J.7__ZPIC_Zone7_Medi-MediRFPTO0002.doc

RFP-CMS-2007-0027 Attachment J.7 Zone 7 Medi-Medi Task Order 0002 RFP

ZONE 7

TASK ORDER 0002

MEDICARE-MEDICAID DATA MATCHING PROGRAM (MEDI-MEDI)

ATTACHMENT J.7

Zone 7 Medicare-Medicaid Data Match Program (Medi-Medi) Task Order 0002 NOTE: Only those contract sections, which differ from the Umbrella IDIQ contract terms and conditions, or provide more detailed information specific to this particular Task Order, are provided below. For those contract sections not identified below, all terms and conditions of the Umbrella IDIQ contract remain in effect.

Signature of the Contractor below represents acceptance of this task order award.

Signature of Contractor Representative

Title

Date

SECTION B - SUPPLIES OR SERVICES PRICES/COSTS

B.1

DESCRIPTION OF SERVICES

The Contractor shall support the CMS’ audit, oversight and fraud, waste and abuse detection, deterrence and prevention activities for Medicare and Medicaid claims in Zone 7: Florida.

B.3

DETERMINATION OF ORDER TYPE/PRICES/COSTS

This is a Cost Plus Award Fee (CPAF) task order. The total estimated cost of this task order is __TBD____. The total base fee is ___TBD_____. The total award fee is _TBD__. The total estimated CPAF is ___TBD____.

GRAND TOTAL

* CLIN 0001 includes a transition or implementation phase from 05/01/08-09/30/08

SECTION F - DELIVERIES OR PERFORMANCE

F.2 PERIOD OF PERFORMANCE

The period of performance for this task order is May 15, 2008 through April 30, 2009 which includes a transition or implementation period from May 15, 2008 through September 30, 2008, plus four (4) one (1) year options. The contract may be renewed thereafter in accordance with contract section H.1, Contract Renewal.

SECTION G - CONTRACT ADMINISTRATION DATA

G.5

PROJECT OFFICER/GOVERNMENT TASK LEADER

b.

GOVERNMENT TASK LEADER (GTL)

The Government Task Leader (GTL) for this effort is ____TBD__ The Associate Government Task Leader for this effort is ___TBD___ G.9

HHSAR 352.270-5 KEY PERSONNEL

The key personnel required for this task order are:

Task Order Program Director - The Task Order Program Director is required to be full time and on-site.

Benefit Integrity (BI) Manager – The BI Manager is not required to be full-time.

Chief Legal Counsel - Chief Legal Counsel is not required to be full time.

Medical Review (MR) for BI Manager – The MR for BI manager is not required to be full time.

Medical Director – The Medical Director is not required to be full time.

Chief Statistician – The Chief Statistician is required to be full time but not on-site.

G.13

SUBCONTRACTING PROGRAM FOR SMALL AND DISADVANTAGED BUSINESSES

c.

Consent to Subcontract is hereby granted for the following entities:

(To Be Determined at Time of Award, if applicable)

SECTION H - SPECIAL CONTRACT REQUIREMENTS

H.2

CONFLICT OF INTEREST

The Conflict of Interest Certificate submitted for the IDIQ award dated __________ is hereby incorporated by reference.

H.19

WAGE DETERMINATION

Wage Determination will be incorporated at time of task order award.

SECTION L.III PROPOSAL INSTRUCTIONS:

L.III.1

PROCUREMENT TIMELINE

Request for Proposal (RFP) Released:

October 10, 2007

Pre-Proposal Conference:

October 17, 2007

Questions Due:

October 24, 2007 (5:00 pm Eastern Time)

Answers Issued:

November 2, 2007 (estimated)

Notice of Intent to Submit Proposals:

December 4, 2008 (1:00 pm Eastern Time) Technical & Business Proposals

(Written) Due:

December 18, 2008 (12:00 pm Eastern Time)

Oral Presentations Begin (Zone 7):

January 9, 2008 (estimated) Oral Presentations End (Zone 7):

January 17, 2008 (estimated) Award of Zone 7 IDIQ Contract and task orders:

May 15, 2008(estimated)

L.III.2

GENERAL INSTRUCTIONS

The following establishes the acceptable minimum requirements for the format and content of proposals.

A. Award Description: CMS intends to award a Cost Plus Award Fee ZPIC Task Order for this effort. However, the Contracting Officer retains the right to award any other type of task order.

B. When/Where/How Many Proposals to Submit:

The Offeror shall submit a limited written technical and a business proposal in two (2) separate three-ring locking binder. The limited written technical proposal shall be labeled “Zone 7 Task Order 0002 Volume I” and the business proposal shall be labeled “Zone 7 Task Order 0002 Volume II.” One (1) original copy of each proposal shall be signed by an official authorized to bind your organization, plus ten (10) copies and one (1) CD of each proposal, shall be received by Gina Romano, Contract Specialist, no later than 12:00pm on December 18, 2007 in accordance with the submission of the ZPIC IDIQ, RFP-CMS-2007-0027. You will be advised of your oral technical proposal presentation date and time upon notification of your intent to submit a proposal to RFP-CMS-2007-0027. Oral presentation slides/handouts, if applicable, shall be presented at the time of oral presentation. (NOTE: Proposals are to be submitted in three ring locking binders separate from the IDIQ binder and separate from the Task Order 0001 binder. Binders shall be 10.25 inches by 11.5 inches maximum height and length (There is no limitation on depth).

Proposals shall be delivered to the following address—one (1) original, plus ten (10) copies, and one (1) CD of the limited written technical proposal, Volume I, and the business proposal, Volume II-:

Centers for Medicare & Medicaid Services

Office of Acquisition and Grants Management

Division of Medicare Support Contracts ATTN: Gina Romano, Contract Specialist

7500 Security Boulevard, Mail Stop C2-21-15

Baltimore, Maryland 21244-1850

Phone: 410-786-8645

E-mail: Gina.Romano@cms.hhs.gov

The Centers for Medicare & Medicaid Services (CMS) is located in a secure building. Therefore, when hand-delivering proposals in response to CMS solicitations, Contractors should allow for ample time to obtain parking and building passes from the Security Guards.

In addition, Contractors are advised that the CMS mailroom only accepts mail from the U.S. Postal Service. When utilizing overnight mail carriers you are cautioned that you must allow ample time for the proposal to be delivered to the Contract Specialist by the overnight carrier by the times specified in this RFP since they are not accepted in the CMS mailroom.

C. Late Proposals: Proposals received after the date(s) and time(s) specified above will not be accepted. For this provision, a proposal includes all proposal submissions from the ZPIC and its subcontractors (i.e., hard copies and electronic copies/submissions) to all recipients identified in L.III.2.B. above. If any portion of the proposal is not received by the above specified date and time(s), you will be contacted and advised that the proposal is being rejected.

D. Intent to Submit a Proposal: The Offeror’s intent to submit a proposal on the ZPIC IDIQ, RFP-CMS-2007-0027, for the Zone constitutes the intent to submit a proposal on this task order.

E. RFP Questions and Answers: Questions shall be submitted in accordance with the ZPIC IDIQ, RFP-CMS-2007-0027, Section L.I.1.B Offerors must distinguish questions regarding this task order from all other questions.

F. Award of a Task Order: CMS will evaluate proposals in accordance with Section M.III of this task order solicitation. Award of a task order is anticipated no later than May 15, 2008.

G. Costs for Proposal Submission: This solicitation does not commit the Government to pay any cost for the preparation and submission of a proposal. In addition, the Contracting Officer is the only individual who can legally commit the Government to the expenditure of public funds in connection with the proposed acquisition.

L.III.3 TECHNICAL PROPOSAL ORGANIZATION

The task order technical proposal shall consist of two parts: 1) a limited written technical proposal and 2) an oral technical proposal presentation. See the TO-SOW for workload assumptions.

Part I – Limited Written Technical Proposal Organization: The limited written technical proposal shall include ONLY the following information:

The Written Technical Proposal shall be organized as follows:

TAB 1

Table of Contents TAB 2 Technical Proposal Assumptions

TAB 3

Resumes/Letters of Commitment

TAB 4

ZPIC Organizational Chart (for the task order)

TAB 5

Work Breakdown Structure

TAB 6

Staffing Plan

L.III.4 TECHNICAL PROPOSAL INSTRUCTIONS

Part I – Limited Written Technical Proposal (Volume I)

The number of pages for the limited written technical proposal is specified for each element. A limited written technical proposal shall be submitted as follows:

Table of Contents (page limit: unlimited) Offerors shall include a Table of Contents that identifies and clearly labels the various technical proposal narrative sections.

TAB 2

Technical Proposal Assumptions (page limit: 5 pages)

Offerors shall provide technical proposal assumptions in detail that are used in preparing their technical proposal submission.

TAB 3 Resumes/Letters of Commitment The Offeror shall provide a resume for each key personnel and a standard letter of commitment for each key personnel not currently employed by the Contractor. Letters of commitment shall include the date of availability, the salary accepted, how long the individual's commitment is binding, and be signed by the individual and the Contractor’ corporate authorized official. Resumes shall not exceed 3 pages and letters of commitment shall not exceed 2 pages.

TAB 4 ZPIC Organization Chart (page limit: unlimited) The Offeror shall provide an organization chart sufficient to provide an understanding of the roles and responsibilities or placement of proposed personnel for the task order. The Offeror shall identify if the personnel is with the prime contractor or subcontractor. If the personnel are with the subcontractor, the Offeror shall identify the subcontractor’s company name.

TAB 5 Work Breakdown Structure (page limit: unlimited) The Offeror shall provide a Work Breakdown Structure (WBS) that addresses all related tasks required in this task order. The WBS is for aiding in evaluating the Offeror's knowledge and understanding of the SOW requirements and the effort involved in incorporating the additional workloads. The WBS shall be in Microsoft Project, Excel 5.0 or an equivalent software application.

TAB 6

Staffing Plan (page limit: 5 pages) The Offeror shall provide its key personnel/staffing plan to perform the TO SOW requirements to include its plan to obtain, hire and maintain staff.

Part II – Oral Technical Proposal Presentation

The contractor’s oral presentation for the task order will be combined with the IDIQ oral presentation. Refer to the ZPIC IDIQ, RFP-CMS-2007-0027, Section L.I.3.2, Oral Technical Proposal Presentation Instructions. See also, Section M.III of this solicitation.

L.III.5 BUSINESS PROPOSAL ORGANIZATION

The contractor shall submit, at a minimum, a business proposal supported by cost and pricing data adequate to establish the reasonableness of the total proposed (This pricing method is mandatory and allows for more effective analysis of contract costs among ZPICs).

The standard ZPIC business proposal spreadsheet(s), RFP-CMS-2007-0027 Exhibit E.3.C, shall be used for task order pricing. The line items on the spreadsheets may be modified to fit your company specifics. However, we ask that you do not change the columns and report costs in accordance with each column as identified. Please make sure that the spreadsheet headers identify the Zone, Offeror name, task order number, CLIN and year of the task order as stated above.

Workload Assumptions and Constraints for Proposal Submission: The following workload assumptions are based on the SOW requirements and illustrate what is to be assumed for proposal submission.

· Assume the task order award dates listed in Section B of this RFP in conjunction with the TO-SOW assumptions. A five (5) month transition or implementation period should be assumed for the initial transition or implementation of a state.

· Workload assumptions are found in the TO-SOW.

· Costs associated with matching Part C and Part D data with Medicaid data shall not be included in the Offeror’s proposal.

A written business proposal, Volume II, is required for this task order. The number of pages for the business proposal is unlimited.

The business proposal shall be comprised of the Business Proposal Spreadsheets and the Business Proposal Narratives as follows:

A. Business Proposal Spreadsheets

This section shall contain only the business proposal spreadsheets (Exhibit E.3.C).

B. Business Proposal Narrative Organization

The Business Proposal Narratives shall be organized as follows:

Table of Contents

TAB 2

Proposal Checklist

TAB 3

Business Proposal Assumptions

TAB 4

Subcontracts

TAB 5

Equipment and Property (if applicable)

TAB 6

Contract Forms, Representations and Certifications

TAB 7

Service Contract Act

TAB 8

Umbrella Contract Section H.2 - Conflict of Interest

L.III.6 BUSINESS PROPOSAL INSTRUCTIONS (unlimited pages)

The Offeror’s business proposal must stipulate that it is predicated upon all the terms and conditions of this solicitation. In addition, it must contain a statement to the effect that it is firm for a period of at least 240 days from the date specified for receipt of offers by the Government.

Proposal submission of other than cost or pricing data is required to be in the format prescribed in the business proposal spreadsheet – Exhibit E.1. In addition, FAR 15.408, Table 15-2 provides instructions on preparing a proposal and the supporting documentation required. For assistance in proposal preparation, see publication DCAAP 7641.90 dated January 2004 entitled “Information for Contractors” published by the Defense Contract Audit Agency. The full text of this publication is available on the Internet at http://www.dcaa.mil.

Business proposals will be submitted following the instructions included in Table 15-2 at FAR 15.408, the CLIN structure provided with the solicitation, and in accordance with the statement of work (SOW).

The business proposal is presumed to represent an Offeror’s best effort to respond to the solicitation. Any inconsistency, whether real or apparent, between promised performance and price should be explained in the proposal. Any significant inconsistency, if not explained, raises a fundamental issue of the understanding of the nature and scope of the work required and of the Offeror’s financial ability to perform the contract and may be grounds for rejection of the offer. The burden of proof for cost credibility is with the Offeror.

Prospective Offerors, at a minimum, must submit a business proposal supported by information other than cost and pricing data (See FAR 15.4) adequate to establish the reasonableness and realism of the proposed business proposal.

Facilities Capital Cost of Money: Pursuant to HHSAR 315.404-4, when facilities capital cost of money (cost of capital committed to facilities) is included as an item of cost, a reduction in the profit objective shall be made in an amount equal to the amount of facilities capital cost of money proposed/claimed. This effectively makes the inclusion of cost of money in a proposal as an element of cost irrelevant.

A. Business Proposal Spreadsheet Instructions

The Offeror shall use the business proposal spreadsheet (see Exhibit E.3.C) provided. The business proposal spreadsheet indicates the levels of proposed costs that are to be provided to the extent that an Offeror’s accounting system is able to capture cost data for that particular section.

The Offeror shall use the business proposal spreadsheet (including all tabs in the spreadsheet) for all pricing and include the following:

· Labor for Prime and Subcontractors: Offerors shall provide labor rates for all labor categories that are expected to be used in the performance of the ZPIC task order. For each labor category please show the “number of labor hours times hourly labor rate equals resultant total dollar amount” by year. Subcontract direct labor shall be shown in the same manner, however, under the subcontract line item. Such labor rates shall be projected for the base year and all option years. Please also note that there is a column for Full Time Equivalent (FTE) levels. This is to help CMS understand the total number of FTES when multiple staff is accommodated in one line item. Please also provide the productive labor hours for exempt and non-exempt employees.

· Travel - All travel costs proposed shall be reimbursed on a cost reimbursement basis in accordance with the Federal Travel Regulation (FTR). The Contractor shall consolidate travel costs into one line item. However, a separate schedule (tab within Exhibit E.1) shall be provided for travel cost breakdown of proposed travel expenses consisting of the following: “From” and “To” cities, number, types and purpose of trips, number of travelers, duration of trip for each destination, mileage, per diem, air fare, and miscellaneous expenses.

· Other Direct Costs (ODCs): These include materials, equipment, etc. The Offeror shall consolidate ODCs into one line item. However, a separate schedule (tab within Exhibit E.3.C) shall be provided to breakdown ODCs. The separate schedule shall provide a detailed itemization of each ODC.

· Subcontracts: The Offeror shall consolidate subcontractor costs per subcontractor on the business proposal spreadsheet. However, all proposed subcontractors shall submit a separate and complete business proposal spreadsheet in the same format as the Offeror’s business proposal spreadsheet. Subcontractors may submit their business proposal spreadsheet showing the breakdown of costs to CMS in a separately sealed package.

· Indirect Rates: The Offeror shall provide the indirect rates as applicable along with the relative percentages on the business proposal spreadsheet.

· Fee: The Offeror shall provide each fee separately along with the relative percentages on the business proposal spreadsheet.

· Summary Rollup Of All Costs: In addition to the individual contract line item summaries the Offeror shall include a summary sheet inclusive of all costs (tab within Exhibit E.3.C).

B. Business Proposal Narrative Instructions

The business proposal narratives shall include the following:

TAB 1: Table of Contents

Offerors shall include a Table of Contents that identifies and clearly labels the various business proposal narrative sections.

TAB 2: Proposal Checklist Offerors shall complete the business proposal checklist provided at Exhibit E.1 of RFP-CMS-2007-0027.

TAB 3: Business Proposal Assumptions Offerors shall provide all proposal assumptions in detail that are used in preparing their business proposal spreadsheet submission. Assumptions should include rationale for all business proposal elements.

The business proposal narratives shall be used to support the business proposal spreadsheet and include, at a minimum, the following:

Labor:

· The Offeror’s proposed labor rates shall be supported with payroll information, letters of intent or salary survey information.

· If the labor rates are escalated, the Offeror shall provide rationale for the proposed escalation rate.

· The Offeror’s productive labor hours for exempt and non-exempt employees.

· The Offeror shall provide labor rationale by labor category and should describe how the basis of the hours was determined (e.g. historical data, technical experience, etc.):

Travel:

· The Offeror shall provide the basis of the estimate and detailed rationale for all travel.

· The Offeror shall submit a copy of their corporate travel policy.

· The Contractor shall provide a brief explanation of how travel costs are reimbursed to employees within its organization, i.e. per diem allowance versus submitting receipts, etc.

ODCs:

· The Offeror shall provide the basis of estimate and detailed rationale for each item of ODC.

Fee:

· The Offeror shall provide the basis of estimate and detailed rationale for each proposed fee. The Offeror shall also disclose if any fees are added to the subcontractors.

Indirect Rates (Overhead Rate, General & Administrative, Fringe, etc. as appropriate):

· The Contractor shall provide the indirect cost rate percentages used for the task order assumption.

TAB 4: Subcontracts

The Offeror’s business proposal narrative submission shall include the following subcontract information to be evaluated:

a. A copy of the subcontract agreement which includes, at a minimum:

(1) The supplies or services to be subcontracted with identification of associated SOW tasks;

(2) Identification of the type of subcontract to be used (e.g. Time and

Material, Firm Fixed Price);

(3) Proposed subcontract price; and,

(4) Flow down of appropriate FAR and prime contract clause from prime contractor.

b. Certificate of Current Cost or Pricing Data; as appropriate,

c. Subcontract Negotiation Memorandum reflecting:

(1) The principal elements of the subcontract price negotiations;

(2) The most significant considerations controlling establishment of initial or revised prices;

(3) The reason cost or pricing data were or were not required;

(4) The extent, if any, to which the Offeror relied on the subcontractor’s cost or pricing data in determining the price objective and in negotiating the final price;

(5) The extent to which it was recognized in the negotiation that the subcontractor’s cost and pricing data were not accurate, complete or current; the action taken by the Offeror and the subcontract; and the effect of any such defective data on the total price negotiated;

(6) The reasons for any significant difference between the Offeror’s price objective and the price negotiated; and,

(7) A complete explanation of the incentive fee or profit plan when incentives are used. The explanation shall identify each critical performance element, management decision used to quantify each incentive element, reasons for the incentives, and a summary of all trade-off possibilities considered.

d. Extent to which adequate price competition was obtained, or justification for its absence.

e. Statement as to whether the proposed subcontractor is on the List of Parties Excluded from Federal Procurement and Non-procurement Programs.

TAB 5: Equipment and Property

(a) Equipment to be purchased: If additional equipment must be acquired, you must include in your business proposal the description and estimated cost of each item and whether you propose to furnish the item with your own funds.

(b) Government Property:

i. It is the Department of Health and Human Services’ (HHS) policy that contractors provide all equipment and facilities necessary for performance of the contract; however, in some instances, an exception may be granted to furnish government owned property or to authorize a purchase with contract funds.

ii. You must identify all government-owned property in your possession and all property acquired from federal funds, to which you have title, which is proposed to be used in the performance of the prospective contract.

iii. The management and control of government property must be in accordance with HHS Publication OS-686 entitled, "Contractor's Guide to Control of Government Property (2007)," which can be accessed at http://www.knownet.hhs.gov/log/AgencyPolicy/HHSLogPolicy/contractorsguide.htm

TAB 6: Contract Forms, Representations and Certifications - Signed, dated, and fully executed package consisting of:

--SF-33, Solicitation, Offer and Award (Block 12: Please note that offers are valid for a period of no less than 240 days);

--RFP Section B;

--RFP Section G;

--RFP Section H;

TAB 7: Service Contract Act

Offerors should identify those proposed labor categories subject to the Service Contract Act of 1965, as Amended (FAR 22.10) and provide a crosswalk to the labor category in the applicable Wage Determination for their place of performance. Offerors may obtain Wage Determinations at www.servicecontract.fedworld.gov (click on “selecting SCA WDs” to obtain wage determination).

TAB 8: Umbrella Contract Section H.2 - Conflict of Interest

In order for a Contractor to be eligible for award of a Task Order, the Government must ensure that the Contractor is free, to the greatest extent possible, of all conflicts of interest for each Task Order. ZPICs could have organizational relationships that create potential conflicts of interest that may affect award of this task order.

In order to be considered for award of this Task Order, the Contractor is required to submit one of the following (Note: Failure to submit the required information will deem a Contractor’s proposal to be non-responsive to this RFP):

a. The disclosure of information contained in contract section H.2.d., Conflict of Interest Evaluation. Only information that has changed from that disclosed in the most recent revision shall be submitted.

OR

b. If no information has changed, a statement shall be included in the Task Order proposal that:

1) The Organizational Conflict of Interest Certificate of (DATE) is correct and accurate as of the date of the Task Order proposal; and,

2) The Contractor has reviewed the information in the (DATE) Organizational Conflict of Interest Certificate with respect to the work to be performed for this task order, and has determined that it has no actual, apparent or potential conflicts of interest exist for the specific work required by this Task Order.

SECTION M.III - EVALUATION FACTORS FOR TASK ORDER AWARD

M.III.1GENERAL PROCEDURES FOR AWARD OF TASK ORDER

Refer to Section M.I.1 of the ZPIC IDIQ, RFP-CMS-2007-0027

M.III.2

MEDICARE-MEDICAID DATA MATCHING PROJECT (MEDI-MEDI) TASK ORDER TECHNICAL EVALUATION CRITERIA The total points that can be earned for the Medi-Medi technical proposal are 1800.

1. Technical Understanding and Approach (including Management Approach) (900 Total Points) A. Technical Understanding (100 Points) - The Offeror shall will be evaluated on its technical understanding of the Medi-Medi program, Medicaid and fraud, waste, and abuse within the Zone. At a minimum, the Offeror should be able to demonstrate in its technical proposal, its technical understanding and approach (including management approach) to the areas listed below:

· the Medi-Medi vision and the ability to operationalize it.

· the fraud, waste, and abuse landscape within the Zone

· the structure of the Medicaid program and structure in the states within the Zone

· national and state-specific Medicaid issues

· the Medicaid Program Integrity structure and function in the states within the Zone

· WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people)

B. Potential Fraud Investigations (100 Total Points) - The Offeror shall be evaluated on its technical understanding and approach (including management approach) to Potential Fraud Investigations. At a minimum, the Offeror should be able to demonstrate in its technical proposal, the areas listed below:

· potential fraud investigations including joint investigations with Medicaid.

· Proactive measures that will be taken to detect, deter and prevent potential fraud in Medicare and Medicaid.

· Federal Investigative Database

· prioritization

· internal tracking system

· WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people)

C. Case Referrals to Law Enforcement (100 Total Points) - The Offeror shall be evaluated on its technical understanding and approach (including management approach) to Case Referrals to Law Enforcement. At a minimum, the Offeror should be able to demonstrate in its technical proposal, the areas listed below:

· preparation and documention of case referrals to Law Enforcement (LE)

· joint case referrals

· the role of the Medi-Medi Steering Committee in case referrals

· internal tracking system

· WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people)

D. Administrative Actions (100 Total Points) - The Offeror shall be evaluated on its technical understanding and approach (including management approach) to Administrative Actions. At a minimum, the Offeror should address the following areas in its presentation:

· Types and approach to Administrative Actions for Medi-Medi

· Medicaid administrative actions

· the process of identifying and recouping overpayments in Medicare and Medicaid

· internal tracking system

· WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people)

E. Law Enforcement Requests (50 Total Points) - The Offeror shall be evaluated on its technical understanding and approach (including management approach) to fulfilling Law Requests for Information from law enforcement, participating states, and other Medi-Medi sources. At a minimum, the Offeror should address the following areas in its presentation:

· fulfilling Medi-Medi requests including data analysis and medical review for benefit integrity

· HIPAA and the Privacy Act responsibilities

· WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people)

F. Data Analysis (300 Total Points) – The Offeror shall be evaluated on its technical understanding and approach (including management approach) to Data Analysis. At a minimum, the Offeror should address in its presentation the following areas:

· employment of data and statistical analysis software

· acceptance of large data extracts from CMS and single state agencies

· approach to data matching

· identification of data analysis projects which will yield results for Medicaid and Medicare

· proactive data analysis

· data analysis leads prioritized for potential fraud investigations and possible referral to LE

· complex data analysis

· data related deliverables

· WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people)

G. Medical Review for Benefit Integrity (50 Total Points) - The Offeror shall be evaluated on its technical understanding and approach (including management approach) to performing medical review in particular to Medi-Medi cases and investigations. At a minimum, the Offeror should address the following areas in its presentation.

· Performance of medical review for benefit integrity

· development and recommendation of edits, including follow-up

· Acquisition of medical records

· duplication of effort

· investigation and case selection

· support for MR determinations

· WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people)

H. Risk Analysis And Mitigation Plans (100 Total Points): The Offeror shall be evaluated on its technical understanding and approach (including management approach) to assuring that the transition of ZPIC work from the outgoing contracator is performed efficiently and effectively with minimal risk to benefit integrity work. The Offeror should demonstrate in its presentation each of the following:

· transition and implementation approach and plans

· Medi-Medi implementation process

· risks associated with implementing Medi-Medi programs

· appropriate communication between the outgoing contractor and the ZPIC

· education

· facility and infrastructure

· risks associated with transitioning and implementing multiple Medi-Medi Programs, task orders and/or Zones

· continuity of the potential fraud investigations and cases

· WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people)

2. Coordination and Communication (500 Total Points)

A. Coordination with Task Orders within the ZPIC (150 Total Points): The Offeror shall be evaluated on its understanding and approach to coordination with the task orders in the Zone:

· coordination with other task orders to provide interaction with Medi-Medi partners and avoid duplication of effort

· internal tracking system

· coordination with internal and external entities

· coordination internally to address potential areas of vulnerability and fraud, waste and abuse activities across the task orders

· WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people)

B. Coordination with Other ZPICs (50 Total Points): The Offeror shall be evaluated on its understanding and approach to coordination with other ZPICs with regard to Medi-Medi:

· coordination of Medi-Medi activities with other ZPICS

· addressing fraud, waste and abuse across Zones

· sharing of information with other ZPICs

· WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people) C. Coordination with CMS and Other Stakeholders/Partners (e.g., LE, State Agencies, MFCUs, MACs, ACs) (100 Total Points): The Offeror shall be evaluated on its understanding and approach to coordination with these entities and its approach to the JOA with the participating states:

· Medi-Medi is an equal partnership between Medicaid and Medicare

· coordinating and communicating with CMS

· Medi-Medi JOA

· the Medi-Medi Steering Committee

· regular and ad hoc interactions with participating states

· resource limitations participating states face or may face

· interaction with stakeholders/partners

· maintenance of a good working relationship with its Medi-Medi partners

· coordination with Medi-Medi stakeholders/partners

· communication of potential areas of vulnerability

· WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people) 3.

Key Personnel And Staffing Plan (200 Total Points) - The Offeror shall be evaluated on its plan to have key personnel that are qualified to perform this Task Order and are available to begin work immediately in order to meet aggressive timelines. The Offeror shall also be evaluated on its staffing plan for the hiring of essential personnel. At a minimum, the Offeror should address in its presentation the following areas:

· key personnel meet the qualifications in the USOW section 1.1.7-1.1.7.2.11

· organizational structure

· staffing plan and retention plan

· management plan and structure for the Medi-Medi

· training plan

· implementation and operational activities for each Medi-Medi state

· staffing that can be quickly accomplished and cause the least amount of disruption

· WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people) 4.

Security Plans (50Total Points) – The Offeror shall be evaluated on its plan for security – both IT and physical. At a minimum, the Offeror should address the following:

· Place of performance

· Facility plan including internal and external security, i.e. the facility floor plan, computer files)

· the subcontractor’s physical and IT security plan (if applicable)

· IT security plan

· WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people) 5.

Quality Assurance (100 Total Points) – The Offeror shall be evaluated on its plan to adequately address and implement a thorough quality assurance program which is oriented toward continuous quality improvement. At a minimum, the Offeror should address the following:

· continuous improvement program

· components of operations

· quality of service/products of subcontractors (if applicable)

· evaluation of employees in a manner that does not create employee incentive or evaluation programs (i.e., bonuses and/or awards) based on the number of denials, convictions, or referrals to LE

· decisions made by medical reviewers, BI analysts, etc.

· WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people) 6.

Small Business Utilization (100 points) - CMS will perform a subjective assessment based on consideration of all relevant facts and circumstances. The Government is seeking to determine whether the Offeror has demonstrated a commitment to use Small Businesses (SBs) concerns for the work that it intends to perform as the prime contractor. This requirement is only applicable to Large Businesses. Small Businesses for NAICS code 541990 proposing on this solicitation shall be exempt from this evaluation criterion and shall automatically receive 100 points. Offerors will be evaluated, at a minimum, on the following:

A) The extent to which SB concerns are specifically identified;

B) The extent of an Offeror’s commitment to use SB concerns. Are subcontract arrangements already in place, letters of commitment, etc? Is proof of SB certification provided?

C) The complexity and variety of the work SB concerns are to perform. Greater weight will be given for arrangements where the SB(s) are performing work of a greater variety and complexity.

D) The realism of the proposal;, E) The extent of participation of SB concerns in terms of the value of the total acquisition; and

F) WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people).

7.

Subcontracting Approach (Evaluated if using subcontractors only) (Pass/Fail) – At a minimum, the Offeror should address in its presentation, the following:

· Choice of subcontractor

· commitment of subcontractor

· if the subcontractor under any Corporate Integrity Agreement with the Office of Inspector General or other Federal Agency

· initiatives to identify any adverse integrity issues with the subcontractor

· WBS (i.e., timelines, dates, compliance with the WBS outlined in the umbrella SOW, number of people)