DME MAC JA Section B thru M 12-30-09.docx

TABLE OF CONTENTS

PART I – THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICES/COSTS

SECTION C - DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

C.1 STATEMENT OF WORK

SECTION D - PACKAGING AND MARKING

D.1 PACKAGING AND MARKING

SECTION E - INSPECTION AND ACCEPTANCE

SECTION F - DELIVERIES OR PERFORMANCE

SECTION G - CONTRACT ADMINISTRATION DATA

SECTION H - SPECIAL CONTRACT REQUIREMENTS

SECTION I - CONTRACT CLAUSES

SECTION J - LIST OF ATTACHMENTS

SECTION K - REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS OF OFFERORS OR QUOTERS

SECTION L - INSTRUCTIONS, CONDITIONS AND NOTICES TO OFFERORS

SECTION M - EVALUATION FACTORS FOR AWARD

Page | i

SUPPLIES OR SERVICES AND PRICES/COSTS

BRIEF DESCRIPTION OF SERVICES

The purpose of this contract is to obtain the Durable Medical Equipment (DME) – Medicare Administrative Contractor (MAC) specified fee-for-service health insurance benefit administration services, including Medicare claims processing and payment services, for durable medical equipment, prosthetics, orthotics and supplies. This contract award is for Jurisdiction A which includes the states of Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.

TYPE OF CONTRACT

CMS anticipates award of a Cost-Plus-Award-Fee (CPAF) contract.

AWARD FEE

The amount of award fee the Contractor earns, if any, will be based on an evaluation by the Government of the contractor’s performance in accordance with the Performance Evaluation Award Fee Plan (see Attachment J-6). The CMS Fee Determination Official (FDO) will determine the amount of award fee earned by the contractor for the evaluation period. The determination of the amount of the award fee for the evaluation period is a unilateral decision made solely at the discretion of the FDO. Upon receiving written notification from the FDO of the amount of award fee earned for the evaluation period, the Contractor may submit an invoice for the earned award fee. The Government may unilaterally change the Performance Evaluation Plan at any time. However, any revisions to the evaluation criteria in the Performance Evaluation Plan shall be presented to the Contractor prior to the evaluation period in which it will be used. The award fee evaluations will be performed on an annual basis with the actual evaluation taking place in the month immediately following the evaluation period. The award fee available for each period shall be a portion of the total award fee pool available for the entire contract period (see Section G.23).

*Note: A sample Performance Evaluation Award Fee Plan (see Attachment J-6) is provided. The final Award Fee Plan will be provided at time of contract award.

ESTABLISHED COST AND AWARD FEE

The estimated cost of this contract is $TBD. The base fee is $TBD. The maximum available award fee is $TBD. Total cost plus base fee plus award fee is $TBD.

TASK DIRECTIVES

The Contracting Officer may use individual Task Directives with specifically defined scopes and schedules to direct the contractor to perform special projects. Task Directives may also be issued to request a special administrative or user support services project. This mechanism will be used on a project-by-project basis and will be incorporated into the contract through the Changes clause (FAR 52.243-2).

Task Directives issued under this contract may be fixed price or cost reimbursement. The contractor is required to establish separate cost accounts for each Task Directive issued and to segregate those costs on their vouchers.

SCHEDULE OF SUPPLIES/SERVICES

CLIN 0001 –IMPLEMENTATION

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

TOTAL CLIN 0001 –IMPLEMENTATION

$TBD

$TBD

$TBD

$TBD

CLIN 0002 - DME MAC Services/ Base Period Operations Option

0002AA - Program Management

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

0002AB - Medicare Integrity Program

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

0002AC – Recovery Audit Contract (RAC) Activities

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

TOTAL CLIN 0002 – DME MAC Services/Base Period Operations Option

$TBD

$TBD

$TBD

$TBD

CLIN 0003 - DME MAC Services/Option Period One

0003AA - Program Management

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

0003AB - Medicare Integrity Program

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

0003AC – Recovery Audit Contract (RAC) Activities

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

TOTAL CLIN 0003 – DME MAC Services/ Option Period One

$TBD

$TBD

$TBD

$TBD

CLIN 0004 - DME MAC Services/Option Period Two

0004AA - Program Management

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

0004AB - Medicare Integrity Program

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

0004AC – Recovery Audit Contract (RAC) Activities

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

TOTAL CLIN 0004 – DME MAC Services/ Option Period Two

$TBD

$TBD

$TBD

$TBD

CLIN 0005 - DME MAC Services/Option Period Three

0005AA - Program Management

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

0005AB - Medicare Integrity Program

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

0005AC – Recovery Audit Contract (RAC) Activities

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

TOTAL CLIN 0005 – DME MAC Services/ Option Period Three

$TBD

$TBD

$TBD

$TBD

CLIN 0006 - DME MAC Services/Option Period Four

0006AA - Program Management

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

0006AB - Medicare Integrity Program

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

0006AC – Recovery Audit Contract (RAC) Activities

$TBD

$TBD

$TBD

$TBD

$TBD

$TBD

TOTAL CLIN 0006 – DME MAC Services/ Option Period Four

$TBD

$TBD

$TBD

$TBD

CLIN 0007 – Outgoing Transition Option Period

$TBD

$TBD

$TBD

TOTAL DME MAC JURISDICTION A

$TBD

$TBD

$TBD

*Refer to Section G.19, Complimentary Credits.

DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

STATEMENT OF WORK

The Statement of Work (SOW) is provided under Section J as Attachment J-1 and shall be made a part of the contract. The SOW takes precedence over the Internet Only Manuals and Paper-Based Manuals unless otherwise specified

PACKAGING AND MARKING

PACKAGING AND MARKING

All deliverables required under the contract must be shipped and marked in accordance with Section F. Deliverables and any other requirements are set forth herein.

INSPECTION AND ACCEPTANCE

FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address: www.arnet.gov/far/.

Federal Acquisition Regulation (FAR) Clauses:

52.246-5 INSPECTION OF SERVICES – COST REIMBURSEMENT (APR 1984)

APPROVALS BY THE CONTRACTING OFFICER TECHNICAL REPRESENTATIVE

All services or supplies to be delivered to the Contracting Officer Technical Representative (COTR) will be deemed to have been accepted 30 calendar days after date of delivery, except as otherwise specified in this contract, if written approval or disapproval has not been given within such period. The COTR's approval or revision to the services or supplies delivered shall be within the general scope of work stated in the contract.

INSPECTION OF SERVICES – COST-REIMBURSEMENT

All work under this contract is subject to inspection and final acceptance by the Contracting Officer or the duly authorized representative of the Government.

The Government's COTR is a duly authorized representative of the Government and is responsible for inspection and acceptance of all items to be delivered under this contract.

Inspection and acceptance of the Contractor's performance shall be in accordance with FAR Clause 52.246-5 "Inspection of Services-Cost Reimbursement."

DELIVERIES OR PERFORMANCE

FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address: www.arnet.gov/far/.

Federal Acquisition Regulation (FAR) Clauses:

52.242-15 STOP WORK ORDER (AUG 1989) ALTERNATE I (APR 1984)

PERIOD OF PERFORMANCE

The work and services hereunder shall be completed as follows:

The period of performance for completion of all work under this contract shall be from the effective date of contract award through 12 months, plus four (4) one (1) year options as follows:

Workload Transition Activities Not to exceed 6 months from exercise of option**

*CLIN 0001 and CLIN 0002 shall be completed within 12 months after date of contract award.

**This option shall be exercised no earlier than 6 months prior to the expiration of the current year of performance.

Note: The option periods delineated above are subject to the option clause in Section I of this contract.

DELIVERABLES

A list of deliverables is provided under Attachment J-2 and hereto made part of this contract.

All deliverables required under this contract shall be packaged, marked and shipped in accordance with U.S. Government specifications. The Contractor shall guarantee that all required materials shall be delivered in immediate usable and acceptable condition.

The Contractor shall submit all required deliverables and reports in accordance with the attached schedule. Reports submitted under the contract shall reference and cite the contract number and identify CMS as the sponsoring agency.

Satisfactory performance under the contract shall be deemed to occur upon delivery and acceptance by the Contracting Officer, or the duly authorized representative, of the following items in accordance with the schedule Attachment J-2, (reports submitted under the contract shall reference and cite the contract number and identify CMS as the sponsoring agency):

The following abbreviations apply to the schedule, Section J-2:

Note: Additional deliverables may be assigned as part of the product planning process. Individual products may be released on a flow basis, as necessary by the direction of the COTR.

All electronic files shall be submitted in a format that is compatible with Microsoft Office PC-based software. As this requirement is subject to change, the contractor shall be able to adapt to any new CMS standard in order to submit deliverables. Unless specifically denoted as “workday(s),” all timeframes are in calendar days, calendar weeks, calendar months, etc. after the effective date of the contract.

Deliverables email: xxxxx_Deliverables@cms.hhs.gov

CONTRACT ADMINISTRATION DATA

ACCOUNTING AND APPROPRIATION DATA

(To be incorporated at time of award)

PAYMENT, SELECTED ITEMS OF COST REIMBURSEMENT CONTRACTS

Travel Costs (Including Foreign Travel) The Contractor shall be reimbursed for travel costs in accordance with FAR 31.205-46.

Per Diem Expenses for subsistence and lodging shall be reimbursed to the Contractor only to the extent where overnight stay is necessary for performance under this contract. Incurred costs shall be considered to be reasonable and allowable only to the extent that they do not exceed, on a daily basis, the maximum per diem rates in effect at the time of travel as set forth in the Federal Travel Regulations. See FAR 31.205-46(2).

Cost of Materials The cost of materials furnished or used under this contract shall be reimbursed in accordance with paragraph (b) of the clause entitled "Allowable Cost and Payment (FAR 52.216-7)" for cost reimbursement contracts. Expendable material costs for items such as office supplies, report paper, etc., and tools of the trade shall be priced in accordance with the Contractor’s approved accounting practices or standards, as applicable. The Contractor shall be required to support all material costs claimed.

Relocation Costs In accordance with FAR 31.205-35, relocation costs, either direct charged or included in the contractor's indirect cost pools, associated with an individual not completing a term of service equal to one year working under this contract shall be an unallowable cost under this contract.

DISSEMINATION, PUBLICATION & DISTRIBUTION OF INFORMATION

Data and information either provided to the Contractor, or to any subcontractor or generated by activities under this contract or derived from research or studies supported by this contract, shall be used only for the purposes of the contract. It shall not be duplicated, used or disclosed for any purpose other than the fulfillment of the requirements set forth in this contract. This restriction does not limit the contractor's right to use data or information obtained from a non-restrictive source. Any questions concerning "privileged information" shall be referred to the Contracting Officer.

Some data or information may require special consideration with regard to the timing of its disclosure so that preliminary findings which could create erroneous conclusions are not stipulated. Also, some data or information, which relate to policy matters under consideration by the Government, may also require special consideration with regard to the timing of its disclosure so that the open and vigorous debate, within the government, of possible policy options is not damaged.

Any questions about use or release of the data or information or handling of material under this contract shall be referred to the Contracting Officer who must render a written determination. The Contracting Officer's determinations will reflect the results of internal coordination with appropriate program and legal officials.

Written advance notice of at least forty-five (45) days shall be provided to the Contracting Officer of the Contractor's desire to release findings of studies or research or data or information described above. If the Contractor disagrees with the Contracting Officer's determination, and if this disagreement cannot be settled by the Contractor and the Contracting Officer in a mutually satisfactory manner, then the issue will be settled pursuant to the "Disputes" clause.

Any presentation of any report, statistical or analytical material based on information obtained from this contract shall be subject to review by the COTR before dissemination, publication, or distribution. Presentation includes, but is not limited to, papers, articles, professional publications, speeches, testimony or interviews with public print or broadcast media. This does not apply to information that is requested pursuant to the Federal Freedom of Information Act.

The COTR review shall cover accuracy, content, manner of presentation of the information, and also the protection of the privacy of individuals. If the review finds that the Privacy Act is or may be violated, the release/use of the presentation shall be denied until the offending material is removed or until the Contracting Officer makes a formal determination, in writing, that the privacy of individuals is not being violated.

If the review shows that the accuracy, content, or manner of presentation is not correct or is inappropriate in the light of the purpose of the project, the COTR shall immediately inform the Contractor, in writing, of the nature of the problem. If the Contractor disagrees, the COTR may insist that the presentation contain, in a manner of equal importance, materials, which show the government's problem with the presentation.

The Contractor agrees to acknowledge support by CMS whenever reports of projects funded, in whole or in part, by this contract are published in any medium. The Contractor shall include in any publication resulting from work under this contract, an acknowledgment substantially, as follows:

"The analyses upon which this publication is based were performed under Contract Number ________________________, entitled, ____________________________,” Sponsored by the Centers for Medicare & Medicaid Services, Department of Health & Human Services."

Any deviation from the above legend shall be approved, in writing, by the Contracting Officer.

SUBCONTRACTING REPORTING

The Contractor shall report all subcontract awards to small, small disadvantaged, women-owned, HUBZones, veteran-owned and service-disabled veteran-owned small business concerns. The reports shall be prepared using the electronic Subcontracting Reporting System (eSRS) via the internet at http://www.esrs.gov. The Individual Subcontracting Report (ISR), formerly SF294, shall be submitted semi-annually for the periods of October 1 through March 31 and April 1 through September 30. The Summary Subcontracting Report (SSR), formerly, SF 295 shall be submitted annually for the period of October 1 through September 30. The report(s) shall be delivered not more than thirty (30) calendar days following the close of each period covered.

SUBCONTRACTING PROGRAM FOR SMALL AND SMALL DISADVANTAGED BUSINESSES

The contractor hereby agrees to implement the conditions of the subcontracting plan submitted and approved by the Contracting Officer for this contract. The Small Business and Small Disadvantaged Business Subcontracting Plan is hereby incorporated and made a part hereof as Attachment J-3 of this contract.

SUBCONTRACT CONSENT

To facilitate the review of a proposed subcontract by the COTR and the Contracting Officer, the Contractor shall submit the information required by the FAR Clause 52.244-2 entitled, "Subcontracts" to the Contracting Officer. The Contracting Officer shall review the request for subcontract approval and the COTR's recommendation and advise the Contractor of his/her decision to consent to or dissent from the proposed subcontract, in writing.

Consent is hereby given to issue the following subcontract(s):

(To be completed at time of award, if applicable)

SERVICE OF CONSULTANTS/ SUBCONTRACTORS

For the purposes of this contract, consultants are considered subcontractors. The Contractor shall follow the procedures established in FAR Clause 52.244-2. The Contracting Officer shall review the request for subcontract approval and the COTR's recommendation and advise the Contractor of his/her decision to consent to or dissent from the proposed subcontract, in writing.

For utilization of the services of any consultants under this contract, the Contractor shall be reimbursed in accordance with the rate(s) set forth below.

(To be completed at time of award, if applicable)

GOVERNMENT REPRESENTATIVES

The following CMS personnel are the points of contact for this contract:

CONTRACTING OFFICER TECHNICAL REPRESENTATIVE (COTR)

Centers for Medicare & Medicaid Services

Attn: TBD

CONTRACTING OFFICER (CO)

Centers for Medicare & Medicaid Services

Office of Acquisition and Grants Management

Division of Medicare Contracts

Attn: TBD, Mail Stop C2-21-15

7500 Security Boulevard

Baltimore, MD 21244-1850

(410) 786-xxxx

Email: xxxxx@cms.hhs.gov

CONTRACT SPECIALIST (CS)

Centers for Medicare & Medicaid Services

Office of Acquisition and Grants Management

Division of Medicare Contracts

Attn: TBD, Mail Stop C2-21-15

7500 Security Boulevard

Baltimore, MD 21244-1850

(410) 786-xxxx

Email: xxxxx@cms.hhs.gov

CONTRACTING OFFICER RESPONSIBILITY

In accordance with FAR 52.201-1 Definitions, the term ‘Contracting Officer’ means a person with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings. The term includes certain authorized representatives of the Contracting Officer acting within the limits of their authority delegated by the Contracting Officer.

Notwithstanding any of the other provisions of this Contract, the Contracting Officer shall be the ONLY individual authorized to:

Enter into and commit/bind the Government by contract for supplies or services;

Accept nonconforming work or waive any requirement of this Contract;

Authorize reimbursement to the Contractor for any costs incurred during the performance of the Contract; and Modify any term or condition of this Contract, i.e., make any changes in the SOW; modify/extend the period of performance; change the delivery schedule.

CONTRACTOR PROJECT MANAGER

(To be completed at time of award) will serve as Project Manager. It will be his/her responsibility to obtain the staff necessary and to direct the work for the conduct of this project. The Project Manager shall also keep the Government COTR and Business Function Leads (BFLs) up to date regarding all technical, cost and schedule-related issues. The Government reserves the right to approve any necessary successor to be designated as Project Manager.

CONTRACTING OFFICER TECHNICAL REPRESENTATIVE

The following COTR(s) will represent the Government for the purpose of this contract:

[TBD]

The COTR is responsible for: (1) monitoring the Contractor's technical progress, including the surveillance and assessment of performance and compliance with all substantive project objectives; (2) interpreting the SOW and any other technical performance requirements; (3) performing technical evaluation as required; (4) performing technical inspections and acceptances required by this contract; (5) assisting in the resolution of technical problems encountered during performance; (6) providing technical direction in accordance with Section G.12; and (7) reviewing of invoices/vouchers.

The COTR does not have the authority to act as an agent of the Government under this contract. Only the Contracting Officer has the authority to: (1) direct or negotiate any changes in the SOW; (2) modify or extend the period of performance; (3) change the delivery schedule; (4) authorize reimbursement to the Contractor any costs incurred during the performance of this contract; or (5) otherwise change any terms and conditions of this contract.

The Government may unilaterally change its COTR designation.

The COTR may be assisted by the BFL. The BFLs will not have the authority to provide technical direction in accordance with Section G.12, however, they may be responsible for: (1) monitoring the Contractor's technical progress, including the surveillance and assessment of performance and compliance with all substantive project objectives; (2) interpreting the SOW and any other technical performance requirements; (3) performing technical evaluation as required; (4) performing technical inspections and acceptances required by this contract; (5) assisting in the resolution of technical problems encountered during performance; and (6) reviewing of invoices/vouchers.

TECHNICAL DIRECTION

Performance of the work under this contract shall be subject to the technical direction of the COTR. The term "technical direction" is defined to include, without limitation, the following:

Directions to the Contractor which redirect the contract effort, shift work emphasis between work areas or tasks, require pursuit of certain lines of inquiry, fill in details or otherwise serve to accomplish the contractual SOW.

Provision of information to the Contractor, which assists in the interpretation of drawings, specifications, or technical portions of the work description.

Review and, where required by the contract, approval of technical reports, drawings, specifications, and technical information to be delivered by the Contractor to the Government under the contract.

Technical direction must be within the general Scope of Work stated in the contract. The COTR does not have the authority to and may not issue any technical directions which:

Constitutes an assignment of additional work outside the general Scope of Work of the contract.

Constitutes a change as defined in the contract clause entitled "Changes - Cost Reimbursement."

In any manner causes an increase or decrease in the total estimated contract cost, fixed-fee, or the time required for contract performance.

Change any of the expressed terms, conditions, or specifications of the contract.

All technical direction shall be issued in writing by the COTR or shall be confirmed by him/her in writing within five working days after issuance.

The Contractor shall proceed promptly with the performance of technical direction duly issued by the COTR in the manner prescribed by this article and within his/her authority under the provisions of this article.

If, in the opinion of the Contractor, any instruction or direction issued by the COTR is within one of the categories as defined in (l) through (4) above, the Contractor shall notify the Contracting Officer in accordance with FAR 52.243-1, Changes-Cost Reimbursement Alt I.

DESIGNATION OF PROPERTY ADMINISTRATOR

The CMS Property Administrator, Administrative Services Group, Office of Property and Space Management at (410) 786-6462, is hereby designated the property administration function for this contract. The Contractor agrees to furnish information regarding Government Property to the Property Administrator in the manner and to the extent required by the Property Administrator, his duly designated successors, and in accordance with FAR Part 45 and Department of Health & Human Services (DHHS) Manual entitled, Contractor's Guide for Control of Government Property, (DEC 2008). This manual is provided under Section J, Attachment J-22 and is hereby made part of this contract.

GOVERNMENT FURNISHED PROPERTY

Pursuant to FAR Part 45 – Government Property and FAR clause 52.245-1, Government Property (JUN 2007), of this contract, the Government will furnish for performance of the work required herein a list of property, which is provided under Attachment J-5 and is hereby made part of this contract.

CONTRACTOR FURNISHED PROPERTY

A list of Contractor Furnished Property is incorporated as Attachment J-23 (To be completed at time of award).

INVOICING AND PAYMENT (See Attachment J-4, Billing Instructions)

Submission of invoices for payment:

Once each month following the effective date of this contract, the Contractor may submit to the Government an invoice for payment, in accordance with FAR clause 52.216-7 “Allowable Cost & Payment.” The Government shall make provisional payments on all invoices pending the completion of a final audit of the Contractor’s cost records.

To expedite payment, invoices shall be prepared and submitted as follows:

Original and four (4) copies shall be submitted to the address below:

Department of Health & Human Services

Centers for Medicare & Medicaid Services

OFM/Division of Accounting Operations

P.O. Box 7520

7500 Security Boulevard

Baltimore, MD 21207-0520

--For overnight delivery:

Department of Health & Human Services

Centers for Medicare & Medicaid Services

OFM/Division of Accounting Operations

7500 Security Boulevard/Mailstop: C3-11-03

Baltimore, MD 21244-1850

One (1) copy shall be sent to the COTR.

Content of invoice:

Contractor’s name;

Invoice date;

Contract number;

Description, CLIN, cost or price and quantity of property and/or services actually delivered or rendered, breakout of hours incurred by labor category;

Travel cost shall be broken down to include number of trips, numbers and name of individuals per trip, mode of transportation, mileage charge and length of stay;

Other substantiating documentation or information as required by the contract;

Name, title, phone number and complete mailing address of responsible official to whom payment is to be sent and notify in the event of defective invoice; and Period of performance or delivery date of goods or services provided.

Invoice payment

Reimbursement for invoices submitted under this contract shall be made not later than thirty (30) days after receipt of the original invoice from the Contractor in the copies requested at the paying office designated above.

Payment will be authorized after the Division of Accounting has received a certification of the invoice by the COTR and verification that the invoice amount is consistent with the schedule set forth under Section B of this contract. Any discrepancies determined as a result of the audit could delay the processing of the invoice and may result in the invoice being returned to the Contractor for corrections. Inquiries relating to payments should be directed to the Office of Financial Management/Accounting Management Group, ATTN: Jean Katzen on (410) 786-5423 or Suzanne Turgeon on (410) 786-1924.

Interest on overdue payment

The Prompt Payment Act, Public Law 97-177 (96 Stat.85.31 U.S.C. 1801) and FAR 52.232-25 Prompt Payment (OCT 2003), is applicable to payments under this contract and requires the payment of interest on payments made more than 30 days after receipt of an invoice by the Division of Accounting Operations, pursuant to FAR 32.907.

Determinations of interest due will be made in accordance with the provisions of the Prompt Payment Act and Office of Management and Budget Circular A-125.

SEPARATION OF MEDICARE INTEGRITY PROGRAM AND PROGRAM MANAGEMENT FUNDING

Funding for Medicare Integrity Program activities under section 1893 of the Social Security Act is derived from a different source than funding for the other functions (called “Program Management functions”) which the Contractor performs pursuant to the authority of section 1874A of the Social Security Act. Therefore, separate accounts shall be designated for Medicare Integrity Program activities and the Program Management functions which the Contractor performs pursuant to the authority of section 1874A. The Contractor shall separately account for costs incurred to perform Medicare Integrity Program activities and its Program Management functions under this contract. In no event shall the Contractor apply funding which is designated for Medicare Integrity Program activities to costs incurred in performing its Program Management functions authorized by section 1874A; similarly, the Contractor shall not apply funding designated for costs incurred in performing its Program Management functions under section 1874A to Medicare Integrity Program activities.

SEPARATION OF TRUST FUND EXPENDITURES/ACCOUNTING FROM ADMINISTRATIVE EXPENDITURES/ACCOUNTING

Any costs which are properly chargeable by a provider of services, physician, or supplier as benefit costs in accordance with Title XVIII of the Social Security Act, its implementing regulations and this contract, shall not be chargeable to this contract as administrative costs (i.e., either Medicare Integrity Program or Program Management costs). The Contractor shall separately account for benefit payments made by it from costs incurred to perform its Medicare Integrity Program activities and its Program Management functions under this contract.

COMPLEMENTARY CREDITS

The contractor shall separately account for complementary credits and reflect the current and cumulative totals on their monthly invoice. The estimated amounts for complementary credits shall be shown as a reduction to the total costs amount (i.e.: After application of any fees) within each applicable CLIN. Complementary Credits for crossover claims will be accounted for on a cash basis.

METHOD OF PAYMENT

In accordance with FAR 52.232-33, Payment by Electronic Funds Transfer – Central Contractor Registration (OCT 2003), the Centers for Medicare & Medicaid Services (CMS) shall only make an electronic reimbursement/payment.

In accordance with FAR 52.204-7, Central Contractor Registration (APR 2008), the contractor must register in the Central Contractor Registration (CCR) database.

The contractor shall notify CMS’ Division of Accounting Operations of all EFT and address changes in CCR via the following email address: CCRChanges@cms.hhs.gov

CORRESPONDENCE PROCEDURES

To promote timely and effective administration, correspondence (except for invoices), submitted under this contact shall be subject to the following procedures:

Technical Correspondence - Technical correspondence (as used herein, this term excludes correspondence which proposes or otherwise involves waivers, deviations or modifications to the requirements, terms or conditions of this contract) shall be addressed to the COTR with an informational copy of the basic correspondence to the Contracting Officer.

Other Correspondence - All other correspondence shall be addressed to the Contracting Officer with an informational copy of the basic correspondence to the COTR.

Subject Lines - All correspondence shall contain a subject line, commencing with the contract number and assigning consecutive numbers (serial numbers to permit accountability), as illustrated below:

EXAMPLE: Contract No. - 500-00-XXXX Sequence # - XX (YEAR) – XXXX Subject - Request for Subcontract Consent

DATA TO BE DELIVERED

Any working papers, interim reports, data given by the Government or first produced by the Contractor under the contract or collected or otherwise obtained by the Contractor under the contract, or results obtained or developed by the Contractor (subcontractor or consultants) pursuant to the fulfillment of this contract are to be delivered, documented, and formatted as directed by the Contracting Officer.

In addition, information and/or data, which are held by the Contractor related to the operation of their business and/or institution and which are obtained without the use of Federal funds, shall be considered "PROPRIETARY DATA" and are not "subject data" to be delivered under this contract.

AWARD FEE PLAN

A sample Award Fee Performance Evaluation Plan upon which the determination of award fee is based is identified herein as Attachment J-6.* The award fee plan contains details on how the Contractor will be evaluated periodically for its performance. The general criteria upon which the Contractor will be evaluated substandard, expected or superior in performing each function includes such elements as efficiency, ingenuity, responsiveness, perceptiveness, thoroughness, timeliness, and resourcefulness.

The Contractor may submit self-evaluations of performance for each period under consideration. The Performance Evaluation Board in reaching its determination will consider these self-evaluations.

*Note: A sample Performance Evaluation Award Fee Plan is provided. The final award fee plan will be provided at time of contract award.

WORKING PAPERS

The Contractor shall provide, at the request of the Contracting Officer, all the working papers used by the participating officials and employees of the Contractor in connection with all work undertaken pursuant to the contract.

FINAL INDIRECT COST CEILING RATES – ADVANCE UNDERSTANDING

Insert at Time of Award

Pursuant to FAR Clause 52.216-7, Allowable Cost and Payment, this advance understanding sets forth final indirect cost rate ceilings as delineated in the table above. Contractor reimbursement of allowable indirect costs by the Government is limited to the final indirect cost rate ceilings.

Where indirect cost rates exceed the final indirect cost rate ceilings set forth in this advance understanding, the contractor shall only be reimbursed at the final indirect cost rate ceilings. The Government is not obligated to pay any additional amount whereby indirect costs are incurred above the established final indirect cost rate ceilings. The contractor shall not recoup amounts occasioned by the incurrence of indirect costs above the established final indirect cost rate ceilings on other contracts or grants with the Government.

This advance understanding shall not change any monetary ceiling, contract obligation, or specific cost allowable or disallowance provided for in this contract.

In accordance with Federal Acquisition Regulation (FAR) (48 CFR Chapter 1) Clause 52.216-7(d)(2), Allowable Cost and Payment incorporated by reference in this contract in Part II, Section I, the cognizant Contracting Officer representative responsible for negotiating provisional and/or final indirect cost rates is identified below:

Director, Division of Financial Advisory Services

Office of Acquisition Management and Policy

National Institutes of Health

6100 Building, Room 6B05

6100 Executive Blvd. MSC-7540

Bethesda, MD. 20892-7540

The period or periods for which such rates will be established shall correspond to the contractor’s fiscal year(s). The final rate proposal shall also be submitted to the Contracting Officer at:

Centers for Medicare & Medicaid Services

Office of Acquisition and Grants Management

Attn: TBD

7500 Security Boulevard, MS C2-21-15

Baltimore, MD 21244-1850

USE OF GOVERNMENT DATA (REPORTS/FILES/COMPUTER TAPES OR DISCS)

Any data given to the contractor by the Government shall be used only for the performance of the contract unless the Contracting Officer specifically permits another use, in writing. Should the Contracting Officer permit the contractor the use of Government-supplied data for a purpose other than solely for performance of this contract and if such use could result in a commercially viable product, the Contracting Officer and the contractor must negotiate a financial benefit to the Government. This benefit should most often be in the form of a reduction in the price of the contract; however, the Contracting Officer may negotiate any other benefits he/she determines are adequate compensation for the use of these data.

Upon the request of the Contracting Officer or the expiration date of this contract, whichever shall come first, the contractor shall, upon instructions from the Contracting Officer, return or destroy all data given to the contractor by the Government. However, the Contracting Officer may direct that the data be retained by the contractor for a specific period of time, which period shall be subject to agreement by the contractor. Whether the data are returned, retained, or destroyed shall be the decision of the Contracting Officer with the exception that the contractor may refuse to retain the data. The contractor shall retain no data, copies of data, or parts thereof, in any form, when the Contracting Officer directs that the data be returned or destroyed. If the data are to be destroyed, the contractor shall directly furnish evidence of such destruction in a form the Contracting Officer shall determine is adequate.

INCORPORATION OF CONFLICT OF INTEREST CERTIFICATE

The Contractor’s Conflict of Interest Certificate, submitted in response to the solicitation’s Section H.4, dated XXXXX, is hereby incorporated and made a part hereof of this contract (Attachment J-XX).

INCORPORATION OF REPRESENTATIONS AND CERTIFICATIONS

The Contractor has completed the annual representations and certifications electronically via the Online Representations and Certifications Application (ORCA) website at http://orca.bpn.gov. After reviewing the ORCA database information, the contractor verified by submission of their proposal that the representations and certifications currently posted electronically have been entered or updated within the last 12 months, are current, accurate, complete, and applicable to this contract (including the business size standard applicable to the NAICS code referenced for this contract), as of the date of this contract and are incorporated in this contract by reference.

SPECIAL CONTRACT REQUIREMENTS

HHSAR 352.270-5 KEY PERSONNEL (JAN 2006)

The key personnel specified in this contract are considered to be essential to work performance. At least 30 days prior to diverting any of the specified individuals to other programs or contracts (or as soon as possible, if an individual must be replaced, for example, as a result of leaving the employ of the Contractor), the Contractor shall notify the Contracting Officer and shall submit comprehensive justification for the diversion or replacement request (including proposed substitutions for key personnel) to permit evaluation by the Government of the impact on performance under this contract. The Contractor shall not divert or otherwise replace any key personnel without the written consent of the Contracting Officer. The Government may modify the contract to add or delete key personnel at the request of the contractor or Government.

All proposed substitutions must be submitted, in writing, to CMS at least thirty (30) days prior to the proposed substitution or as soon as reasonably known. Each request shall provide a detailed explanation of the circumstances necessitating the proposed substitution, a complete resume and any other information required by CMS. All proposed substitutions must have qualifications equal to or greater than the person(s) being replaced.

When key personnel positions are vacated due to unforeseen circumstances, a proposed replacement shall be submitted in writing for approval no later than 30 calendar days from the date the position was vacated. Interim replacements should be identified when a permanent replacement cannot be identified within this time frame. The Centers for Medicare & Medicaid Services (CMS) may consider a 60-day interim replacement until a permanent replacement is secured.

The following individuals are considered “key” under this contract:

(To be completed at time of award)

Project Manager

Chief Information Officer

Claims Processing Manager

Compliance Officer

Contract Administrator

Implementation Project Director

Chief Financial Officer

Provider Customer Service Program Manager

Systems Security Officer

Program Safeguard Contractor and Zone Program Integrity Contractor Liaison

Contractor Medical Director

Medical Review Manager

Statistical Expert

CONDITIONS OF PERFORMANCE

In addition to the performance requirements of this contract set forth under Section C, Description/Specifications, Work Statement, the Contractor may be required to comply with the requirements of any revisions in legislation or regulations, which may be enacted or implemented during the period of performance of this contract, and are directly applicable to the performance requirements of this contract. In the event that revisions in legislation or regulations are enacted and do impact the performance requirements of this contract, the Contractor will have an opportunity to assess the cost and schedule impacts of such revisions and will, when applicable, be provided an equitable adjustment subject to the negotiated indirect cost ceiling(s) established in the contract.

CONFLICT OF INTEREST

General: It is essential that the Contractor and the services provided to Medicare beneficiaries under this contract be free, to the greatest extent possible, of all…