RFP-CMS-2010-0031 Amend 01.pdf

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RFP-CMS-2010-0031

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1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT

THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

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AGG/ER

410-786-6648 Contracting Officer Edward M. Rutherford

DMSC

BALTIMORE MD 21244-1850

7500 SECURITY BLVD., MS: C2-21-15

CMS,OAGM,MCG,DMSC

R10103006/07/2010000001

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

7. ADMINISTERED BY (If other than Item 6)CODE 6. ISSUED BY

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

05/21/2010

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

E. IMPORTANT: Contractor is not, is required to sign this document and return __________________ copies to the issuing office.

ORDER NO. IN ITEM 10A.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

HITEC - Payment File Development Contractor

Answers to questions submitted in response to above referenced solicitation.

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

EDWARD M. RUTHERFORD

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

NSN 7540-01-152-8070

Previous edition unusable

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

RFP-CMS-2010-0031

Amendment 000001

RFP Section L.15 LIMITED WRITTEN TECHNICAL PROPOSAL INSTRUCTIONS, Question: TAB B, Implementation Approach states “The offeror shall submit an Implementation Plan that presents the proposed technical approach to perform the requirements of the SOW within the specified timeframe.” Please provide the specified timeframe. How long is the implementation period?

Answer: The PFDC must be capable of making payments (both paper check and

EFTs) no later than 4/1/11. Because this also depends upon the capabilities of the NLR which is under development, a contingency plan is required from the PFDC by 11/1/2010 to propose an alternative means of making these HITECH payments by the 4/1/11 deadline.

SOW General Questions

Question: Would the government entertain offerors whom can demonstrate abilities to perform this effort that possess no recent experience in issuing billion dollar Medicaid payments?

Answer: Section M.2.C, Past Performance states that experience in issuing 1$B in

Medicare payments is an evaluation factor

Question: Will the government pay for set-up of software, facilities, equip. etc or will this need to be established prior to award?

Answer: CMS requires the contractor to have all the necessary software, facilities, equipment, etc at time of award.

Question: Will awarded offeror work with CMS to determine the exact implementation date?

Answer: The PFDC must be capable of making payments (both paper check and

EFTs) no later than 4/1/11. Because this also depends upon the capabilities of the NLR which is under development, a contingency plan is required from the PFDC by 11/1/2010 to propose an alternative means of making these HITECH payments by the 4/1/11 deadline.

Reference to “Medicare Bank”

Question: If an offeror is currently using a Medicare bank can they use the established relationship or will the PFDC be required to use a specific Medicare bank?

Answer: The bank will be one of two current Medicare banks; the PFDC will not have a choice in the selection of the bank.

Question: Will the PFDC be required to interact with HIGLAS? If so, please specify the extent of interactions?

Answer: There is no requirement for the PFDC to interact with HIGLAS.

SOW Specific Questions

Section A Medicare EPS

Question: Can you provide more details or a link to a document that describes the registration process for Medicare EPs to be eligible for HITECH payments?

Answer: The RFP for the registration and attestation modules was in FEDBIZOPs www.FBO.gov during the competition; the award was made to CGI.

Section A.1 HITECH file

Question: Is the HITECH file a flat file or will a specific format be used?

Answer: The format for the payment file downloaded from the NLR will be arranged between the NLR and PFDC contractors.s

Question: Can you provide a list of all the fields in the HITECH file?

Answer: The fields in the business requirements include:

Provider Type (Medicare EP or hospital) http://www.fbo.gov/�

Payment Type (Initial, Maximum or HPSA for Medicare EP, Initial, Adjustment or Final Reconciliation Payment for Medicare hospital CCN, if Medicare hospital Legal business name Address

NPI

Payee TIN Legal Business Name of entity EHR incentive payment amount Banking account Routing number Banking account type (Checking or Savings)

Section A.1 Summery file

Question: What is the unique identifier for each payee that is supposed to be used for the summary file (Tax ID, or some proprietary CMS ID)?

Answer: Payees are not identified or itemized on the summary payment file; the summary file contains the subtotals and total payments by hospital and EP, and category of payment.

Question: Is the summary a flat file? If not what is the expected format.

Answer: The format for the payment file downloaded from the NLR will be arranged between the NLR and PFDC contractors.

Question: What are all the data elements that the summary file should contain?

Answer: The summary file sent by the PFDC to OFM/DFSE shall include: Payment

Date, the Total Number of Records in the Detailed Payment File, Category of Payment (HPSA) and subtotal amount, the Total Number of Hospital Payments and EP Payments and their respective sub total payment amounts, and the Total Dollar amount for the monthly Payment Cycle.

Section A.1 Payment Process Overview

Question: Page 3 states “… the PFDC shall forward the payment file to the Treasury…”

What division of the Treasury will receive the file and are they on CMSNet or is there a requirement to connect to the Treasury through some other network connection? If another network connection is required will the PFDC be responsible for the cost and implementation?

Answer: The FPLP netting is coordinated with Financial Management System

(FMS)/Treasury; the current process for regular Medicare is automated through HIGLAS; we do not have an automated process in place for HITECH payments, as such, this may need to be developed by the PFDC.

The bidder is advised to consider these development costs as part of their proposals; however, the bidder should also consider that payments are on a monthly cycle so these transactions with FMS would be limited to 12 annually implying a non-automated solution for file transfer between the PFDC and FMS may be more cost effective.

Question: Page 3 states “CMS approves… notifies both the Medicare bank and the PFDC of the approval/authorization for payment.” (1) Please specify the timeframes for:

Approvals/Authorizations for payment from CMS and Treasury in order to make payments. (2)Treasury to notify PDFC that funds have been deposited in order to send paper checks

Answer: The current timetable is 15 days as follows: 1st day of the calendar/payment month the NLR produces a payment file the PFDC; the PFDC must then forward the file in an agreed upon format to FMS/Treasury for FPLP offsetting; FMS/Treasury will provide the PFDC with an the offset file in less than 24 hours; the PFDC must include the offset amounts, the netted payment amount, and the PLB code into the file and develop two payment files – the 820 EFT file for the bank and the positive pay check issuance file – the PFDC must submit the payment summary file to CMS for approval by the 6th day of the calendar/payment month; CMS will certify funds and approve payment by the 8th day of the calendar/payment month; CMS will submit the summary file to DPS/FACS which forwards the file to Treasury on the 9th day – the Treasury will take 5 days to process any file over $50 million; the Treasury will deposit the funds into the bank on the 14th day; the deposit will trigger notification to the PFDC to mail checks to recipients and for the bank to issue EFT deposits on the 15th day of the month.

Question: Page 3 states “… the PFDC also uploads the errors from the return file into the

NLR for correction by the FI/Carrier/MACs.” Please specify the file format and data requirements to upload the errors into the NLR.

Answer: The file format will be arranged between the PFDC and the NLR contractor.

Question: Page 3 states “The PFDC downloads the EFT corrections from NLR...” Please provide examples of EFT corrections that will be received from the NLR. What are the data elements and file format requirements for the file sent back to the bank?

Answer: EFT corrections will consist of updated banking information; recipient banking information will be provided to the NLR from the shared systems;

this banking information is current and verified; if there are unexpected errors, the PFDC must submit the errors into the NLR for correction in a separate file; The FI/Carrier/MACs will correct this banking information and update the NLR; the PFDC will download the corrected banking information from the NLR and reprocess the payment in the next payment cycle; the PFDC will not have to research or correct banking information;

the file formats will be developed by the PFDC and the NLR contractor.

Question: Page 3 states “The PFDC updates the NLR and CMS records/reports to account for both overpayments and underpayments resulting from either: 1) cost report settlements for hospitals; and/or 2) over and underpayments to EPs.” Please specify how the PFDC will obtain the information required to account for both overpayment and underpayment determinations (i.e., 1. Cost report settlements for hospitals; and/or 2. Over and underpayments to EPs). Will the PFDC be expected to retrieve this information from MSTAR and/or HIGLAS? Will the PFDC issue demand letters for the overpayments and follow the Medicare Financial Manual Chapters 3 and 4 for debt collection.

Answer: CMS will issue a forthcoming change request that will outline these processes and requirements. The Audit Contractor will select and audit recipients for compliance and meaningful use; after identifying and overpayment, the Audit Contractor will send a demand letter to the recipient and copy the MAC and the PFDC; the PFDC will update the NLR that an overpayment has been identified with an overpayment indicator, demand letter dates, AR numbers, collection status codes, amounts collected, and interest accrued. All collections both EFT offsets and paper check payment from providers will be received by the FI/Carrier/MACs; the FI/Carrier/MACs will forward these receivables into the lockbox maintained by the PFDC at the bank. The PFDC will update the NLR with collections on a flow basis until the AR is satisfied. The PFDC will not interact with the shared systems to coordinate these processes as all HITECH payments and collections are occurring outside the shared systems. Overpayments that are identified by a different entity occurring as a result of administrative error or other reason not related to meaningful use will be addressed using the same processes. The monthly workload for overpayments is unknown and there is no existing Medicare proxy system to use to use as a basis for the workload estimate that we are aware of.

Question: Will HIGLAS be used as the accounting system to record the financial tracking of payments? Will the bank account used interface with HIGLAS? Will the PFDC have access to HIGLAS and be responsible for the accounting associated with incentive payments?

Answer: Neither the PFDC nor the bank will interface with HIGLAS; HITECH payments are not claims payments and they are being tracked and accounted for separately.

Section A.1 - Bullets

Question: Page 3 – Bullet 3. Funding by Treasury. Will the PFPC receive a notification that the treasury has made the funding payment?

Answer: The PFDC will be notified by the bank that a deposit has been made by the

Treasury into the HITECH account.

Question: Page 3 - Bullet 4. Positive Pay. Will the pay/no-pay decision for check be made by the Medicare banks just based on the check issuance file or does the PFDC provider play a role in the payment decision process?

Answer: The pay/no pay decision are done by the bank based upon the matches with positive pay checks issuance file.

Question: Page 3 – Bullet 4. Return File. Can the PFDC request a specific format for return transactions from the Medicare bank or has the format already been decided? If so can the format be made available to us as part of the RFP process?

Answer: The return file format should be compatible with the payment file because the status of EFT payments from the return file must be uploaded into the NLR. However, the file exchange in your question is between the bank and the PFDC; therefore, the specific format can be arranged after the PFDC award has been made.

Question: Page 3 – Bullet 5. Payment History File Update. Is the payment history file a flat file? If not what is the expected format?

Answer: The formats for file exchanges not otherwise detailed in the SOW are to be arranged between the PFDC and the NLR contractor, CMS, and Banks.

Question: Page 3 – Bullet’s 4-10. Payment History File Update. What are all the data elements and status codes that CMS requires?

Answer: Refer to the SOW and the prior answers; codes to detail payment status will be provided after award; codes to detail type of FPLP offset will be provided after award; codes to detail overpayment collections status have not been determined.

Question: Page 3 – Bullet 9. Bank Accounts. Can you provide examples what activities need to be covered to meet the following requirement :"The PFDC maintains the HITECH bank account with the participating Medicare bank"?

Answer: The PFDC manages the bank account and has responsibility for all transactions, accounting, and reporting.

Question: Page 4 – Bullet 1. Lockbox. What type of data will the Medicare EPs and

Hospitals be asked to provide when returning an overpayment?

Answer: Overpayments will be collected either through offset by the MACs or collected through paper checks from the providers sent to the MACs; the MACs will forward these collection to the PFDC lockbox at the bank; the PFDC will update the NLR regarding all overpayment collections and AR status.

Section C, Lockbox

Question: Can the overpayment of funds be returned via ACH?

Answer: See above answer.

Section C, 508 compliance

Question: Should the PFDC provide a front end to CMS that enables CMS personnel to check payment status and pull reports?

Answer: No.

Section D Workload Estimates

Question: What is the estimated volume of returned checks?

Answer: CMS does not have volume estimates for returned checks; mailing addresses will uploaded into NLR by the shared systems and included on the payment file available to the PFDC; updated address corrections for returned mail received by the PFDC will be uploaded into the NLR by the FI/Carrier/MAC after the PFDC uploads the request for address corrections into the NLR.

Question: Will the EPs and hospitals receive their HITECH initiative through monthly installments or a one-time payment?

Answer: The NLR will provide the PFDC with a payment file on a monthly cycle for all hospitals and EPS eligible for payment in that monthly cycle; however, recipients will only receive a payment once annually excepting adjustment payments to hospitals.

Question: Please clarify if Medicare EPs and hospitals are eligible to receive payments each month. If so, will all EPs and hospitals receive a payment every month? If not, what percentage of EPs and hospitals will receive a check each month?

Answer: The PFDC will make payments on a monthly cycle to all eligible hospitals and EPs; these hospitals and EPs will only receive one payment annually with some minor exceptions associated with adjustments for hospitals.

Question: Please provide the average size and level of detail for the Remittance Advice that will accompany paper checks.

Answer: The RA for paper checks must include the same contents/detail as the EFT

RA in the 820 file. We recommend that you review the requirements of the SOW to determine the level of detail; broadly, the RA must include the reason for the payment (HITECH), the amount, the period to which the payment applies, type of payment (HPSA), any adjustments that are made due to FPLP, the PLB reason code, as well as a number to contact with questions.

SOW Section II. Business Requirements

Question: How will CMS notify the PFDC that the monthly payment cycle has been approved?

Answer: The process used for HITECH is modeled after the current process used to pay demonstration projects; in the current process, the approval is provided through email. The PFDC may propose alternatives to this process for CMS to consider but that is not required.

Question: What is the estimated volume of inquiries the PFDC will receive from the

FI/Carrier/MAC and HITECH Help Desk? Will the PFDC also be required to respond to provider inquiries? If so, what is the anticipated volume of provider inquiries?

Answer: The PFDC will not receive or respond to questions directly from HITECH payment recipients. The volume of questions referred to the HITECH help desk is unknown, however, these questions will be addressed by the HITECH help desk staff and the information provided will generally be drawn from the NLR not from the PFDC. The PFDC is not expected to maintain a help desk for anything other than technical questions that may come from CMS, the bank, the NLR contractor/help desk, or the FI/Carrier/MACs.

Question: Will the PFDC be held to a Service Level Agreement (SLA) for the time between file receipt and EFT/check issuance? If so, please provide details of the SLA.

Answer: An SLA is not required for the PFDC

Question: What systems and processes are included in the CMS approval of the monthly payment cycle? Is this an automated process? What is the timeframe for CMS to provide approval to the PFDC?

Answer: This is a manual process; the PFDC submits the summary file through email to CMS for review and approval; CMS will routinely audit the detailed as necessary.

Question: In order to update a payment address, CMS requires Providers to submit an enrollment form 855I. Will CMS allow the PFDC to go outside this process and update payment address? If so, will the PFDC be required to access PECOS and the standard systems for all regions/contracts?

Answer: Updated payment information will be provided through the NLR; assuming full NLR functionality, the PFDC will not be expected to go outside this automated process.

Question: Please provide the expected paper check file retention policy for the PFDC.

Answer: PFDC will be expected to maintain all files/records of HITECH payments made by both EFT and paper check through the life of the project as required by CMS policy.

Question: Will the PFDC include corrected payments for reprocessing in the next monthly payment cycle or will the PFDC be required to run an additional cycle for corrected records?

Answer: The PFDC will process the corrected payments in the next monthly cycle unless otherwise directed by CMS.

Question: Please provide an estimated monthly workload for FI/Carrier/MAC and HITECH Help Desk questions related to monthly payments. In addition, please provide estimated handle time for inquiries. Also, what entity is responsible for calls from Providers regarding incentive payment?

Answer: The PFDC will not receive or respond to questions directly from HITECH payment recipients. The volume of questions referred to the HITECH help desk is unknown, however, these questions will be addressed by the HITECH help desk staff and the information provided will generally be drawn from the NLR not from the PFDC. The PFDC is not expected to maintain a help desk for anything other than technical questions that may come from CMS, the bank, the NLR contractor/help desk, or the FI/Carrier/MACs

Question: Please clarify how the PFDC will update NLR and CMS records to account for overpayments and underpayments resulting from cost report settlements and or over and underpayments to EPs. Will the PFDC have access to all standard system regions?

Answer: CMS will issue a forthcoming CR that will outline these processes and requirements. The PFDC will update the NLR with all payment related information including over/under payments; this update includes overpayment indicators, demand letter dates, AR numbers, collection status codes, amounts collected, and interest accrued.

Question: Does CMS expect the PFDC to accept and process overpayment refunds using a standalone system, or within the standard systems? What entity determines overpayments and underpayments? Is it expected that the overpayments will be as a result of computations from the NLR, audits from providers who have self-certified, errors by the PFDC, or other sources? If the source is other than errors by the PFDC, how will the PFDC be made aware of the overpayment? In addition, please provide an estimate monthly workload for overpayments.

Answer: CMS will issue a forthcoming CR that will outline these processes and requirements. The Audit Contractor will select and audit recipients for compliance and meaningful use; after identifying and overpayment, the Audit Contractor will send a demand letter to the recipient and copy the MAC and the PFDC; the PFDC will update the NLR that an overpayment has been identified with an overpayment indicator, demand letter dates, AR numbers, collection status codes, amounts collected, and interest accrued. All collections both EFT offsets and paper check payment from providers will be received by the FI/Carrier/MACs; the FI/Carrier/MACs will forward these receivables into the lockbox maintained by the PFDC at the bank. The PFDC will update the NLR with collections on a flow basis until the AR is satisfied. The PFDC will not interact with the shared systems to coordinate these processes as all HITECH payments and collections are occurring outside the shared systems. Overpayments that are identified by a different entity occurring as a result of administrative error or other reason not related to meaningful use will be addressed using the same processes. The monthly workload for overpayments is unknown and there is no existing Medicare proxy system to use to use as a basis for the workload estimate that we are aware of.

Question: What type of connectivity proposal should be implemented for the file based exchange between CMS and PFDC?

Answer: The file exchange with CMS is limited to the summary file and requests for reports and the detailed payment file as needed; no additional connectivity is required.

Question: Can you provide any additional details on the requested reconciliation process?

Answer: The explanation in the SOW is adequate.

Question: How is the PFDC notified that Treasury has funded the account?

Answer: Answered in prior question: The PFDC will be notified by the bank that a deposit has been made by the Treasury into the HITECH account.

Question: What system will the PFDC use to upload a file into NLR?

Answer: The PFDC must develop connectivity with the NLR; an interface is being developed specifically for the PFDC by the NLR contractor; it is assumed the PFDC will develop its own system for file development, storing/archiving, and accounting/reporting, however, the NLR is the system of records for

HITECH.

Business Requirements Optional Task

Question: Does CMS want bidders to cost the Optional Task?

Answer: Yes, there is an extremely strong probability that FPLP offsetting will be required and the bidder should include this work in their cost estimates.

Question: What systems and processes are included in the Federal Payment Level Program process? Is this an automated process? What is the timeframe for the Treasury to return a file with offset amounts to the PFDC?

Answer: The FPLP process is detailed adequately in the SOW; the process is currently automated for regular Medicare through HIGLAS however there is no similar automated process for HITECH payments – this would have to be developed; the timeframe for receiving an offset file from Treasury is less than 24 hours.

Question: If a FPLP adjustment is made to the HITECH payments by the PFDC is the summary file send to CMS:

a. Only before the adjustment as outlined on page 3 of the SOW?

b. Before and after the adjustment?

c. Only after the adjustment has been made?

Answer: Refer to SOW. The summary file contains the gross not the net payment amounts.

Question: Please provide a list of FPLP codes.

Answer: WU and ZZ

Reporting Requirements

Question: How should reports be delivered to CMS?

Answer: Reporting delivery requirements shall be arranged after award.