Attachment 1 - RFP Jurisdiction F Offeror Questions - Final.xlsx

XLSX spreadsheet 58 KB Posted Nov 1, 2010

Attached to: A/B MAC Jurisdiction F Request For Proposal
Solicitation number: RFP_CMS_2010_0050
Issued by: Department of Health and Human Services Centers for Medicare and Medicaid Services

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Amendment 2 - Attachment 1 RFP Questions Answers

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File	Type	Posted
Amendment 2 - SF-30.pdf	PDF	Nov 1, 2010
Amendment 2 - Page 2.docx	DOCX document	Nov 1, 2010
J-01 Statement of Work REDLINED for Amendment 2	—	Nov 1, 2010
J-02 Deliverable Schedule REDLINED for Amendment 2.xlsx	XLSX spreadsheet	Nov 1, 2010
J-22 Contractor Furnished Property REDLINED for Amendment 2.docx	DOCX document	Nov 1, 2010
Attachment 2 - RFP_Sections_B_-_M REDLINED for Amendment 2.docx	DOCX document	Nov 1, 2010
SF-30.pdf	PDF	Oct 7, 2010
Section L.16.a - Volume IIA.docx	DOCX document	Oct 7, 2010
J-2 Deliverable Schedule - Red Line Version.xlsx	XLSX spreadsheet	Oct 7, 2010
SF-33.pdf	PDF	Oct 5, 2010
AB MAC Jurisdiction F RFP Attachments.zip	ZIP file	Oct 5, 2010
AB MAC Jurisdiction F RFP Sections B - M.docx	DOCX document	Oct 5, 2010

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Section B

ID	Section	Question	Answer/Action	Amendment 1?	Amendment #
B1	B. 6 Schedule of Supplies	The schedule in Section B appears to have omitted the RAC SLINs (AG & AH) that were included within the Cost Proposal Templates (Attachments J-9 through J-16). Please clarify whether this schedule in Section B should be modified to include additional SLINs (such as AG & AH), or should the offeror not propose costs for RAC activities (AG & AH) in the Cost Proposal Templates (Attachments J-9 through J-16)?	Section B has been revised to include SLINs AG and AH for CLINs 0002 - 0006.

&D A/B MAC Jurisdiction F

&9RFP-CMS-2010-0050

Amendment No. 000002 &9&A &9&P

Section F

ID	Section	Question	Answer/Action	Amendment 1?	Amendment #
F1	Section F.3 - Deliverables, page 11	It appears that the last paragraph in this section may be missing language at the very end. The last sentence reads: "Unless specifically denoted as "workday(s)," all timeframes." Please clarify if there is missing information and if so provide the missing information.	Section F.3 has been updated to include the conclusion of this sentence.
F2	F.2 PERIOD OF PERFORMANCE	On page 10, Implementation (CLIN 0001) is listed as lasting 4 months from the effective date of contract award. However, in Section L.11, page 92, Proposal Assumptions, paragraph a. Implementation Cutover Date, the solicitation states “Completion of the movement of the Jurisdiction to the incoming MAC shall occur within six (6) months of award”. These references appear to conflict with one another. Please clarify the Period of Performance for the Implementation Activities as a 4 versus 6 month timeframe may impact implementation costs.	Implementation is six months. Section F.2 Period of Performance has been updated to reflect this change and all workloads in Section L.11 for Base Year have been updated to reflect a six month level of effort.
F3	F.3 DELIVERABLES	Page 11, F.3, paragraph e., last sentence, refers the offeror to JSM Number 10037 for further information on deliverable submission. This appears to be a typo and the reference should be JSM Number 10337. Please clarify the correct JSM reference.	Section F.3, paragraph e. has been corrected to reflect JSM 10337.
F4	F.3 DELIVERABLES	Page 12, F.3, last paragraph, the last sentence of the paragraph appears to be truncated. “Unless specifically denoted as “workday(s)”, all timeframes……..” Please provide the additional wording to complete this sentence.	Section F.3 has been updated to include the conclusion of this sentence.

&D A/B MAC Jurisdiction F

Amendment No. 000002 &9&A &9&P

Section G

ID	Section	Question	Answer/Action	Amendment 1?	Amendment #
G1	Section G.17 Separation of Medicare Integrity Program and Program Management Funding	Would CMS please assign either a “MIP” or “PM” designation to each of the SOW codes?	Cost templates show PM or MIP designation. Offerors can ascertain which SOW elements are PM and which are MIP from these CLIN templates. CLIN XXXXAA is Part A PM; CLIN XXXXAB is Part A MIP; CLIN XXXXAC is Part B PM; CLIN XXXXAD is Part B MIP; CLIN XXXXAG is Part A PM RAC; and CLIN XXXXAH is Part B PM RAC.

&D A/B MAC Jurisdiction F

RFP-CMS-2010-0050

Amendment 000002 Section G

Section H

ID	Section	Question	Answer/Action	Amendment 1?	Amendment #
H1	Section H.3 Conflict of Interest, Pages 27 through 32. Throughout section H.3 there are paragraph reference points that do not appear to be correct, as follows:

Page 27 states “paragraph H.3.c.” – should this be H.3.d instead ?

Page 30 states “paragraph H.3.d.1 (a) through (h)” - should this be (a) through (i) instead ?

Page 31 states “paragraph H.3.d.1. (g) (3)” - should this be H.3.d.1. (h) (3) instead?

Page 31 states “paragraph H.3.d.1. (g) (3) and (4)” - should this be H.3.d.1. (h) (3) and (4) instead?

Page 31 states “paragraphs H.3.d.1. (g) (1) and (2)” - should this be H.3.d.1. (h) (1) and (2) instead?

We suggest that CMS revise the references as noted above.	Secion H.3 Conflict of Interest, pages 27 through 32 have been revised to correct various reference points in this amendment.
H3	H.3.d.2	This section states that a Conflict of Interest Certificate is submitted in the following situations:

a) With the offeror’s proposal;

b) When the CO request a revision in the certificate;

c) Within 45 days of any change in the information submitted in accordance with paragraph H.3.d.1 of this section. The first annual certification shall be submitted on the anniversary date that the contract become fully operational and annually thereafter; and

d) As part of the annual conflict of interest certification by an independent auditor

Though this certification requirement is included in Section H.3, the submission of the Annual Conflict of Interest Certification is not listed on the Deliverable Schedule. Please clarify.

The deliverble schedule Attachment J-02 has been updated to reflect the deliverable of the Annual Conflict of Interest Certification.

&D A/B MAC Jurisdiction F

Amendment No. 000002 &9&A &9&P

Section J

ID	Section	Question	Answer/Action	Amendment 1?	Amendment #
J1	J-05 (WPS)	Please confirm whether CMS will continue to license STARS (Service Tracking Analysis Reporting System), a Viable Information Processing Systems, Inc. (VIPS) software product for MACs to use in conducting data analysis?	CMS has a perptual use license for the STARS system.
J2	J-01 Statement of Work C.5.1 Workload Implementation Requirements, page 29	In this section, CMS discusses the “Drug Cap workload” yet there is not a corresponding SOW section that describes work process requirements for a Drug Cap workload. Please clarify.	The “Drug CAP workload” referenced in the Workload Implementation Requirements is the Competitive Acquisition Program-related requirements covered in section C.5.8.7 of the SOW. Offerors should note that this workload is identified as a separate “state” in the Part B CICS region. Since a Part B region can only accommodate 4 “states”, this workload will no longer be identified as a separate “state” in order to accommodate the Part B merge of Alaska, Idaho, Oregon, and Washington into a single CICS region.
J3	J-01 Statement of Work C.5.1 Workload Implementation Requirements, page 29	In this section, CMS discusses the “Drug Cap workload”. Please clarify if this workload refers to the Drug Competitive Acquisition Program (CAP) designated carrier workload.	The “Drug CAP workload” referenced in the Workload Implementation Requirements is the Competitive Acquisition Program-related requirements covered in section C.5.8.7 of the SOW. Offerors should note that this workload is identified as a separate “state” in the Part B CICS region. Since a Part B region can only accommodate 4 “states”, this workload will no longer be identified as a separate “state” in order to accommodate the Part B merge of Alaska, Idaho, Oregon, and Washington into a single CICS region.
J4	J-01 Statement of Work C.5.1 Workload Implementation Requirements, page 29	In this section CMS discusses the “Drug Cap workload”. If this workload is the Drug Competitive Acquisition Program (CAP) designated carrier workload, please clarify the status of the contract: operational, postponed, or cancelled.	This business requirement does refer to the Drug Competitive Acquisition Program (CAP) designated carrier workload. This workload is currently operational.	1
J5	J-01 Statement of Work C.5.1.8 CONSOLIDATION OF PART A AND PART B EDITS - page 69	The SOW requires a consolidation of edits for all edits. Does the incoming contractor have update access to the UAT environment prior to the cutover period to load and test the consolidated edits?	The awardee will have the option to utilize a separate newly created set of CICS regions (for production and UAT) to establish its reference files, unless the awardee is the incumbent contractor for that specific workload segment, in which case its reference files will already have been established and it can utilize its UAT region if it needs to make any adjustments. Furthermore, in such cases the CMS is open to discussing how best to handle any potential conflicts between the transition and quarterly release user acceptance testing.
J6	J-01 Statement of Work C.5.3.1.1.3 PART B NON-HIGLAS WORKLOAD MERGE - page 78	Will the incoming contractor have inquiry access to the production environment at least 60 days prior to cutover for preparation of the Production simulation and validation?	Given that CMS would establish a separate set of new CICS regions (see answer to J5), this will not be necessary. The legacy contractors will be available to answer any questions the awardee may have about their legacy environments, with the exception of questions that pertain to protected data.
J7	J-01 Statement of Work C.5.3.1.1.3 PART B NON-HIGLAS WORKLOAD MERGE - page 78	Will the incoming contractor have access to the UAT and production environment to establish the necessary tables and crosswalks during the Mapping process required as part of the Workload Merge process?	Given that CMS would establish a separate set of new CICS regions (see answer to J5), this will not be necessary. The legacy contractors will be available to answer any questions the awardee may have about their legacy environments, with the exception of questions that pertain to protected data.
J8	J-01 Statement of Work C.5.3.2.7 CMS Alternate Front End Program – page 88	This SOW indicates a contractor may need to support an Alternate Front end environment. Should bidders include this expense?	Offerors should not include this expense. All MACs supporting an Alternate Front End for a legacy FI or carrier have already been selected. It is not necessary for offerors to plan for or include this expense.
J9	J-01 Statement of Work C.5.3.2.7 CMS Alternate Front End Program – page 88	How long would CMS expect the Alternate program support to continue?	The Alternate Front End Option is not applicable to this procurement. It is a temporary program already in place, that will conclude when all legacy contractors have been transitioned out of the program.
J10	J-01 Statement of Work C.5.4.1 Key Personnel, page 89	The Statement of Work for Key Personnel is C.5.4.1. The cost templates only allow for C.5.4.1 to be charged as PM function (SLIN AA or AC). As an example, the Key Personnel – Medical Director has previously been 100% charged to MIP (SLIN AB or AD). Please clarify which SLIN should include costs for the fully dedicated Key Personnel.	Key personnel shall be priced under the corresponding CLIN Template WBS element in accordance with the Offerors accounting standards. In this example, the Medical Director can be priced as direct labor under the appropriate MIP SLIN. Offerors that choose to list their Key Personnel as direct labor should include them in the personnel listings of the appropriate SLIN worksheet (either PM or MIP).
J11	J-01 Statement of Work C.5.10.1.3.1 Acknowledgement of Redetermination Request, Page 143	The standard states “The Contractor shall acknowledge the request for redetermination within 14 calendar days of receipt of the request in the Contractor’s mailroom.” Currently the instruction within the IOM does not address acknowledging the redetermination request. (See IOM 100-04 Chapter 29). The only acknowledgement requirements within the IOM pertain to QIC. Please confirm that CMS intends to exceed the IOM by requiring acknowledgment of the redetermination request.	In accordance with Section C.1 of the SOW, for purposes of this contract, when differences or conflicts occur, this SOW shall take precedence over the IOMs unless otherwise specified. The standards stated in Section C.5.10.1.3.1 are correct as stated.
J12	J-01 Statement of Work C.5.10.1.7 Acknowledgement of Redetermination Request, Page 144	Circumstance “f” states that one of the reasons for dismissal is “When the Contractor has not issued an initial determination on the claim for which a redetermination is sought”. However, the IOM states this is not a valid reason for dismissal according to IOM 100-04 Chapter 29 Section 310.6. Does CMS intend to update IOM 100-04 Chapter 29 Section 310.6 indicating that the Contractor may dismiss a request for redetermination if the Contractor has not issued an initial determination on the claim or the matter for which a redetermination is sought? An example of a situation in which this would apply is when a claim is denied as unprocessable (W status). Unprocessable claims are considered not to have had an initial determination and currently are performed as an inquiry. Please clarify the intent of this Statement of Work.	In accordance with IOM Chapter 29, Section 310.6, a case can be dismissed for cause, in that the party does not otherwise have a right to a redetermination (because no initial determination was rendered). For additional reference please see 42 CFR 405.952(b)(6).	1
J13	J-01 Statement of Work C.5.10.1.9 Acknowledgement of Redetermination Request, Page 145	This section states that the Contractor shall mail to all parties by the redetermination at their last known addresses a written notice of the redetermination decision that is accurate, clear and concise. Please confirm that the issuance of a Remittance Advice (RA) in the instance of a fully favorable decision meets this requirement and that a Fully Favorable letter is not required.	The RA does not meet the requirement in the instance of a fully favorable decision. A decision letter is required. Refer to IOM 100-4, Chapter 29, Section 310.8 for the model fully favorable redetermination notice.	1
J14	J-01 Statement of Work Section C.6.1.2.1. Supply of Appeals Case Files, Page 191	This section states that the Contractor shall supply to the QIC all appeals case file information within five (5) calendar days of request. This statement conflicts with IOM 100-04 Chapter 29 Section 320.6 which states that the Contractor has 7 calendar days. In addition, the CMS 2592 report is programmed to capture 7 days. Should this requirement be revised to state 7 days in order to comply with IOM instruction and shared system reporting?	In accordance with Section C.1 of the SOW, for purposes of this contract, when differences or conflicts occur, this SOW shall take precedence over the IOMs unless otherwise specified. The standards stated in Section C.6.1.2.1 are correct as stated.
J15	J-01 Statement of Work C.7.7.2 Internet Security -- Provider Internet Portal, page 199	Please confirm the intent of Section C.7.7.2 is for Internet portals to meet the applicable Telecommunication security administration activities listed in Section C.5.3.2 and not the activities specific to Electronic Data Interchange (EDI) administration.	Guidance for provider Internet portal architecture, security, privacy, and data interchange is included in IOM Pub.100-17, section 5, per section C.5.7.3.4 (Provider Internet Portal) of the SOW (page 125).
J16	J-01 Statement of Work C.5.7.3.4 Provider Interne Portal, page 125 and C.7.7.4 Provider Feedback -- Provider Internet Portal, page 199	Please confirm that staffing for Provider Internet Portal should be cross-referenced to SOW C.5.7.3.4 Provider Internet Portal.	Section C.7.7.4 Provider Feedback - Provider Internet Portal has been deleted in its entirety and is replaced by C.5.7.3.4 Provider Internet Portal. Please disregard any CLIN template submissions associated with C.7.7.4. These changes are reflected in the updated Attachment J-01 Statement of Work in this solicitation.
J17	J-01 SOW C.5.10.5 Administrative Law Judge Hearings	Will CMS please confirm that the reference made to the DMEMAC should be a reference to the MAC?	Updated lanaguge can be found in the new Attachment J-01 Statement of Work included in Amendment 2.
J18	J-01 SOW C.5.10.5.1 Coordination	Will CMS please confirm that the reference made to the DME QIC and DMEMAC should be references to the MAC QIC and MAC.	Updated lanaguge can be found in the new Attachment J-01 Statement of Work included in Amendment 2.
J19	J-01 SOW C.5.12.1 Development of Medical Review Strategy	Will CMS please clarify the reference made to DMEPOS benefit as we do not what should be referenced here.	Updated lanaguge can be found in the new Attachment J-01 Statement of Work included in Amendment 2.
J20	J-01 SOW C.6.1.1.1 Referrals to Quality Improvement Organizations	Clarification is needed regarding C.6.1.1.1 Referrals to Quality Improvement Organization. The SOW indicates that “the Contractor shall make appropriate referrals to the QIO for medical necessity determinations (emphasis added) in accordance with IOM Pub. 100- 04, Chapter 29, §3600; IOM Pub. 100-10, Chapter 4, §4070 C and E; and 42 CFR 476.80(b).” Additionally, the “Background” of the SOW indicates “QIOs also review cases from acute care hospitals and long-term care hospitals to make sure the care was medically necessary, provided in the appropriate setting, and coded correctly.”

However, with the implementation of CR 5849, CMS transitioned medical review for Inpatient Prospective Payment System (IPPS) hospitals and Long-Term Care Hospitals (LTCHs) to the Fiscal Intermediaries (FIs) and Medicare Administrative Contractors (MACs). The Program Integrity Manual (PIM) (IOM, Pub 100-8, Chapter 6, § 6.5.2.A clearly outlines that FIs and the MACs are now responsible for making medical necessity determinations, and therefore, a referral to the QIO is unwarranted for that reason. As per the IOM, PIM 100-8, Chapter 6, § 6.5, referrals are to be sent to the QIO for the following reasons:

• medically unnecessary procedures (§ 6.5.4)

• readmissions (§ 6.5.7.B)

• transfers (§ 6.5.8.B)

• circumvention of PPS (§ 6.5.9) It is believed that the medically unnecessary procedures (which represent a quality of care issue) should continue to be referred to the QIO, but medical necessity determinations now fall within the purview of the FIs and MACs.

Will CMS please confirm that SOW C.6.1.1.1 is no longer valid and that the referenced IOM Pub. 100-04, Chapter 29, §3600 does not exist?

Section C.6.1.1 is a MAC requriement but the section has been amended to eliminate medically necessary referrals and the IOM Pub. 100-04, Chapter 20, §3600 reference has been deleted. The revised Attahcment J-01 Statement of Work has been included in this amendment.

As per the IOM, PIM 100-8, Chapter 6, § 6.5, referrals are to be sent to the QIO for the following reasons:

• medically unnecessary procedures (§ 6.5.4)

• readmissions (§ 6.5.7.B)

• transfers (§ 6.5.8.B)

• circumvention of PPS (§ 6.5.9)

Medically unnecessary procedures (which represent a quality of care issue) should continue to be referred to the QIO, but medical necessity determinations now fall within the purview of the FIs and MACs.

1
J21	J-01 SOW C.5.4.10.3 Correcting Internal Control Deficiencies – Corrective Action Plan Process	Currently, the CAP program is not active. Does CMS anticipate that it will be active with Jurisdiction F or was the inclusion an unintentional oversight?	The MACs are to comply with the CAP program requirements as identified in Section C.5.4.10.3 of the Statement of Work.	1
J22	J-02 Deliverable Schedule C.6.1.1.1 Referrals to Quality Improvement Organizations	This deliverable does not appear to be applicable as the MAC will not be making referrals to the QIO for medical necessity determinations. Will CMS please confirm that referrals will not be made to the QIO for medical necessity determinations?	The MAC will not be making referals to the QIO for medical necessity determinations. The updated J-01 Statement of Work is included in this amendment.	1
J23	J-02 Deliverable Schedule C.5.4.3.2 for deliverable name of Corrective Action Management Process Report; C.5.4.3.4 for Incident Reporting and Response Report; and C.5.4.10.3 for Corrective Action Plan (CAP).	While RFP/SOW reference for C.5.4.3.2 is very vague and not specific to required documents, C.5.4.3.4 is very specific to the correction of security related findings and deficiencies from systems related audits such as the SAS 70, Section 912, OIG Audit, and assessments. However the Deliverables Schedule for item C.5.4.3.4 shows that an Incident Reporting and Response Report is due to CMS. Within the RFP/SOW on # per item C.5.4.3.4 there is absolutely no mention of a requirement for the Incident Reporting and Response Report. While a separate POA&M report to CMS is required according to the BPSSM, can this line in the Deliverables Schedule be eliminated, especially since the POA&M in order to meet item C.5.4.3.4 is submitted via the item C.5.4.3.2 item in the Deliverable Schedule? Regardless, these two lines seem to duplicate each other. For item C.5.4.10.3, this is another Corrective Action Plan that needs to be submitted to the OFM area. However on the Deliverables schedule for the CMS Business Owner Functional Area, perhaps OIS needs to be eliminated since the Corrective Action Management Process Report (POA&M) / for Correction of Deficiencies is already being submitted to OIS. Furthermore, shouldn’t OIS be changed to CMS/OA/CMM/MCMG/DPA?	There are two reporting methods for Corrective Actions Plans. One to OFM (Quarterly CAP Report) that is Security related findings and Financial Findings and the other is to CM/MCMG/DPA that is only Security Related Findings (POA&M). Attachment J-2 Deliverable Schedule has been updated for the C.5.4.10.3 Corrective Action Plan to include CMS/CM/MCMG/DPA in the CMS Business Owner column. The updated Attachment J-2 Deliverable Schedule is included in Amendment 2.
J24	J-02 Deliverable Schedule C.5.4.3 for the deliverable name of Information Technology Systems Contingency Plan Report and C.5.4.9 for the Comprehensive Continuity of Operations (COOP) Plan.	Both of these documents / requirements appear to be redundant. For the first reference, C.5.4.3.2 is very vague and not specific to required documents, the Deliverables Schedule does refer to the BPSSM for further guidance. For the reference C.5.4.9, the related SOW requirement name from the RFP/SOW “Business Continuity Planning and Disaster Recovery” also refers back to IOM Pub 100-17, which is the BPSSM, same as for the Information Technology Systems Contingency Plan Report from C.5.4.3. The only additional reference mentioned in C.5.4.9 is the reference to Federal Preparedness Circular 65, Federal Executive Branch Continuity of Operations Plan. Can the Deliverables Schedule requirement for the C.5.4.3, Information Technology Systems Contingency Plan Report, be eliminated since it appears to be a duplicate of C.5.4.9, Comprehensive Continuity of Operations (COOP) Plan? Both items show they should be submitted to the OIS, but shouldn’t this be changed to CMS/OA/CMM/MCMG/DPA?	Attachment J-2 Deliverable Schedule has been updated to reflect the correct CMS Business Owner. No deliverables were deleted. The updated Attachment J-2 Deliverable Schedule is included in Amendment 2.
J25	J-01 SOW C. 5.1: Workload Implementation Requirements	The table of business requirements, requirement number XXXX.1.4, indicates that the Drug Cap workload shall be combined with the Part B Alaska workload. Can CMS clarify if the Drug Cap workload is a separate CICS region? Which legacy contractor is currently handling this workload? If it is a separate CICS region that must be merged, can CMS clarify how this additional CICS merger impacts the ability to also merge the Idaho workload with the Part B Alaska, Oregon and Washington workload since the MCS system can only handle 4 separate workloads in one CICS region.	The drug Cap workload is in the same CICS region as the Part B Alaska, Oregon, and Washington workload, which is why it will no longer be identified as a separate MCS “state”.
J26	J-01 SOW C. 5.1: Workload Implementation Requirements	The table of business requirements, requirement number XXXX.5.5 indicates that the MCS maintainer shall make whatever changes are needed to accommodate the new merged CICS UAT and Production regions. Are there current claim/correspondence region code limitations in the fourth MCS state versus MCS states one, two and three? Is the MCS maintainer planning to add additional region codes in state four?	Each MCS state places restrictions upon allowable regions for that state, and therefore, if a legacy workload’s MCS state is changed, it is possible that some claims will have to be moved to another region as part of the transition process. The MCS maintainer will consult with the MAC prior to making any such change. It is likely that this will only occur if the Idaho Part B workload is merged with the existing Alaska, Oregon and Washington Part B workloads. That decision will be made following consultation with the MAC.	1
J27	J-01 SOW C.5.3.1.1.1 HIPAA Compliant Translation Software	The SOW indicates: “The translation/validation software package shall provide: Translation and editing of the outbound flat files for the X12N 277 claim status and X12N 835 remittance advice received from the shared system into the HIPAA-compliant X12N transactions.” Should this SOW reference include the X12N 277 claims acknowledgement transaction?	This SOW reference does include the X12N 277 claims acknowledgement transaction, in the third bullet:

“The production of a ASC X12 999 acknowledgement file, ASC X12 TA1 (X12 transactions only), or if specified at a later date, alternate ASC X12 or ASC X12N transactions designed for acknowledgement, error reporting, or claim development, e.g., 999 acknowledgement, 277 claim acknowledgement and 824 non-claim acknowledgement for the submission of error reports back to the submitter.”	Size	Categories
	J28	J-01 SOW C.5.3.2.1.1 EDI Enrollment Form	The SOW indicates: “The Contractor shall prepare to gather the information from the EDI enrollment/registration package (OMB 0938-0983A & 0938-0983B) package.”

Does CMS expect this to occur during the Contractor’s implementation or ongoing phase? Will CMS allow the current existing EDI Enrollment forms to be maintained on file or will EDI OMB forms be required for EDI trading partners?	CMS is not requiring the use of the new forms at this time.	1
	J29	J-01 SOW C.5.3.2.6 CMS Certification/Recertification Testing Program	The SOW states: “The Contractor shall, on an annual basis perform the MAC Front End Recertification activities in conjunction with direction from CMS and in cooperation with the Single Testing Contractor (STC). The initial Certification of the MAC Front End Certification must be completed prior to exchanging transactions (ASC X12 or other standard transaction) with the MAC’s trading partner community. The MAC shall initiate a Joint Operating Agreement (JOA) with the STC contractor for the Certification Testing Program if no JOA for this activity exists. Should a JOA exist between the STC for other testing activities, then this Certification Testing Program activity shall be added to that JOA.”

Since 5010 will not be in production until 2012, is it correct to assume that the first recertification effort will not occur until 2013?	5010 is in production as of January 1, 2011. The initial Certification Testing will be completed by then. For planning purposes, the offeror should plan to undergo a re-certification test during 2011.
	J30	J-01 SOW Section C.5.4: Administrative Requirements	Throughout Section C.5.4, the SOW specifies that certain key personnel must be, “dedicated to Medicare lines of business”, meaning that the individual identified for the position may work on more than one MAC contract, or more than one Medicare contract. This individual may not perform duties on any non-Medicare line of business without approval by the Contracting Officer. When CMS refers to a “non-Medicare line of business” in this statement, is that reference to private commercial lines of business?	Non-Medicare line of business references private commercial lines of business and all other non-Medicare lines of business.	1
	J31	J-01 SOW C.5.4.1.3 Chief Financial Officer	The SOW requires the Chief Financial Officer to have “an accounting degree from a four-year college or university, and possess an active Certified Public Accountant (CPA) license, or meeting the eligibility requirements to sit for the CPA examination”.

Prior to the late 1980s, a Bachelor’s Degree in Accounting was not a standard offering in colleges and universities within the United States. Rather, a person wishing to pursue a career in accounting or their CPA license did so by acquiring a Bachelor’s Degree in Business Administration with a major in Accounting. The curriculum for a Bachelor’s in Business Administration included such fields of study as accounting theory, financial statements, cost accounting, taxes, auditing, and financial analysis. A Bachelor’s Degree in Business Administration with a major in Accounting meets the educational requirement for a candidate to sit for the CPA exam. As such, A Bachelor’s Degree in Business Administration with a major in Accounting meets CMS’ education requirement of “an accounting degree from a four-year college or university. Does CMS concur?	All resumes for these positions are evaluated to determine the acceptablity of the person proposed. Offerors shall demonstrate how their proposed Key Personnel staff meet the requriements of the SOW and CMS concurs that the case that you illustrate meets CMS' education requirement.	1
	J32	J-01 SOW C.5.7.1 Provider Outreach and Education	This section refers to IOM Pub. 100-09, Chapter 6, §20.3, but that is primarily the section for POE data analysis. Should this reference include all of Chapter 6, §20?	The MAC SOW C.5.7.1 Provider Outreach and Education has been updated to reflect this change. The change can be found in the updated Attachment J-01 Statement of Work in this solicitation.	1
	J33	J-01 SOW C.5.7.1 Provider Outreach and Education	This section states that “Measurement tools will be provided to the contractors by CMS. See Appendix C for more information.”However, Appendix C of the SOW addresses data release policies and procedures, not measurement tools. Can CMS provide the measurement tools?	Meassurement tools refer to the templates for the Provider Service Plan and the Education Activity Report.
	J34	J-01 SOW C.5.7.1.1 Data Analysis	This section refers to IOM Pub 100-09, Chapter 6, §20.2, should this reference be Chapter 6, §20.3.	Chapter 6, §20.3 is the correct reference. Attachment J-01 Statement of Work has been updated and is included in this solicitation amendment.
	J35	J-01 SOW C.5.8.1.1 Direct Data Entry Support	The SOW states that the “Contractor shall provide connectivity for the remote providers to access Direct Data Entry (DDE)”.
Can CMS clarify if the Contractor must provide the DDE access through its own local data center or is the access provided through a CMS approved third party vendor directly to the Enterprise Data Center? As a result of the transition to Enterprise Data Centers, MACs no longer offer DDE access through their own local data centers.		1
	J36	J-01 SOW C.5.10.1.2 Document Imaging and Indexing	The SOW requires all redetermination requests be scanned, including documentation and incoming correspondence supplied in support of the request. Document imaging shall include scanning a claim in its entirety when it reaches the MAC, performing Quality Assurance (QA) on scanned images, indexing the scanned images, and using these scanned images to make a decision on the claim. At a minimum, all images shall be indexed by date scanned, MAC contract number, claim number and beneficiary HICN. The contractor shall electronically image and index all redetermination correspondence upon receipt in the corporate mailroom. Please clarify if using a single, reliable index to accomplish retrieval meets the requirements of this SOW section, versus using multiple indexing references (e.g., HIC, claim number).	The SOW requires that at a minimum, all images shall be indexed by date scanned, MAC contract number, claim number, and beneficiary HICN.	1
	J37	J-01 SOW C.5.10.5 Administrative Law Judge Hearings	The first sentence of this SOW section indicates that the contractor will participate in the Administrative Law Judge (ALJ) hearing process as a participant (see 42 CFR 405.1010). However, in the next paragraph it states the contractor should establish a process for assessing the notices of hearing received to determine which cases should be selected for participation. Are the MACs required to participate in all ALJ hearings or can they select which hearings to attend?	As stated in the SOW, C.5.10.5, "A process should be established by the contractor for assessing the notices of hearing received to determine which cases should be selected for participation. Offerors can establish their own criteria for participation as stated later in the same section. Factors to be examined should include; policy implications, dollars at issue, program integrity matters, and the extent to which a particular issue is or has been, a recurring issue at the ALJ level. Participation as a participant affords contractors an opportunity to submit position papers and to provide oral testimony. Contractors should ensure that a minimum of 60% of the participation includes position papers, in hearings of which you are notified. Contractors should also ensure that a minimum of 40% of the participation includes oral testimony, in hearings of which you are notified. The workloads associated with the ALJ Hearing Participation/Support has been corrected and can be found in the updated Section L.11 of this solicitation. The revised total is inclusive of both Part A and Part B hearings.	1
	J38	J-01 SOW C.5.11.2: Banking Relations	The SOW references the recent transition to the CMS approved banks (U.S. Bank, JP Morgan Chase). Once a contractor is identified for this MAC jurisdiction, will a Bank transition be needed during the implementation period should the incoming MAC’s current bank be different from the current bank servicing this workload?	Yes, the Medicare claims processing contractors will only deal with one bank. Therefore, if the successful offeror has a relationship with another bank other than those identified in section C.5.11.2 of the SOW, an a transition to the new bank, during implementation will be needed.	1
	J39	J-01 SOW C.5.11.4 Non-MSP Overpayment	The second paragraph of this SOW section states: “For HIGLAS workloads, due to the interest accrual grace period, the second and third demand letters are issued on day 36 and 66 to ensure the correct interest amounts are included in the second and third demand letter.”

It is our understanding that the HIGLAS third demand (intent to refer letter) is generated out of HIGLAS on day 126 (not day 66). Does CMS intend to modify the intent to refer letter timeline or is this a typo?	The third demand letter issued from HIGLAS is on day 66 for Non-MSP debts.
	J40	J-01 SOW C.5.11.4.4 PSOR and POR Systems	This SOW states: “Carriers & Intermediaries and/or MACs that have not transitioned to HIGLAS are no longer required to enter and update certain overpayments into the PSOR & POR”. It appears that the word “not” should be deleted, please clarify.	The SOW has been updated to correct this section and has been included as part of this Amendment.
	J41	J-01 SOW C.5.11.5 Non-MSP Debt Collection Activities	The 3rd paragraph of this SOW section states: “In addition, the contractors are required to report back to CMS CO the cumulative dollar amount of the recoveries up to four times per year…”

The prior sentence speaks to all overpayments, including overpayments resulting from OIG audits. Is this reporting to CMS up to four times per year requirement specific to only OIG audit related overpayments?	YES, this was a change in the ongoing JSM for OIG Reporting published in April/May 2010.	1
	J42	J-01 SOW C.6.1.2.1 Supply of Appeals Case Files	This SOW section states: “The Contractor shall supply to the QIC all appeals case file information, within five (5) calendar days of request.”

The IOM states in Pub.4, Chapter 29, Section 320.4 that “Contractors shall send/transmit the case file within 7 calendar days of the date of the QIC's request”. Please clarify the timeframe requirement for supplying case files to the QIC.	In accordance with Section C.1 of the SOW, for purposes of this contract, when differences or conflicts occur, this SOW shall take precedence over the IOMs unless otherwise specified. The standards stated in Section C.6.1.2.1 are correct as stated.
	J43	J-02 Deliverable Schedule - C.5.11.2.3.2 - Deliverable SOW Reference	Estimated Allowance for Uncollectible Accounts has a due date of “4 days after quarter end” for HIGLAS contractors. The HIGLAS CFO reports do not close until the 4th day after the end of the quarter. Would CMS consider revising the due date to 5 days after quarter end?	The 4th working day after quarter end is the HIGLAS standard for all HIGLAS contractors for both of these activities.
	J44	J-02 Deliverable Schedule - C.5.11.9 –Deliverable SOW Reference	Financial Reporting and Accounting addresses CFO reporting requirements for non-HIGLAS workloads only. Will CMS specify the equivalent reporting requirements for HIGLAS workloads?		1
	J45	J-05 GFP	Government Furnished Property Name: Shared Systems—FISS
Reference is made to SuperOps being included within the FISS core system. Please confirm that ECPS will be part of the FISS shared system.	ECPS is part of the FISS System. ECPS is not a requirement but rather an option available to Offerors to use should they choose to do so.
	J46	J-05 GFP	Government Furnished Property Name: Training Materials (national)
Can CMS provide insight into what is meant by training materials related to SOW C.5.4.4 Quality Improvement, and what will be included with the materials?	Training Materials (national) has been deleted from the Deliverable Schedule. An updated Attachment J-02 Deliverable Schedule is included in this solicitation.	1
	J47	J-22 CFP - C.5.3.2.2.2 – Common Edits and Enhancement Module (CEM) Software components and hardware	Websphere Message Broker is listed as a requirement. The CEM developers currently do not require Websphere Message Broker in order to operate the CEM. Will CMS remove this requirement from Attachment J-22 or will Websphere Message Broker be a requirement in this solicitation?	Websphere Message Broker is not required for CEM at this time. The updated Attachment J-22 Government Furnished Property is included in this solicitation amendment.
	J48	Section C.5.10.5 Page 146, Administrative Law Judge Hearings. Section	C.5.10.5 Administrative Law Judge states contractors will participate in the ALJ hearing process as a participant and recommend to the Project Officer instances where they believe the DMEMAC should invoke party status. Please clarify if the DMEMAC reference is accurate.	The Statement of Work has been corrected and can be found in the updated Attachment J-01 of this solicitation.
	J49	SOW C.5.11.1.1, Page 149 indicates that the Contractor is to designate an alternative CFO.	Are the Offerors required to identify and submit a resume for the alternate CFO with their initial proposal?	Offerors are not required to submit the resume of any personnel not identified as Key Personnel in the solicitation.

&D A/B MAC Jurisdiction F

Amendment No. 000002 &9&A &9&P

Section L

ID	Section	Question	Answer/Action	Amendment 1?	Amendment #
L1	P. 85, L9 Proposal Submission and Delivery	Page 85, L.9 Proposal Submission and Delivery. L.9 of the RFP states one original and seven copies of the Business Proposal – Volume II, plus seven CD-ROM copies of the Business Proposal Cost Templates should be submitted. However, on page 115 of the RFP, it states “Volume IIA Business Proposal Cost Templates - (CD-ROM), which suggests the Volume IIA templates should be submitted on CD-ROM only. Please confirm that it is acceptable to only submit Volume IIA Business Proposal Cost Templates on CD (one CD per box).	MCMG Suggested Response based on January 2010 response to the same question in the DME MAC Jurisdiction A competiton: Hard copies of the Business Proposal are required along with the CD-ROM format.
L2	P. 94 & 103, L. 11 Proposal Assumptions	Page 94 and 103, L.11 Proposal Assumptions. On page 103 the 'note' for RAC Adjustments Part A (Claims) states the appeals rate CMS generally uses is between 5-10% for workload estimates. The Part A RAC Redeterminations workload on page 94 is actually 20.58% of the RAC workload listed on page 103 (referencing base year as example). Please clarify appeals workload / rate for this workload for both Part A and B.	The Note associated with the RAC workload has been modified. Offerors shall propose to the workloads as stated in the updated Section L.11 of the solicitation.
L3	P. 97, L.11 Proposal Assumptions	Page 97, L.11 Proposal Assumptions. The Wage Index Reviews workload provided doesn’t appear to be accurate. The workload provided is 2,589 for Option Year 1; however, there are only 219 Acute Hospitals on which wage index reviews would be conducted. At most, the workload should be 219. Please clarify the numbers for this workload.	The Wage Index Reviews workload has been updated. The new workload assumption are found in the updated Section L.11 of the solicitation.
L4	P. 97, L.11 Proposal Assumptions	Page 97, L.11 Proposal Assumptions. There is no Interim Rate Review (or other reimbursement-type workload) provided in the Provider Reimbursement and Audit section of the table. Please provide the reimbursement workload.	A workload for Interim Rate Reviews has been added to the workload assumptions found in Section L.11 of this solicitation.	1
L5	P. 98, L.11 Proposal Assumptions	A workload is not provided for the Part B Inquiries backlog- Written Correspondence pending. Are bidders to assume that there will be no backlogs If backogs are expected, would CMS provide the number for this workload?	There is no Part B Inquiries Backlog - Written Correspondence Pending. The workload category has been deleted from the updated Section L.11 of the solicitation.	1
L6	P. 98, L.11 Proposal Assumptions	Page 98, L.11 Proposal Assumptions. The backlog provided for Part A Inquiries Backlog – Written Correspondence Pending is 811 in the base year, and continues into Option Years 1-4. Please clarify if the workload for the option years should be listed as zero.	The Part A Inquiries Backlog-Written Correspondence Pending workload has been updated. The new workload assumptions are found in the updated Section L.11 of the solicitation.
L7	P. 99, L.11 Proposal Assumptions	Page 99, L.11 Proposal Assumptions. There appears to be workload numbers for non-MSP Part B demands under the heading of ‘PM Non-MSP overpayment Demand letter sent,’ as well as under the heading of ‘PM Non-MSP Overpayments for Part B’. Please confirm the workload numbers for Non-MSP Part B Demands.	The workload numbers are the total of all demand letters sent (1st,2nd and 3rd-ITR). A notation has been added to both Part A and Part B. The changes are found in the updated Section L.11 of this solicitation.	1
L8	P. 101, L. 11 Proposal Assumptions	Page 101, L.11 Proposal Assumptions. MSP On-site Hospital Reviews/Audits appear to be overstated. RFP section C.5.14.5, "Each year the Contractor shall conduct a review of 10% of the hospitals up to a maximum of 20 per state in its jurisdiction." Since the maximum workload would be 10% of the total number of hospitals (471 Acute and Critical Access Hospitals stated on page 97), the maximum number of MSP Hospital Audits would appear to be 47 in Option Years 1-4 (32 in the Base Year). Please clarify.	CMS agrees that the numbers in the table are incorrect. For all of JH, a total of no more than 47 hospitals would be reviewed during all option years while that number would be 24 for the base year. The workload chart in Section L.11 of the solicitation has been updated to reflect this change and is included as part of this Amendment to the solicitation.
L9	P. 103, L. 11 Proposal Assumptions	Page 103, L.11 Proposal Assumptions. For RAC Adjustments Part A (Claims) - SLIN 000XAG, please clarify if the note regarding percentage of workload that is considered appeals, collections, and treasury are also applicable to Part B. If not, are there assumptions available for the Part B workload?	The appeals, collections and treasury workload percentages apply to both Part A and Part B.
L10	P. 108, Tab B, L14. b	Page 108, Tab B: Past Performance Instructions. L.14.b states that Past Performance Questionnaires (PPQs) will be kept on file and used for all current and future proposals. If a contractor has PPQs on file from a recent proposal submission, do new PPQs need to be completed that identify MAC Jurisdiction F?	PPQs from previous MAC procurements (DME re-competes) can be used for upcoming A/B MAC procurements as well.
L11	P. 115 and 118, L. 15	Page 115 and 118, L.15 Volume II – Business Proposal Organization and L.16.a Volume IIA – Business Proposal Cost Template Instructions. The information being requested in Tabs 1 through 8 of Volume IIA - Business Proposal Cost Templates is included in Tab 9 - Cost Templates. Please provide instruction to bidders on how you would like this information broken out for Tabs 1-8.	Section L.15 Volume II - Business Proposal Organization and L.16.a Volume IIA - Business Proposal Cost Template Instructions have been revised and are included in the updated solicitation document incorporated in Amendment 2.
L12	L. 16	Page 1, Amendment 1 – Section a. Volume IIA - Business Proposal Cost Template Instructions. L.16.a (Amendment 1) states the cost templates (CLINs 0002-0006) are submitted at the SLIN level only. For example on attachment J-12, do we submit the CLIN tab (CLIN-0003) which includes the SLINS or do we submit the SLIN tab (SLIN-0003AA) which includes WBS’s?	Both the SLIN and the CLIN worksheets shall be submitted. Offerors shall submit the costs for the SLIN level (e.g., SLIN 0000XAA) and roll up all SLIN costs into the corresponding CLIN level.
L13	Section L.9 Proposal Submission and Delivery page 85 and L.15 Volume II Business Proposal Organization, page 115	Do we need to print the Cost Templates in Volume IIA? In Section L.9, the instructions request “One (1) original and seven (7) copies of the Business Proposal – Volume II; plus seven (7) CD-ROM copies of the Business Proposal Cost Templates”. However, in Section L.15 section (1), states, “Volume IIA Business Proposal Cost Templates – (CD-ROM)”. Please advise if CMS would like the Cost Templates on CD only, or if CMS would like printed copies.	MCMG Suggested Response based on January 2010 response to the same question in the DME MAC Jurisdiction A competiton: Hard copies of the Business Proposal are required along with the CD-ROM format.
L14	Section L.11 a. Implementation Cutover Date, p. 92	In this section, CMS defines the implementation cutover dates for offerors to use when preparing their bids. Please clarify the implementation cutover date of “6/20/11” for the “AZ/MT/UT/ND/SD/WY” Part A workload considering the anticipated award date, as outlined in section L.11.c. (page 93), is July 1, 2011.	The implementation cutover dates have been updated and can be found in the updated Section L.11 of this solicitation.
L15	Section L. 11 Proposal Assumptions-Workloads, p. 94	Under PM Appeals Part A & B of A Workload, the Total Reopenings totals are the same, 1,762, every Option Year, while the Clerical Error Reopenings workloads increase each Option Year. Please clarify whether a contractor should bid to the Clerical Error Reopenings workloads and not the Total Reopenings workloads.	Workload numbers have been revised and can be found in the updated Section L.11 of this solicitation.
L16	Section L.11 Proposal Assumptions- Workloads, p. 94	The clerical error reopenings volume is significantly higher than the non-clerical error reopenings volume. Experience shows that the opposite is true. All mass adjustments, overpayment set-ups, fee schedule adjustments, claims adjustments and most big box cases are done as non-clerical error reopenings. As stated on page 94, the Clerical Error Reopenings volume is inconsistent with current workloads and will have a significant negative impact on projected staffing. Please confirm that the volumes as printed on page 94 are correct.	Offerors shall process both clerical and non-clerical errors, as appropriate. The workloads provided are correct and shall be used in preparation of the proposals. These workloads can be found in Section L.11 of this solicitation.	1
L17	Section L.11 Proposal Assumptions - Workloads, page 94-95 and Statement of Work C.5.10.5.2 Participation in the ALJ Hearing, pages 147	Section C.5.10.5.2 states "...Participation may include filing position papers and providing testimony to clarify factual and policy issues involved in a case." The workload provided in Section L.11 of the RFP indicates 229 ALJ Hearings Participation/Support for Part A and 208 ALJ Hearings Participation/Support for Part B.

Please confirm that CMS is requiring the JF MAC to participate/support a total of 437 ALJ Hearings in Option Year 1.

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Nov 14, 2017.