AB MAC JH Offeror Questions First Set Answered.xlsx

Intent to Bid

&D A/B MAC Jurisdiction F

&9RFP-CMS-2010-0050

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

Section B

Section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 has a provision that states, “October 1, 2011 Effectively, FI and Carrier contracts must end on this date; all Medicare contract performance periods beginning on or after this date must attach to contracts that were let through competitive procures using the new authority.”

In the event of any delay in awarding this contract would seem to postpone the implementation of the Jurisdiction H. Should this event occur, will the government then attach all FI and Carrier contracts that were let through competitive procures? Please explain.

No Comment

&D A/B MAC Jurisdiction F

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

Section C

Statement of Work C.5.7.2.2.1 IHS Provider Inquiries, page 198 Please clarify whether it is a requirement to have a dedicated toll-free number for IHS or whether these calls can come into the normal provider services toll-free line as long as there is a mechanism to route IHS calls directly to Provider Assistance Liaisons.

22. Section C.5.5 – Provider Enrollment Question/Comment: This section of the SOW states “…For providers who are participating in the Medicare program but do not have an established record in PECOS, the Contractor shall require these providers to complete and submit a complete Medicare enrollment application ( the Internet-based PECOS enrollment application or applicable paper CMS-855, to establish such a record.”

a. Please indicate if this revalidation workload is part of the revalidation workload noted in the workload assumption section of the final RFP.

b. Please provide the volume of providers who don’t have an established PECOS record by CLIN.

a. Is it CMS’ intent to index images only for those Appeals that are being requested by the QIC? Requiring this indexing of all appeals may not have a positive return on investment.

b. Please confirm the date required in the index is the scan date and not the Julian date.

24. Section C.7.2 Indian Health Services Question/Comment: C.7.2 Indian Health Services are included in this jurisdiction. Is there reimbursement and audit work related to the Indian Health Services? Have the provider count and workload been included in the RFP?

25. Section C.7.4 Rural Community Hospital Demonstration Question/Comment: This SOW has a requirement for on-site field audits. Are these audits included in the RFP workload?

C.5.3.1.1 Local Hardware and Software Requirements Question/Comment This section of the JH SOW states “The Contractor shall provide hardware and software identified in Attachment J-22, Contractor Furnished Property (CFP)……”, This appears to be an incorrect Attachment reference. Please clarify that the Contractor Furnished Property reference should be Attachment J-05.

C.5.3.1.1.3 Part B Non-HIGLAS Workload Merge Question/Comment The JH SOW states, “The Contractor shall provide project management, testing, and other services to successfully merge the Idaho Part B Customer Information Control System (CICS) region with the combined Alaska, Oregon, and Washington Part B CICS region at the CDS EDC. Please clarify that this section of the JH SOW should state that the Arkansas, Louisiana, and Mississippi Part B CICS regions will be merged into one CICS Region at the CDS EDC.

C.5.3.1.1.3.3 Mappings, Duplicate PINs, and Testing Question/Comment The JH SOW states that the Contractor shall perform work on Alaska, Oregon, and Washington mappings, duplicate provider identification numbers and testing. Please clarify that this section of the SOW should state the Contractor shall perform work on Arkansas, Louisiana, and Mississippi mappings, duplicate provider identification numbers, and testing.

C.5.3.2.1 Telecommunications for Electronic Data Interchange Question/Comment This JH SOW requirement states the Contractor shall interact with the Individual Authorized Access to the CMS computer services (IACs) to ensure the EDI submitter/receiver is an authorized EDI submitter for each transaction. The use of IACs to validate each EDI transaction could add significant overhead to the EDI framework. If the offeror is an existing A/B MAC, could they use their existing translator, which has a built-in trading partner validation, instead of adding the IAC’s loop?

C.5.3.2.6 CMS Certification/Recertification Testing Program Question/Comment This JH SOW section states that 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. Should the contractor assume that the JOA and certification must be completed prior to any transaction being exchanged, in both the test and production environments?

C.5.4.1.11 Contractor Medical Director (CMD) Question/Comment C.5.4.1.11 states that the offeror must employ a “minimum of one (1) FTE CMD for each line of Medicare business per contract” and “one CMD will be in an executive management role”. We assume that CMS is looking for offerors to propose the “one (1) FTE CMD” as the key personnel. Please confirm.

7. C.5.4.8.1 Review and Comment on Draft Change Requests Question/Comment C.5.4.8.1 states “No response is required if the Contractor concurs with the Change Request (CR).” Please confirm this requirement as it is a change in CMS’ current A/B MAC requirement covered in JSM/TDL-08436, 08-06-1850.

8. C.5.10.1.2 Document Imaging and Indexing Question/Comment C.5.10.1.2 states, “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 that using a single, reliable index to accomplish retrieval meets the requirements of C.5.10.1.2, versus using multiple indexing references (e.g., HIC, claim number).

9. C.5.10.1.3.1 Acknowledgement of Redetermination Requests Question/Comment This requirement states the Contractor is required to acknowledge the request for redetermination within 14 calendar days of receipt of the request in the Contractor’s mailroom. At a minimum, the acknowledgement shall identify the date the request was received, the items/services/claims at issue and verbiage indicating the appeal shall be completed within 60 days of receipt. Requiring the inclusion of the item/services/claims at issue is currently not required in the acknowledgement of redetermination requests. Requiring this information for JH will be labor intensive because this information will be difficult to identify without doing significant manual research, thereby taking resources away from processing the redetermination. Providers often submit multiple claims in large volumes as a single redetermination request. Would this requirement mean that all claims included in the redetermination request need to be acknowledged? Would CMS consider requiring only the Health Insurance Claim Number (HIC) for this requirement?

10. C.5.11.3.2.5.2 Audit Plan Question/Comment This JH SOW requirement states that “The audit plan shall include any cost report in which the Contractor will start audit during the year”. Should this statement more appropriately be worded “the audit plan shall include any cost report in which the Contractor will start and complete audit during the year”?

11. C.5.11.4.3 Description Question/Comment This SOW section states that the RAC will send out the first demand letter and all other letters pertaining to the RAC overpayment will be sent by the Medicare Contractor. Please confirm for RAC overpayments that the only follow-up demand is the Intent to Refer Letter (IRL), and that there is no requirement for the MAC to send out a second demand letter prior to the IRL.

12. C.5.15.1 Review of Provider Billing Records Question/Comment Are “billing records” synonymous with “claims?” Please clarify how this activity differs from Medical Review data analysis. If the same, should the Contractor notify CMS regarding each probe review that is conducted, (e.g., the provider has “aberrant billing”)? If different, please clarify what is meant by aberrant billing in this scenario. Clarify if this same definition applies in SOW requirement C.5.15.2 (Review of Comprehensive Outpatient Rehabilitation Facility Billing Records).

13. C.6.1 Successful Collaboration with Entities Requiring Joint Operating Agreements Question/Comment Section C.6.1 of the SOW requires the MAC to execute a JOA with various business partners, including the EDC and MSPRC. Historically, we have found that the EDCs and MSPRC have not had similar requirements in their contracts with CMS to have JOAs with the MACs. Does CMS intend to require these business partners to have JOAs with the MACs?

14. C.6.1.2.1 Supply of Appeals Case Files Question/Comment 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 seven (7) calendar days of the date of the QIC's request”. Please clarify the timeframe requirement for supplying case files to the QIC.

15. C.7.9.1 Frontier Extended Stay Clinic Demonstration: Medical Review Question/Comment Please provide an estimated workload for this activity.

16. C.7.10 Pay for Performance Check-Writing Question/Comment Will the incentive and bonus payments for Medicare demonstration projects be made via EFT or check, or both?

&D A/B MAC Jurisdiction F

Amendment No. 000002 &9&A &9&P http://www.cms.hhs.gov/DemoProjects Section F

Section Question Answer/Action

&D A/B MAC Jurisdiction F

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

Section G

&D A/B MAC Jurisdiction F

RFP-CMS-2010-0050

Amendment 000002 Section G

Section H

The JH RFP states that NARA compliance will be enforced on this procurement. Please clarify if the records for the JH contract are currently stored in a NARA compliant facility? If so, could a list of the NARA compliant facilities be provided with the vendor name and location?

The records for JH are not currently stored at a NARA compliant facility. For estimating purposes: J4-Trailblazer has 278,948 cubic feet of paper records; and Pinnacle has 87,516 cubic feet of paper records (Arkansas, Louisiana, and Mississippi).

&D A/B MAC Jurisdiction F

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

Section I

&D A/B MAC Jurisdiction F

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

Section J

17. Section C.6.1 Initial Joint Operating Agreement Deliverable Question/Comment The list of parties with whom the JH MAC is required to initiate a JOA is not consistent with the list of required JOAs in Section C.6.1 of Attachment J-01, Successful Collaboration with Entities Requiring Joint Operating Agreements. Attachment J-02, Deliverables Schedule, lists the following parties: Program Safeguard Contractors (PSCs) with Benefit Integrity (BI) task orders; other specialty PSCs, if applicable; Qualified Independent Contractors (QICs); Administrative Qualified Independent Contractors (AdQICs); Quality Improvement Organizations (QIOs); Recovery Audit Contractors (RACs); Beneficiary Contact Center (BCC); and Enterprise Data Center (EDC). Attachment J-01, Section C.6.1., lists the following parties: AdQIC, Appeals Support Contractor, BCC, EDC, PSC/ZPIC, QIC, QIO, RAC, and MSPRC. Please clarify which Attachment represents the appropriate reference for the required initial JOAs for the JH MAC.

18. Section C.6.1 Updated Joint Operating Agreement Deliverable Question/Comment The list of parties with whom the JH MAC is required to update JOAs is not consistent with the list of required JOAs in Section C.6.1 of Attachment J-01, Successful Collaboration with Entities Requiring Joint Operating Agreements. Attachment J-02, Deliverables Schedule, lists the following parties: PSCs with BI task orders; other specialty PSCs, if applicable; QICs; AdQICs; QIOs; RACs; and BCC. Attachment J-01, Section C.6.1, lists the following parties: AdQIC, Appeals Support Contractor, BCC, EDC, PSC/ZPIC, QIC, QIO, RAC, and MSPRC. Please clarify which attachment represents the appropriate reference for the required updated JOAs for the JH MAC.

&D A/B MAC Jurisdiction F

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

Section L

This implies that only 1 CD containing all Volumes should be submitted, in addition to the 5 CDs containing only Volume IIA, the Cost Templates, total of 6 CDs.

However, Section L.9.i states, "Each box shall contain (a) Volume I Technical Proposal, (b) Volume IIA and IIB, Business Proposals, (c) Volume III Conflict of Interest, and (d) Electronic copies/compact disks (CDs) of Volumes I, II, and III."

This implies that each box should contain 3 CDs (1 for Volume I, 1 for Volume II, and 1 for Volume III), and since there will be 6 boxes (1 for Original, 1 for Copy 1 of 5, etc.), that would be 18 CDs total, in addition to the 5 CDs containing only Volume IIA, the Cost Templates.

Please clarify the number of CDs needed. In addition, which box should the 5 CDs containing only Volume IIA, the Cost Templates, be packaged?

CLIN 0001: $ 50,000

CLIN 0002 $140,000

CLIN 0003 $240,000

CLIN 0004 $240,000

CLIN 0005 $240,000

CLIN 0006 $240,000

CLIN 0007 $0

CLIN 0008 $ 50,000

a. Please confirm that the travel costs listed above are intended to capture all travel costs associated with the conferences discussed in Section L.10, paragraph m as well as any other travel required to perform other requirements in the Statement of Work.

b. Please clarify whether the offeror can propose travel costs less than the amounts listed in Section L.15 if based upon Corporate experience they believe actual travel costs to be lower than those provided in the RFP.

c. Please confirm that the offeror is still required to prepare the travel template included in the Cost Proposal templates and if so please clarify whether the costs in the travel templates must reconcile to the travel costs by CLIN included in Section L.15.

Please clarify that Offerors should price at the SOW level but should only submit the CLIN-000X, ODC, and Travel tabs included in the Cost Proposal templates and that the SLIN-000X and individual SOW tabs should not be submitted.

In Section L.8, CMS indicates: “In addition, one (1) copy of each of the Proposals (Volumes I, IIA, IIB, and III), in their entirety, shall be submitted electronically on a CD-ROM submitted in Microsoft Office Word or Excel, version 2007.” It also indicates: “the Business Proposal Cost Templates (on CD-ROM, 5 (five) copies)”

Section L.9.i. Binding and Labeling indicates: “Each box shall contain (a) Volume I Technical Proposal, (b) Volume IIIIA and IIB, Business Proposals, (c) Volume III Conflict of Interest, and (d) Electronic copies/compact disks (CD) of Volumes I, II, and III. The electronic copies of the business proposal templates shall be unprotected and include all formulas utilized in the formation of the spreadsheets.”

11. Section L.10.e Proposal Assumptions - Workloads, page 88 This section does not provide IHS workloads. Please clarify the workloads and provider counts for the IHS and whether CMS included them with the other workloads.

12. Section L.10.e Proposal Assumptions - Workloads, page 90-91 Does CMS contemplate an expected level of Provider Education and Outreach support for IHS providers other than that provided to the rest of the provider customer base?

13. Section L.10.e Proposal Assumptions - Provider Reimbursement and Audit Workloads, page 91 For the "Audits" category, please clarify what the two sets of workload numbers (140 and 307) for Option Year 1 represent. All other workload numbers for Provider Reimbursement and Audit only include one workload number.

14. Section L.10.e Proposal Assumptions - Provider Reimbursement and Audit Workloads, page 91 Please provide the desk review workloads broken down between full desk reviews and limited desk reviews.

15. Section L.10.e Proposal Assumptions - Provider Reimbursement and Audit Workloads, page 91 CMS' workload for Cost Report Settlements for Option Year 1 is 216. The total number of hospitals and other facilities reflects 6,074 in Option Year 1. The workload number for cost report settlements (216) appears to be significantly understated compared to the total number of hospitals and other facilities (6,074). Almost all hospitals and other facilities file cost reports, which will need a Cost Report Settlement as described in the SOW C .11.3.2.6 Final Settlement Section. Please clarify the workload for cost report settlements.

16. Section L.10.e Proposal Assumptions - Provider Reimbursement and Audit Workloads, page 91 CMS' workload for Desk Reviews for Option Year 1 is 704. The total number of hospitals and other facilities reflects 6,074 in Option Year 1. The workload number for cost report Desk Reviews (704) appears to be significantly understated compared to the total number of hospitals and other facilities (6,074). The Contractor is responsible for performing desk reviews of institutional providers filing cost reports (except Hospice and no/low Medicare utilization cost reports) as described in the SOW C .11.3.2.3 Desk Reviews Section. Please clarify the desk review workload.

17. Section L.10.e Proposal Assumptions - Workloads, page 93 What are the IHS telephone/written inquiry workloads?

18. Section L.10.e Proposal Assumptions - Workloads, page 93 Please describe and compare the level of complexity for Indian Health Services provider or patient inquiries relative to other call center workload.

19. Section L.10 Proposal Assumptions – Workloads, page 93 In this section, CMS provides Provider Telephone and Written Inquiry workloads. Please clarify and confirm the definition of these workloads includes both IVR and portal workloads.

20. Section L.10.p Proposal Assumptions, Postage and Printing Costs, page 103 Please clarify whether the 3% escalation should be applied only to postage costs or to postage and materials.

21. Section L.13 Tab C.2: Innovations, page 107 thru 108 & Section L.15.b Tab F.1: Business Proposal Assumptions, page 116 Please clarify whether the Offerors should only include the cost of implementing innovations in Tab F.1 (Business Proposal) or whether the Offerors should also include the expected cost savings of innovations in Tab F.1 (Business Proposal)?

3. Section L.10 Proposal assumptions Question/Comment: AR, LA and MS workload (old J7 workload) has an implementation and base period but CO, NM, OK and TX (old J4 workload) just has an implementation period and no base period. Operations per page 87 start 11/1/11 and 7/23/12 but per page 98 the old J4 workload implementation period ends 8/4/12. Can CMS please clarify? Will there be a base period for the old J4 workload?

4. Section L.10.e. – Annual Workload Assumptions Question/Comment: Can CMS define “backlog- pending” workload noted throughout the workload table?

5. Section L.10.e. – Annual Workload Assumptions Question/Comment: The workload assumptions included under MIP Medical Review (MR) Part A and Part B include two workload items that are not described in the MAC JH SOW or the Program Integrity Manual and they are not reportable workloads in CMS’ MR Strategy Web portal. These include “Medical Review Data Requests” and “Medical Review Limited Education.” Is there a description of the activities represented by these two workload targets?

8. Section L.10.e. – Annual Workload Assumptions Question/Comment: Where is the workload for DCS referrals included?

9. Section L.10.e. – Annual Workload Assumptions Question/Comment: Are RAC collections and referrals included in the Non-MSP categories?

10. Section L.10.e. – Annual Workload Assumptions Question/Comment: Provider/Supplier Duplicate Primary Payments for MIP MSP Postpay Part A verses Part B is worded differently. Should the specific items referenced in Part B, also be included for Part A?

11. Section L.10.e. – Annual Workload Assumptions Question/Comment: What activities are included in MIP MSP Postpay Part A and Part B, Debt Collection and Referrals? The workloads for Part B appear to be virtually nonexistent while the ones for Part A seem high in comparison to the demands.

12. Section L.10.e. – Annual Workload Assumptions Question/Comment: For MSP, will intent to refer letters and DCS referrals be reported anywhere?

13. Section L.10.e. – Annual Workload Assumptions Question/Comment: Is Part A RAC workload correct? The Part A workload number for Complex and Automated Adjustments is the same

14. Section L.10.e. – Annual Workload Assumptions Question/Comment: Provider Reimbursement and Audit workload

a. Desk reviews appear to be substantially understated at 803 for a full option year compared to providers required to file cost reports of 5,721. Is the count of desk reviews correct?

b. Is there an estimate of full desk reviews compared to limited desk reviews?

c. Audit has two sets of workload numbers on page 92. Is one a subset of the other? What do the two numbers represent? Is the percentage of audits to the population of providers correct?

d. For interim rates does the unit count include subproviders?

e. Does jurisdiction H have any PIP providers? If so, how many?

f. Cost report settlements appear to be significantly understated for a full year there are only 246, but there are 5,754 cost reports accepted. Is the count of cost report settlements correct?

g. For tentative settlements does the unit count include subproviders?

h. The SOW includes home office cost statements as a required report to process in C.5.11.3.2, but there is not a count in the RFP for the provider type. Are the home offices included in the workload?

i. Is the count for wage index correct? Normally the number of wage index would equal acute care hospitals.

j. Facilities population by type (page 90) does not identify any FQHCs, is this correct? According to the SOW C.5.11.3.3.8 we are required to complete interim rates on FQHCs.

15. Section L.10.i. – Records Retention and Workload Implementation Handbooks 9.10.5 Question/Comment: The sections state that “the costs associated with the Medicare files and data transfer will be considered implementation costs…” and “the cost of conveyance will be borne by the incoming MAC.” Is the facility where records are currently stored NARA compliant? If it is not, is the offeror responsible for the permanent withdraw fees imposed by the storage vendor? If the offer is responsible for the withdraw fees please provide the fee amounts?

17. L.15 Volume II – General Business Proposal Instructions, page 114 Management or Corporate Investments Question/Comment:

a. Does CMS think that an unfair competitive advantage is being given to contractors previously awarded a contract ---which included a management discount--- thereby giving them a scale advantage when now bidding on a contract that does not allow the management discount to other offerors?

b. Does CMS understand that disallowing financially responsible corporate investments could increase the cost to perform this work?

a. Please define what the agency considers to be a "management discount, corporate contribution, or corporate investment discount" and provide specific examples of what the agency considers to be a "discount" that is covered by this provision.

b. Please confirm that this provision is not intended to preclude an offeror from following its established and disclosed cost accounting practices with respect to home office expenses that are not actually charged to the contractor. If a change to the contractor's established and disclosed cost accounting practices would be required to comply with this provision, how does the agency intend to address any associated cost impacts?

c. Please confirm that this provision is not intended to cover the pricing associated with the provision of goods and services by a parent corporation through an intracompany transfer (per FAR 31.205-26(e)).

d. Will the agency consider a proposed cost reduction that is backed by a parent guarantee?

e. How will the agency determine whether a transaction between the offeror and the parent or sibling corporation is a “corporate investment, or management discount”

f. Please confirm that legitimate changes to an offeror’s DS1, accounting practices, cost pools or other charges, which are in progress or expected to occur, are not a “corporate investment, or management discount.

g. Please confirm that this provision is not intended to preclude an offeror from following its long established and disclosed accounting practices with respect to certain home office expenses that are not included in its cost pools and are not actually charged by the contractor to any of its contracts. If a change to the contractor's established accounting practices would be required to comply with this provision, how does the agency intend to address any associated cost impacts?

h. Please confirm that this provision is not intended to preclude an offeror’s home office from following its long established and disclosed practices with respect to certain home office expenses that although allocated, are not actually charged to the offeror. If a change to the established practice would be required to comply with this provision, how does the agency intend to address any associated cost impacts?

i. Does CMS intend that this provision precludes the offeror from not charging certain home office G&A allocations which the home office agreed to do and for which the offeror has included in its previous bids and proposals.

j. Assuming a contractor has consistently returned certain allocated costs back to its parent for over years, would the “Management or Corporate Investments” prohibition require these costs be included in estimated cost?

Please confirm the number given for provider facilities (6,074) in this section of the RFP is accurate.

21. Section L.10: Proposal Assumptions – Annual Workloads Question/Comment The desk review workloads provided in the JH RFP appear extremely low when compared to the number of facilities provided. For example, in CLIN004 the number of desk reviews is 803; the total facility count is 6,074. While not all of the 6,074 facilities will require a desk review, the desk review workload ratio is typically greater than that represented by 803. Do the RFP desk review workloads include both full and limited desk reviews? Please confirm the desk review workload included in the RFP and clarify if the workload represents full desk reviews, limited desk reviews, or both?

22. Section L.10: Proposal Assumptions – Annual Workloads Question/Comment This section of the JH RFP includes a workload line item for “audit” that reads:

140 140 140 140 Audits 30 307 349 349 349

What does the top and bottom rows within the audit workload line represent? Do they represent in-house audits and the other row field audit workloads? Is the top row related to the states of AR/LA/MS and the bottom row relates to CO/NM/TX/OK? If so, the bottom row should not show 30 for the base year since, CO/NM/TX/OK do not transition until after the base year. Please clarify what this workload represents.

23. Section L.10: Proposal Assumptions – Annual Workloads Question/Comment Does CMS have the audit workload by provider type? If so, could CMS provide that detailed information?

24. Section L.10: Proposal Assumptions – Annual Workloads Question/Comment Could CMS…