J-4 Task Order Beneficiary and Family Centered Care SOW.pdf

STATEMENT OF WORK

FFRDC Services for Beneficiary and Family Centered Care (BFCC) Program

Project Management Organization (PMO) Task Order

I. BACKGROUND

Quality Improvement Organizations (QIOs) are tasked under Section 1154 of the Social Security Act and multiple regulatory provisions with conducting a wide array of case review activities, as specified in the 10th contract cycle scope of work. The primary case review activities include the following: beneficiary complaints and quality of care concerns from various referral sources, appeals and reconsiderations to termination of services/notices of non-coverage, Higher Weighted Diagnosis Related Group (HWDRG) reviews and potential Emergency Medical Treatment and Labor Act (EMTALA) violations in accordance with the Centers for Medicare & Medicaid Services (CMS) guidelines and instructions. Other case review activities include reviews that result from referrals from CMS Central or Regional Offices, the Office of Inspector General and other designated CMS contractors.

As the nation’s largest health insurance program, the CMS directed QIO case review program is not without issues or areas perceived to be problematic. The complex nature of case review and their associated activities often lead to internal QIO processes that are arduous, labor intensive and costly to perform. It also leads to inconsistencies and cost variations in case review processes nationwide.

Due to the wide variation in case review practices and processes and wide range of cost variation, CMS recognizes the need to create a Beneficiary and Family Centered Care (BFCC) Project Management Organization (PMO) in order to increase efficiencies, effectiveness and standardization throughout the program.

The primary objective of this Statement of Work is to obtain FFRDC services to provide guidance in the evolution of the BFCC program, through the development of a BFCC PMO, including but not limited to the following key areas:

1. Develop and refine policy recommendations regarding BFCC oversight, evaluation and improvements to the case review processes in an effort to coordinate the activities of the QIOs, CMS contractors and CMS offices that will be involved in the BFCC program implementation and ongoing management.

2. Develop draft QIO Manual instructions for case review to ensure consistency and efficiency among all QIOs.

3. Research potential solutions for case review IT systems, evaluation of technical recommendations for case review IT solutions, participate in Business Process Modeling (BPM) sessions; provide business requirement recommendations and inputs as needed.

4. Provide input on BFCC project planning and project management.

5. Develop program briefing materials and provide oversight for the development of related educational/training material as it relates to any BFCC tasks.

6. Provide recommendations for BFCC rulemaking, policy development, and QIO oversight consistent with QIO statutory changes.

FFRDC Services for BFCC Program PMO Task Order

7. Recommend alternative strategies and/or opportunities to implement/refine BFCC program monitoring and evaluation methodologies.

8. May participate in briefings on the ongoing development and evolution of the BFCC program.

A. Purpose

The purpose of this task order is to obtain FFRDC operator’s expertise to help assess and improve the operation of the QIO Program, with particular emphasis on the Beneficiary and Family Centered Care (BFCC) Aim and, those activities generally referred to as “case review” activities. CMS needs the independence of an FFRDC operator to help review a program with over 50 contractors supporting the agency. Emphasis will be placed on assisting CMS in its efforts to develop a modernized information technology (IT) infrastructure to include case tracking, standardization of process requirements, improved data management, analysis and sharing functionality, and enhanced financial oversight capabilities.

The tight timelines for program policy development, rulemaking, competitive acquisitions, CMS Investment Life Cycle (ILC) activities, case review system development, and program implementation drive the need for this task order.

II. REQUIREMENTS

General

Independently and not as an agent of the Government, the Contractor shall furnish all the necessary services, qualified personnel, material, equipment and facilities, not otherwise provided by the Government, as needed to perform the requirements of this Statement of Work. The Contracting Officer Representative (COR) shall provide technical guidance to the Contractor on the effort and will coordinate with the contractor, as appropriate, to monitor and evaluate performance of the work.

CMS will utilize the BFCC Aim Lead and BFCC Aim Team expertise to facilitate the development and implementation of the program. CMS requires the expertise of a Contractor with in-depth knowledge of planning, project management, case review measures, process design, contractor management, systems engineering, business process modeling, communication strategies, and federal rule-making, among other areas in order to support CMS. Contractor support to the BFCC Aim Lead and BFCC Aim Team shall work to ensure the BFCC program, in development and implementation of all case review activities, is consistent with all quality improvement programs across CMS.

A. Requirements/Tasks to be Performed

TASK 1: BFCC Program Management, Policy & Program Analysis

TASK 1.1 Develop BFCC Project Plan & Program Management Tools

1. A Kick-off Meeting with the Government Task Leader (GTL) and Contracting Officer’s Representative (COR), and appropriate CMS staff will be held within

3 business days of date of contract award to discuss the proposed tasks prior to the FFRDC initiating work. Afterwards, the Contractor shall:

• Develop a BFCC Program Microsoft Project™ Plan.

• Develop a BFCC Risk and Issues Log.

• Develop a BFCC Program Monitoring and Evaluation Plan.

• Otherwise, report monthly as mutually agreed to with the GTL and COR.

2. The FFRDC shall provide a program management team to:

a. Develop monthly project status reports.

b. Develop a BFCC project plan and project dashboard to convey high level program status to CMS leadership.

c. Facilitate the integration of project plans and timelines across other BFCC activities such as the system requirements and development efforts associated with implementing the BFCC program.

TASK 1.2 Program Oversight

The FFRDC shall provide a program management team to:

1. Provide guidance to CMS to assist with achieving the goals and objectives of the BFCC Program and managing efforts necessary to facilitate operations and further development of the program.

2. Identify and report to CMS any issues or potential risk factors that may inhibit or impede the performance of any BFCC program task. Assists in risk mitigation planning and implementation.

3. Recommend project/program management tools and practices to improve program management and reporting.

4. Recommend methods to improve communication and workflow between QIOs, other CMS contractors and CMS staff including recommendations for improving the SDPS/TOPS memo system.

5. Provide recommendations for acquisitions of required vendors including assisting with RFP development.

6. Support the program’s needs for success in meetings including coordinating the activities of the BFCC Aim Team and its subgroups.

7. Work with the BFCCNCC to coordinate QIO feedback when necessary.

8. Develop and refine the processes necessary to coordinate the work of the various contractors and CMS offices including identification of goals and assumptions which may include such considerations as improved quality of care, efficiency, use of information technology, reduction of disparities or other programmatic goals that will be involved in the BFCC Program implementation and ongoing management.

9. Provide technical and program expertise to CMS in the preparation of presentations, position papers, briefing materials, etc. to enable CMS to make appropriate, efficient, effective decisions/options.

TASK 1.3 Policy and Program Analysis

1. Provide guidance to CMS through assessing the effectiveness of existing BFCC policy and procedures.

2. Provide expertise to CMS in developing and refining a comprehensive BFCC case review program framework for all relevant BFCC initiatives.

3. Provide guidance after the completion of business process modeling (BPM) is completed for case review activities to further enhance process, work flow and business requirements;

4. Identify inefficiencies and or weaknesses in overall case review processes, expenditures (cost variation), data management and analysis, and the application of data to quality improvement initiatives;

5. Recommend improvements for consistency in processing all case review activities within, and across, QIOs.

6. Recommend possible re-structuring of the process for accepting referrals of medical necessity, quality of care and readmission reviews from the MACs, including the specific types of reviews to be referred, the number of reviews to be referred, and options for scheduling referrals to best account for QIO resource management.

7. Identify methods for establishing public use files (PUFs) for future Statements of Work and projects, which can be used in potential releases of QIO information to researchers and OPDIVs.

TASK 1.4 Provide Guidance on Alternative QIO Program Models & Recommendations on Regulatory Revisions

1. Provide guidance on alternative models for delivery of QIO services in light of the October, 2011 statutory changes.

2. Develop relevant recommendations for regulatory language changes needed for the successful implementation of the BFCC Program.

3. Prepare materials to assist in the regulation clearance process. Analyze and develop comment responses received as part of the rulemaking process.

4. Draft responses to comments received in the regulatory clearance processes.

5. Provide guidance during the regulation inquiry period to advise CMS management in policy related discussions.

TASK 2: Facilitate Business and Systems Requirement Development

The FFRDC shall participate in the following activities by performing the following:

1. Provide expertise and program insights to CMS and CMS contractors in developing the BPM for the BFCC program as necessary to determine process, data and program infrastructure components of the BFCC program.

2. Provide an evaluation of technical recommendations for IT solutions, e.g. use of commercial off the shelf (COTS) systems, QIO developed systems or other system development mechanisms.

3. Work directly with the GTL & COTR, BFCC Aim Lead, CMS contractors and designated component individuals (as a team) to coordinate the BFCC development efforts and facilitate the completion of business and system requirements with the PMBR Contractor.

4. Based on user input, provide expertise and guidance to the CMS contractors with primary responsibilities for the development of the BFCC Business Requirements Document for the CMS-designated case review information system.

5. Provide guidance, expertise and oversight for Security Test and Evaluation (ST&E) activities.

6. Work directly with the BFCC National Coordinating Center (BFCCNCC) to ensure that detailed user input regarding case review functions are gathered, considered and appropriately included in the business requirement development and system design and development.

7. Assist in any IT related tasks associated with the CMS-designated case review system to include at a minimum:

a. Participation in technical meetings including JADs, TEPs, Tiger Team Meetings, and working sessions with the case review system developer, PMBR Contractor and infrastructure team as needed.

b. Participate as directed in technical advisory panels to analyze root-cause analysis, detrimental barriers and issues related to technical and systems issues impacting BFCC Aim activities.

TASK 3 Program Monitoring & Evaluation

Facilitate development of BFCC Program Monitoring and Evaluation.

The FFRDC shall provide expertise and recommendations to CMS for the development and execution of BFCC program monitoring and evaluation activities. To the extent feasible within the performance period and contract resources, CMS may direct the FFRDC to develop and pilot analyses required by CMS for evaluation and monitoring purposes.

To the extent the following activities are within scope and budget of the BFCC PMO, the FFRDC will perform the following:

• Work with CMS Contractors and the BFCC program monitoring & evaluation workgroup in guiding the design and development of a BFCC monitoring and evaluation process. In guiding this process, the FFRDC shall also research and solicit feedback on program monitoring methodologies from CMS, and other organizations.

• Further refine the program monitoring and evaluation plan based on inputs from the BFCC Aim Team and other groups and organizations.

• Provide technical expertise for implementing the monitoring plan.

• Provide recommendations pertinent to the evolution of the monitoring and evaluation program.

• Based on a sample of cases, provide Inter-Rater Reliability (IRR) review to monitor case review effectiveness.

TASK 4 Facilitate Outreach & Education Activities

Working with the GTL & COTR, BFCCNCC and other CMS contractors, the FFRDC shall provide input for education and outreach products related to the BFCC Program. BFCC PMO shall work collaboratively with CMS and its stakeholders in order to:

1. Encourage bi-directional communications with stakeholders, leveraging existing communication vehicles and channels.

2. Working with the Beneficiary and Family Centered Care National Coordinating Center, develop a short-term communication plan with updates every six months.

3. Provide CMS with communications-oriented recommendations and guidance for the BFCC program.

4. Assist CMS in the development and coordination of Beneficiary Focus groups.

5. Assure integration of CMS branding elements and compliance with CMS communications policies and guidelines in all products and strategies developed by the BFCC PMO.

6. Provide program expertise for the CMS contractor responsible for production of content for communication vehicles such as newsletters, presentations and press releases.

7. Provide guidance for the CMS contractor responsible for CMS Open Door and Town Hall meetings to identify appropriate messaging and to ensure that the meeting materials are “on-message” with BFCC program policy.

TASK 5 Independent Case Review System Verification and Validation

Develop Pilot

CMS will implement a 6 month pilot of the case review system to be developed. The Contractor will assist CMS in designing and developing the case review system pilot parameters.

Validate Pilot Results

The Pilot will facilitate testing of the CMS-designated case review system. Pilot outputs will be compared to outputs from previous QIO scopes of work and previous case review systems to validate that the BFCC business requirements have been successfully implemented.

The FFRDC shall perform the following activities to validate the Pilot:

1. Develop a test plan describing the approach to be used in evaluating Pilot outputs.

2. Validate that each Pilot QIO’s case review activity is correctly recorded, tracked and maintained by the case review system.

3. Develop a test report documenting the results of this activity.

TASK 7: End of Contract Transition

Transition Plan

Prior to the end of this contract the FFRDC shall be required to provide transition services / phase-out services to the successor selected by CMS. During this transition period, the FFRDC shall work with the new organization, CMS staff, as well as other identified CMS Contractors to ensure continued operation and development of the BFCC Program.

The FFRDC shall cooperate fully with the new organization to ensure that all services continue without interruption.

At a minimum, the Transition Plan shall provide detailed information that will be used to ensure a smooth transition from the FFRDC’s operation to sole operation by the successor organization. At a minimum, the Transition Plan shall provide the following:

• A milestone chart detailing the time lines and stages of transition from the effective date of the transition until the successor organization assumes sole responsibility for the BFCC Program work.

• Plans to communicate and cooperate with the current incumbent FFRDC or contractor.

• An organizational chart that displays internal and external organizational relationships. The organizational chart shall identify the individuals (at all levels) who will be responsible for the transition and their respective roles; details the lines of communication and how the Contractor shall interface with CMS during this phase of contract performance.

As the transition to the new organization is completed, CMS may elect to engage the FFRDC to provide oversight and strategic/advisory services in the following areas:

1. Program Management/Governance

2. Policy Development

3. Systems Engineering

B. Reporting Requirements

At the beginning of the performance period, the GTL and COR will meet with the FFRDC to mutually establish a project timeline that will be submitted and maintained by the FFRDC using the Microsoft Project™ software. Thereafter, the FFRDC shall provide CMS with written status reports on due dates that will be determined by the CMS GTL and COR. The status reports will include updates on work in progress and identification of areas where work or timelines need to be adjusted. The FFRDC shall also provide the deliverable listed under the Schedule of Deliverables.

The cover or first page of the Quarterly Status Report shall contain:

1. The FFRDC’s name and address.

2. The contract number.

3. The report number, including the deliverable number and date as directed and appropriate.

4. The report title and period of performance covered.

The Quarterly Status Reports will be submitted to:

1. Task Order Contract Specialist (CS) - 1 hardcopy.

2. Task Order COR - 1 electronic copy in Microsoft Word, and/or Microsoft Excel, or Adobe PDF format.

3. Task Order GTL - 1 electronic copy in Microsoft Word, and/or Microsoft Excel, or Adobe PDF format.

The GTL and COR will provide the format for the status reports after the contract is awarded. The recipient name and address for the GTL, COR, and Contract Specialist are as specified in the Schedule of Deliverables for the contract as a whole, and the GTL and COR’s name and mailing address will be as specified in the BFCC PMO project-specific deliverables schedule.

C. Period of Performance

The period of performance is:

BASE YEAR CONSISTING OF TWELVE MONTHS (12) FROM DATE OF AWARD

Option to Extend the Term of the Contract

This contract may be extended for 4 option periods:

OPTION YEAR ONE (1) CONSISTING OF TWELVE (12) MONTHS

OPTION YEAR TWO (2) CONSISTING OF TWELVE (12) MONTHS

OPTION YEAR THREE (3) CONSISTING OF TWELVE (12) MONTHS

OPTION YEAR FOUR (4) CONSISTING OF TWELVE (12) MONTHS

D. Government Property

Not Applicable

E. Key Personnel

All key personnel must be approved by CMS. The Contractor shall provide resumes of all key personnel for this contract. Key personnel will be evaluated on:

• The extent to which they possess the appropriate technical knowledge, expertise, and experience on the subject areas described in the Statement of Work.

• The ability to provide a clear demonstration that they are available and dedicated (specify a percentage of time) to this effort and will meet the needs of the CMS customer.

• Ability to conduct and manage all of the areas described in the Statement of Work.

• Key personnel for this contract include:

1. Project Management Lead

2. IT Specialist

F. Place of Performance

The FFRDC shall work primarily in the greater Washington, D.C. metropolitan area to include the FFRDC operator’s facilities, as well as the CMS facilities, near Baltimore. As approved by CMS, the FFRDC operator may participate in conferences and meetings where relevant project issues are discussed. Site visits to QIO locations may be required to meet with CMS contractors, other vendors, operations personnel, or other CMS staff experts. Site visits will be limited and coordinated with the GTL.

III. QUALITY ASSUANCE

Performance Improvement

In addition to regular ongoing quality assurance and progress monitoring and oversight activities, CMS may also conduct a formal evaluation of the FFRDC twice during the course of the contract. The evaluation may include, but is not limited to, a satisfaction survey targeted to the “customers” of the PMO, potentially including other contractors whose work depends on availability of BFCC PMO products and deliverables, and CMS staff identified by the COR. Elements that may be included in the survey include but are not limited to the following:

1. Timeliness

a. Delivery of product or service on the due date in the deliverables table or agreed upon between the GTL, COR and the FFRDC.

b. Establishment/prioritization of due dates that match program priorities and timing of customer needs

2. Quality

a. Accurate, current content, professional presentation

b. Appropriate for setting, useful to providers

3. Relevance

a. Usefulness of the product of service to the customer

4. Completeness, readiness

5. Ease of Use

a. Determined by the product or service characteristics (print information, data collection tools, web site, training program, etc.)

b. Customization of product or service to meet local need(s)

6. Opportunities for Improvement

7. Other satisfaction survey contractor suggestions

CMS will provide the result of any such customer satisfaction surveys to the FFRDC with the expectation that its findings will help the FFRDC with its quality improvement processes.

In addition, CMS may undertake other activities in an effort to improve the program. The FFRDC is expected to participate in such activities, which may include but is not limited to the following:

1. Collaboration (and co-production, in some cases) with other CMS Contractor(s), CMS staff, and other stakeholders.

2. Identification of barriers affecting the BFCC PMO’s work and immediate notification of those barriers to the GTL and COR.

3. Problem-solving activities.

A. BFCC PMO Contractor Evaluation

An assessment of the FFRDC’s performance in this contract will be used as past performance information for future contract award considerations. Elements of the performance assessment may include but are not limited to the following:

1. Completion of specific tasks (deliverables) required in the special study.

2. Financials.

3. Appropriateness of staffing for this contract including number of staff as well as skill sets of staff.

4. Performance in meeting the communication and information needs of dialysis facilities, stakeholders, BFCC Contractor Program, etc., and the quality of activities to improve performance.

5. Participation in other improvement activities.

6. Efforts to address issues/barriers identified.

The performance assessment will be conducted by the GTL, COR, and other appropriate CMS staff.

B. BFCC Program Management Office Monitoring

The GTL and COR will conduct periodic monitoring of the FFRDC’s progress towards completeness of the contract. The frequency and nature of this monitoring is to be determined by the GTL and COR, but is anticipated to occur on a quarterly basis in person or by teleconference or videoconference. The FFRDC will participate in these monitoring activities, including, but not limited to, the provision of a brief summary of activities, internal quality improvement efforts, barriers and efforts to address those barriers, and other pertinent information as directed by the GTL and COR.

The GTL and COR will review and assess reports and work products submitted by the FFRDC as appropriate phases of the contract period. The GTL and COR will conduct the following monitoring activities:

1. Inspect the articles to be delivered.

2. Review and approve of progress at prescribed points before authorization to continue is given.

3. Participate in regularly scheduled progress meetings.

4. Review and comment upon all draft plans, methodological plans, protocols, reports, manuals, and documents within 4 business days of receipt from the FFRDC.

5. Give final approval of all formal deliverables within 10 business days of receipt from the Contractor.

The deliverables and activities outlined in the SOW will be monitored and reviewed by the GTL and COR for completeness (as stated in the SOW), accuracy (to the extent possible), and that time frames and deadlines are met. This will include review of meeting minutes, drafts and finals of all documents within approximately 4 business days of receiving and regularly scheduled teleconferences to track progress of work. The GTL, COR and FFRDC will mutually establish the frequency, dates, and times of the regularly scheduled progress meetings. Progress meetings shall be conducted no less frequently than monthly, though they may be required at more frequent intervals. The following is a list of milestones for the work to be performed that will be monitored and the target dates (dates are approximate) for completion.

IV. References

None

ITEMS TO BE FURNISHED and SCHEDULE OF DELIVERABLES

FFRDC Support for BFCC Program PMO

The Contractor shall submit all required reports and deliverables in accordance with the following schedule. Reports and/or deliverables submitted under this contract shall be in accordance with the SOW entitled “FFRDC Services for Beneficiary and Family Centered Care (BFCC) Program Project Management Organization (PMO)”.

The quarterly reports will be submitted as prescribed under the “Reporting Requirements” section of the statement of work.

The COR will revise this schedule to correspond with the appropriate QIO BFCC contracts.

CO = Contracting Officer COR = BFCC Contracting Officer Representative BFCC GTL = BFCC Government Task Leader BFCC SME = BFCC PMO Subject Matter Expert

TASK Description RECIPIENTS DELIVERY SCHEDULE IN

GOVERNMENT WORK DAYS

TASK1 Kick-off Meeting with COR & appropriate CMS staff

COR, GTL &

CO

Three (3) days of date of contract award

TASK 1 Monthly Status Reports COR & GTL

Monthly by the 15th of the month following performance

TASK 1 Develop BFCC Program Microsoft Project™ Plan

COR & GTL

Thirty (30) days after Kickoff meeting and ongoing

TASK 1 Develop BFCC Risk and Issues Log

Problems must be reported ASAP.

Otherwise, report monthly as mutually agreed to with the GTL &

COR

TASK 2 Facilitate development of business and systems requirements

Coordinate with the GTL & COR

TASK 3 Develop Program Monitoring & Evaluation Plan

TASK 4 Updates to short term communications plan

TASK 6 Test Report that describes evaluation results of BFCC case review system Pilot activity

COR & GTL

ESRD

TASK 7 Transition Plan

ESRD

RECIPIENT NAME AND MAILING ADDRESS:

GTL: TBD

COR: TBD

BFCC Contractor SME 1: TBD

BFCC Contractor SME 2: TBD

Contracting Officer: TBD