer, Program Safeguard Contractor Program

ZPIC Task Order Statements of Work Susan Oken Project Officer

ZPIC Task Order Statements of Work (SOWs) Zone 4

High Fraud Area in Zone 4

Task Order SOW Zone 5

Alabama Arkansas Georgia Louisiana Mississippi North Carolina South Carolina Tennessee Virginia West Virginia

Task Order SOW Zone 5 (continued) This zone will focus more on law enforcement referrals than the other two zones in Cycle 1.

Task Order SOW Zone 7

High Fraud Area in Zone 7

Randy Beardsley, Deputy Director, Division of Benefit Integrity Management Operations

Stephanie Blades-Kaisler, Deputy Director, Division of MMA Integrity

Part A&B vs Part C&D Program Structure Variable On December 8, 2003, Congress enacted the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108–173). Title I of the MMA amended the Act to establish a new voluntary prescription drug benefit program, Medicare Part D, with services beginning January 1, 2006.

Unlike Parts A and B of the Medicare program where Medicare acts as the payer and insurer and generally pays for items and services on a fee-for-service basis, the prescription drug benefit as well as the Medicare Advantage (Part C) program, are based on a private market model. Under this model, CMS contracts with private entities—prescription drug plans (PDPs), Medicare Advantage (MA) plans, as well as other types of Medicare health plans—who then act as the payers and insurers for prescription drug and health care benefits.

I. Account Management (DDBP & RO)

II. Data Analysis and Performance Metrics

(MAG, DFO, DCEP, & DPAP)

Data sources include:

Data analyses:

Auditing

CMS Part C & D Oversight Strategy V. Program Integrity (PIG/DMMAI) and their Zone Program Integrity Contractors (ZPICs) Responsible for all aspects of fraud, abuse, and waste associated with the Parts C & D program Refer fraud & abuse to Law Enforcement

IV. Compliance (POAG/DHPA)

with compliance/enforcement actions III. Audits Regularly Scheduled Audits

(OFM ZPIC contractors)

Targeted Audits (RO & CO)

Program Integrity Compliance & Enforcement Contractor Management

ZPIC Section C – Chapter 3 and Appendix M Part C and Part D

SCOPE OF WORK

CMS has developed an umbrella statement of work to compete and select the ZPICs. As previously discussed, the USOW outlines requirements pertaining to all Medicare Programs.

Chapter 3 and Appendix M:

Provide additional requirements and guidance to promote integrity of the Prescription drug benefit and the Medicare Advantage program (Part C) Establish additional fundamental activities that a ZPIC may be tasked to perform for Parts C and D

What are the ZPICs’ primary duties for Part C & D?

There are a variety of sources for these investigations, but the primary sources are the telephone hotline and the CTM Perform Benefit Integrity Audits of Part C & D Sponsors

Additional Fundamental Part C & D Activities

Part C & D Coordination and Education Requirements

Coordination, Education, and Outreach is a KEY component to our fraud, waste, and abuse prevention and detection efforts.

Other Part C & D Requirements ZPICs May be Tasked to Perform

RDS Sponsor Audits Audits of RDS payment data Audits of RDS actuarial equivalence attestations Monitor and Identify Potential Fraud and Abuse related to E-Prescribing

Disclaimer The information in this presentation is provided as a brief overview of additional fundamental Part C and Part D ZPIC requirements.

The material presented does not include all additional Part C and Part D requirements.

Please refer to Appendix M and the USOW in it’s entirety for all Part C and D requirements.

RFP OVERVIEW – SECTION L

PROPOSAL INSTRUCTIONS

Gina Romano Contract Specialist

RFP OVERVIEW – SECTION L (con’t) Offerors shall not make any assumptions that CMS evaluators have any prior knowledge of their capabilities in performing the SOW requirements.

Offerors proposing on the Zone single Indefinite Delivery Indefinite Quantity contract must also propose on the two respective task orders, 0001 and 0002.

General This RFP will result in the award of 3 stand-alone contracts.

Offerors may submit proposals for any or all Zones.

Separate proposals must be submitted for each Zone. (Separate and independent, full proposals)

Offerors are required to propose separate Key Personnel for each Zone. (Give example – because of awarding more than one zone)

PROPOSAL ORGANIZATION – divided into L.I (IDIQ), L.II (TO 1) and L.III (TO 2)

IDIQ:

Offerors should organize their proposal IAW L.I.1 Proposal Instructions (IDIQ) as follows:

Volume I – Business Proposal Volume II – Limited Technical Proposal Volume III – Conflict of Interest and Compliance Program Task Orders:

Offerors should organize their proposal IAW L.II.2 and L.III.2, General Instructions as follows:

Volume I – Limited Technical Proposal Volume II – Business Proposal

PROPOSAL ORGANIZATION

Clearly label binders/boxes The original of volumes I, II, and III shall be marked “ORIGINAL.”

All copies shall be marked “COPY # __ of __.”

If multiple binders are required for a volume, mark the binders as “Volume I, Business Proposal, Book 1 of 2.”

See additional requirements under L.I.1, L.II.2 and L.III.2

BUSINESS PROPOSAL (IDIQ)

IDIQ

IDIQ: Part C and D Task Orders: as prescribed

BUSINESS PROPOSAL (IDIQ)

SMALL BUSINESS SUBCONTRACTING PLAN

BUSINESS PROPOSAL (Task Order)

Task Order

Technical Proposal

Limited Written (IDIQ and Task Order)

Technical Proposal (IDIQ)

PAST PERFORMANCE

Past Performance – Will be based on the references supplied by the Offeror for the past two (2) years, the National Institutes of Health Database (if applicable) and information obtained through the submission of the past performance questionnaires (Attachment J.9).

Small Business Utilization (only applicable to Large Businesses, should not to be submitted for those qualified as Small Businesses under NAICS code 541990) (Section L.I.3.1.E provides further instructions and requirements)

Technical Proposal (IDIQ)

Oral Conducted for each Zone Offerors will be allowed four (4) hours for their oral presentation.

Offeror must separately address the IDIQ, Task Order 0001 and 0002 within the four (4) hour time allotted (Offerors can decide how much time will be spent for each area) See also L.I.3.2, Oral Technical Proposal

Technical Proposal (Task Orders)

Technical Proposal Assumptions - Offerors shall provide technical proposal assumptions in detail that are used in preparing their technical proposal submission

RFP OVERVIEW – SECTION M

Theresa Schultz Contracting Officer

RFP OVERVIEW – SECTION M (Con’t)

SECTION M ORGANIZATION

SECTION M.I Evaluation Criteria for IDIQ award

SECTION M.II Evaluation Criteria for Task Order 0001

Section M.III Evaluation Criteria for Task Order 0002

TECHNICAL EVALUATION CRITERIA

Each technical proposal and oral presentation shall be evaluated qualitatively and assessed a numeric point score as follows:

TECHNICAL EVALUATION FACTORS AND

SUBFACTORS FOR IDIQ AWARD (SECTION M.I)

1. Technical Understanding & Approach (including Management Approach) Potential Fraud Investigations Case Referrals to Law Enforcement Administrative Actions/Intermediate Sanctions Law Enforcement Requests Data Analysis Medical Review for Benefit Integrity High Risk Areas Risk Analysis and Mitigation Plan(s) Audits (Medicare Parts C & D only) Public Relations/Outreach/Education (Medicare Parts C & D)

SUBFACTORS FOR IDIQ AWARD (SECTION M.I)

2. Coordination and Communication with Task Orders within the ZPIC with other ZPICs with other stakeholders/partners (LE, states, etc)

3. Key Personnel and Staffing Plans

4. Security (IT and Physical Security)

5. ISO/Quality Assurance

6. Past Performance

7. Corporate Experience

8. Small Business Utilization

9. Subcontracting Approach

SUBFACTORS FOR TASK ORDER 0001 (SECTION M.II)

1. Technical Understanding & Approach (including Management Approach) Technical Approach to Medicare Parts A, B, DME and HH+H Investigations of Potential Fraud Case Referrals to Law Enforcement Administrative Actions Law Enforcement Requests Data Analysis Medical Review for Benefit Integrity High Risk Areas Risk Analysis and Mitigation Plan(s)

SUBFACTORS FOR TASK ORDER 0001 (SECTION M.II)

2. Coordination and Communication with Task Orders within the ZPIC with other stakeholders/partners (LE, states, etc)

3. Key Personnel and Staffing Plans

4. Security (IT and Physical Security)

5. Quality Assurance

6. Small Business Utilization

7. Subcontracting Approach

SUBFACTORS FOR TASK ORDER 0002 (SECTION M.III)

1. Technical Understanding & Approach (including Management Approach) Technical Understanding Potential Fraud Investigations Case Referrals to Law Enforcement Administrative Actions/Intermediate Sanctions Law Enforcement Requests Data Analysis Medical Review for Benefit Integrity Risk Analysis and Mitigation Plan(s)

SUBFACTORS FOR TASK ORDER 0002 AWARD (SECTION M.III)

2. Coordination and Communication with Task Orders within the ZPIC with other ZPICs with other stakeholders/partners (LE, states, etc)

3. Key Personnel and Staffing Plans

4. Security (IT and Physical Security)

5. Quality Assurance

6. Small Business Utilization

7. Subcontracting Approach

RFP OVERVIEW – SECTION M (con’t)

COMPETITIVE RANGE

Evaluation of technical proposals (both written and oral).

Evaluation of Business Proposal.

Preliminary responsibility determination.

PROPOSAL EVALUATION

Technical Proposal Evaluation

TEP will evaluate and assign a numeric score in accordance with section M.I, M.II and M.III.

Business Proposal Evaluation

Analyzed and evaluated by a Business Evaluation Panel (not assigned a numeric score)

Conflict of Interest and Compliance Program Proposal

Will be evaluated by a CMS COI designee and/or CMS Compliance Officer (not assigned a numeric score)

CONTRACT AWARD

CONCLUSION

CONCLUSION (cont’d)