J.3.B__Zone4Medi-MediZPICAwardFeePlan.doc

DRAFT

MEDICARE INTEGRITY PROGRAM (MIP)

ZONE PROGRAM INTEGRITY CONTRACTOR (ZPIC)

MEDI-MEDI TASK ORDER

AWARD FEE PLAN

I. Overview and Award Fee Performance Evaluation Periods

This document provides the Award Fee Evaluation Plan for contract number ___________, task order ________. Evaluation criteria contained in this plan will be used to determine the amount of Award Fee that will be earned by the contractor.

Prerequisite for Eligibility for Award Fee: In order to participate in the Award Fee program described in this plan, the contractor must obtain at least a minimum score of “3” or “Good” in each of the four (4) individual perspectives (Quality, Timeliness, Cost Control and Business Relations) for the most recent National Institutes of Health (NIH) Contractor Performance System (CPS) evaluation completed.

Annual Award Fee Evaluation Periods: The annual Award Fee Evaluation Period will correspond with the task order period of performance.

II. Organizational Structure for Award Fee Administration

The following organizational structure is established for both CMS and the Contractor for administering the Award Fee provisions of the contract:

A. Fee Determination Official (FDO): The FDO is the Director, OFM, Program Integrity Group, or, should the program be moved to a different CMS component, the current Director for the Zone Program Integrity Contractor (ZPIC) program. The FDO shall review the recommendation of the Performance Evaluation Panel (PEP) and make a final determination of Award Fee earned and payable to the Contractor for each evaluation period. The FDO may determine a different Award Fee than the PEP recommendation. However, such determinations shall be substantiated by written documentation. The FDO determination shall be made within 45 calendar days following an Award Fee Evaluation Period. The final determination will be forwarded to the Contracting Officer for contractor notification.

B. Performance Evaluation Panel (PEP): The PEP is a panel comprised of the ZPIC Project Officer, Government Task Leader (GTL), Contracting Officer (CO), Contract Specialist and other Government officials as necessary. The responsibilities of the PEP are as follows:

· Monitor the Contractor’s performance during the Award Fee Evaluation Period;

· Perform an in-depth review of the Contractor’s performance at the end of each Award Fee Evaluation Period.

· Prepare an Award Fee Recommendation Report to be submitted to the FDO no later than 30 calendar days after the close of each evaluation period. The report shall include, at a minimum,

· A contractor performance analysis against the evaluation criteria identified herein;

· Recommendation for an Award Fee amount to be earned by the Contractor; and,

· Signatures of all PEP members.

C. Contractor: The Contractor may submit an Award Fee performance evaluation self-assessment (Umbrella SOW Appendix A, Deliverable 27) to the PEP within 15 calendar days following the completion of each Award Fee evaluation period. The self-assessment shall provide substantiating documentation and analysis for each evaluation criteria and shall assess the contractor’s performance against the provided evaluation criteria. The contractor may submit a voucher for the final Award Fee as determined by the FDO at any time after written CO notification.

D. Contracting Officer Notification: The Contracting Officer shall provide the Contractor with written notification of the final Award Fee earned within 50 calendar days of the end of each performance evaluation period.

III. Summary of Tasks & Timeframes:

IV. Award Fee Criteria and Award Fee Pool Distribution

A. Award Fee Criteria: The Contractor shall be evaluated using two evaluation criteria as follows:

Evaluation Criterion 1: Quality of Service 60% of the total available award fee pool is dedicated to Evaluation Criterion 1. Award Fee will be earned if the ZPIC receives a score of 4 (Excellent) or 5 (Outstanding) in the individual Quality of Service key element(s) listed in the table below from the most recent National Institutes of Health (NIH) Contractor Performance System (CPS) evaluation completed during the evaluation period. The ZPIC annual performance evaluation for Quality of Service is measured as shown below:

CMS will use, at a minimum, the following Control Objectives and Key Elements in the review of the ZPIC’s performance within the Quality of Service perspective. A numerical score will be determined for each key element using the following score key:

Scoring Key

0 – Unsatisfactory

1 – Poor

2 – Fair

3 – Good

4 – Excellent

5 – Outstanding

The goal of the award fee is to determine award fee dollars earned for excellence in performance. Therefore, award fees will be earned for those key elements where the score is greater than 3 (Good).

During the first contract year, the award fee will be earned based upon the score in Quality of Deliverables Key Element. In years thereafter, the award fee shall be earned based upon all Key Elements in the Quality of Service perspective. Key Elements to be evaluation for year 2 and beyond will be incorporated into the Award Fee Plan prior to the contract renewal.

Control Objective

Quality of Deliverables

The quality of the ZPIC deliverables is acceptable The ZPIC is considered meeting the requirements (3-Good) if there are no, or very minimal, quality problems in meeting the objectives.

a) submits all deliverables in accordance with the SOW requirements; and the deliverables are accurate, accepted the first time by the GTL, and CMS comments are incorporated into the deliverables, when necessary.

Self Assessment & Evaluation Methodology for Criterion 1:

Self Assessment: The contractor may submit a self assessment for evaluation criterion 1 within 15 calendar days following the completion of each Award Fee evaluation period. The self assessment shall provide CMS with the ZPIC’s assessment of performance achieved for each key element as finalized in the most recent NIH CPS evaluation.

Award fee earned for evaluation criterion 1 is as follows:

PEP Evaluation Considerations: The PEP shall utilize a wide array of resources when reviewing ZPIC performance for Award Fee determination purposes. These resources include, but are not limited to:

1. A complete review of Quality of Service from the most recent annual NIH Performance Evaluation to determine the amount of award fee earned for each key element.

2. Obtaining Government Task Leader (GTL) and Subject Matter Expert (SME) input.

3. A review of the ZPIC’s Self Assessment if applicable.

Evaluation Criterion 2: Business Relations 40% of the total available award fee pool is dedicated to Evaluation Criterion 2. Award Fee will be earned if the ZPIC receives a score of 4 (Excellent) or 5 (Outstanding) in the individual Business Relations key element(s) listed in the table below from the most recent National Institutes of Health (NIH) Contractor Performance System (CPS) evaluation completed during the evaluation period. The ZPIC annual performance evaluation for Business Relations is measured as shown below:

CMS will use, at a minimum, the following Control Objectives and Key Elements in the review of the ZPIC’s performance within the Business Relations perspective. A numerical score will be determined for each key element using the following score key:

Scoring Key

0 – Unsatisfactory

1 – Poor

2 – Fair

3 – Good

4 – Excellent

5 – Outstanding

The goal of the award fee is to determine award fee dollars earned for excellence in performance. Therefore, award fees will be earned for those key elements where the score is greater than 3 (Good).

Control Objective

The ZPIC is considered meeting the requirements (Good-3) if responses to inquiries and/or technical, service, administrative issues are consistently effective.

Steering Committee Meetings: The ZPIC facilitates and provides full administrative support, including provision and arrangement in coordination with the state of meeting space, and preparation and distribution of meeting minutes for the Medi-Medi Steering Committee which should meet not less frequently than quarterly.

Other Communication Mechanisms: The ZPIC has established regular means of communication with the state to avoid duplication of effort, share vulnerabilities, and serve as a forum to work collaboratively on Medi-Medi cases and leads.

25%

Medi-Medi JOA The ZPIC is considered meeting the requirements (Good-3) if responses to inquiries and/or technical, service, administrative issues are consistently effective.

A Medi-Medi JOA is developed by the ZPIC and the state and delineates the roles and responsibilities for each entity specific to a task order. The Medi-Medi JOA, at a minimum, shall include information as required by the Medi-Medi Task Order SOW.

25%

The ZPIC is considered meeting the requirements (Good-3) if responses to inquiries and/or technical, service, administrative issues are consistently effective.

- The ZPIC provides the OIG with access, as needed, to its files, records, and data in accordance with the MOU among the DOJ, OIG, and CMS.

- The ZPIC meets quarterly, or more frequently if necessary, with OIG to discuss all pending and potential cases.

- The ZPIC meets (in-person or telephone) when needed with DOJ to enhance coordination with them on current or pending cases.

25%

The ZPIC is considered meeting the requirements (Good-3) if responses to inquiries and/or technical, service, administrative issues are consistently effective.

- The ZPIC is accessible to the GTL and SMEs, as applicable.

- The ZPIC responds promptly and completely to CMS requests for information/action.

- The ZPIC keeps CMS informed about issues requiring CMS oversight or intervention.

25%

100%

Self Assessment & Evaluation Methodology for Criterion 2:

Self Assessment: The contractor is not required to submit a self assessment for evaluation criterion 2.

Award fee earned for evaluation criterion 2 is as follows:

PEP Evaluation Considerations: The PEP shall utilize a wide array of resources when reviewing ZPIC performance for Award Fee determination purposes. These resources include, but are not limited to:

1. A complete review of the Quality measure on the most recent Annual NIH Performance Evaluation is required in order to allocate points to the above categories.

4. Obtaining Government Task Leader (GTL) and Subject Matter Expert (SME) input.

5. A review of the ZPIC’s Self Assessment of Evaluation Criterion 2 if applicable.

B. Award Fee Pool and Distribution:

1. Award Fee Pool: The total amount of Award Fee available is as follows:

2. Distribution of Award Fee Pool: The Award Fee pool is distributed among the two criteria in the following way:

60%

Example of Award Fee Determination

Total Award Fee Pool is $100,000 allocated as follows:

60% or $60,000 – Evaluation Criterion 1

40% or $40,000 – Evaluation Criterion 2

Step 1: Determine Eligibility:

The ZPIC has achieved at least a minimum score of “3” or “Good” in each of the four (4) individual perspectives (Quality, Timeliness, Cost Control and Business Relations) for the most recent National Institutes of Health (NIH) Contractor Performance System (CPS) evaluation completed during the evaluation period. The ZPIC is, therefore, determined eligible to participate in the award fee program.

Step 2: Determine Award Fee Earned for each criterion:

Evaluation Criterion 1 – The ZPIC received the following scores under each key element within Quality of Service in the most recent NIH/CPS evaluation completed during the evaluation period:

Scoring Key

0 – Unsatisfactory, 1 – Poor, 2 – Fair, 3 – Good, 4 – Excellent, 5 – Outstanding

TOTAL

$60,000

$54,000

Evaluation Criterion 2 – The ZPIC received the following scores under each key element within Business Relations in the most recent NIH/CPS evaluation completed during the evaluation period:

Scoring Key

0 – Unsatisfactory, 1 – Poor, 2 – Fair, 3 – Good, 4 – Excellent, 5 – Outstanding

TOTAL

$40,000

$29,000

Attachment J.3.B

Zone 4 Medi-Medi Task Order 0002 Award Fee Plan