AB MAC JK RFP-CMS-2012-0005 Amendment 000001.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

2. A[,4ENDMENT/MODIFICATION NO

000001

6. ISSUED BY

CMS, OAGM, MACG, DEMAC

7111 SECURITY BLVD. , MS: B2-I4-21

BALT]MORE MD 2L244_1850

8. NAI\4F AND ADDRESS OF CONTRACTOR (No.. street, county, state and ztp Code)

I1. THIS ITEM ONLY

7. ADMINISTERED BY (lf other than ltem 6)

Tasha Logan Contract Speciallst 4r0-1 B6-A2L9

AIVIENDl\ilENT OF SOLICITATION NO

PAGE OF PAGE

PROJECT NO. (lf applicabte) l

AGG,/TL

RFP-CMS-2012-0005

DATED (SEE ITEM 11)

a5/24/2412

1OA. MODIFICATION OF CONTRACT/ORDER NO

108 DATED (SEE |TEM 13)

1. CONTRACT ID C

3, EFFECTIVE DATE

a6/22/2Ar2

4, REQUISITION/PURCHASF REO NO

FACILITY CODE

ETheabovenumberedsolicitationisamendedassetforthinltem'14. ThehouranddatespecifiedforreceiptofOffers njs extended. Elis not extended offers must acknowledge receipt of thls arendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing Items 8 and 1 5' and returning t copres of lhe amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted, or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE oF youR AcKNowlEDGEMENT Io BE REcEtvED AT THEPLACEDESIGNATEDFORTHERECEIPTOFOFFERSPRTORTOTHEHOURANDDATESPECiFTEDMAyRESULTTNREJECTTONOFyOUROFFER. tfby virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or tetter makes referencetothesolicitationandthisamendment andisreceivedprjortotheopeninghouranddatespecified

'12. ACCOUNTING AND APPROPRTATTON DArA U requircd) l3.THISITEMONLYAPPLIESTOMODIFICATIONOFCONTRACTS/ORDERS. ITMODIFIESTHECONTRACT/ORDERNO.ASDESCRIBEDINITEMI4.

CHECK ONE A. THIS CHANGE ORDER lS ISSUED PURSUANf rO:specify authority) IHE CHANGES SET FORTH tN |TEM 14 ARE t\,,tADE tN THE CONTRACTORDER NO. IN ITEI,4 1OA

B THE ABOVE NUIiIBERED CONTRACT/ORDER lS l\,4ODlFlED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying offrceAPPrOPriAtiONdAtE, EIC.) SETFORTHINITEMl4,PURSUANTTOTHEAUTHORIryOFFANASIOI(bI.

MENTAL AGREEMENT IS

tVpe of modification

PURSUANT TO AUTHORITY OF

E.IMPORTANT: Contractor ! is not. n is reguired to sign this document and return coptes to the issuing oflice

I4 DESCRIPTlON OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter whre feasibte.)

The purpose of this amendment is to incorporate the following revisions to the solicitation:

(1) Section C - Description/Specifications /Work Statement/ including C.1,.

(2) Section H * Special Contract Requirements, including H.5;

(3) Section L - Instructions, Condltlons and Notices to Offerors, including L.7, L.9.i and L.11 .b;

(4) Section J - List of Attachments/ includrng J-01, J*08 and J-09,.

(5) Defete afl references to Bridget Hamel and replace with Bridget Rineker and

(6) Provide responses to sollcitation questions.

Period of Performance: 07/25/2013 to IO/Ii/2013

Except as provided herein, all terms and conditions oi the document referenced in ltem 9A in full force and effect '15A. NAME AND TITLE OF StcNER (Type or print) (Type or print)

1 58. CONTRACTOR/OFFEROR

DARD FORM 30 (REV. 10-83)

Prescrlbed by cSA

FAR (48 CFR) 53.243

OF CONTRACTING

of person authoized to sign) dDt&

RFP-CMS-2012-0005

Amendment 000001

A/B MAC Jurisdiction K

Page 2 of11

The purpose of this amendment is to incorporate the following changes into the solicitation and provide responses to solicitation questions. The solicitation is amended as follows:

I. PART I - THE SCHEDULE

A. SECTION C _ DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

1. subsection c.1, STATEMENT oF woRK, is amended as follows:

STATEMENT OF WORK is hereby deieted and a revised J-01 STATEMENT OF

WORK dated June 21, 2012, is hereby incorporated and provided as an attachment hereto.

B. SECTION H, SPECIAL CONTRACT REQUIREMENTS

l. Subsection H.5, HEALTH INSURANCE PORTABTLITy and AccouNTABrLrrY ACT of 1996 (HrpAA) BUSINESS ASSOCTATE PROVISION II is deleted in its entirety andplaced with the following:

HIPAA Business Associate Provision II

Definitions:

All terms used herein and not otherwise defined shall have the same meaning as in the Health Insurance Portability and Accountability Act of 1996 ("HIp AA; 42 U.S.C. sec. 1320d) and the corresponding implementing regulations. Provisions governing the Contractor's duties and obligations under the Privacy Act (including CMS' data use agreements) are covered elsewhere in the contract.

"Business Associate" shall mean the Contractor.

"Covered Entity" shall mean CMS'Medicare Fee for Service program andlorpre-Existing Condition Insurance Plan.

"Secretary" shall mean the Secretary of the Department of Health and Human Services or the Secretary's designee.

Obligations and Activities of Business Associate

1. Business Associate agrees to not use or disclose Protected Health Information ("pHI"), as defined in 45 C.F.R. $ 160.103, created or received by Business Associate from or on behalf of Covered Entity other than as permitted or required by this Contract or as required by law.

2. Business Associate agrees to use safeguards to prevent use or disclosure of PHI created or received by Business Associate from or on behalf of Covered Entity other than as

A.

b.

A/B MAC Jurisdiction K provided for by this Contract. Furthermore, Business Associate agrees to use appropriate administrative, physical and technical safeguards that reasonably and appropria-tely protect the eonfidentiality, integrity and availability of the electronic protected health information ("EPHI"), as defined in 45 C.F.R. 160.103, it creates, receives, maintains or transmits on behalf of the Covered Entity to prevent use or disclosure of such EpHI.

3. Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of PHI by Business Associate in violation of the requirements of this Contract.

4. Business Associate agrees to report to Covered Entity any use or disclosure involving PHI it receives/maintains from/on behalf of the Covered Entity that is not provided for by this Contract of which it becomes aware. Furthermore, Business Associate agrees to report to Covered Entity any security incident involving EPHI of which it becomes aware' The Business Associate shall report any violation in use or disclosure involving PHI or any security incident to CMS within one (1) hour of discovery in accordance with the "CMS Guide for the Incident Reporting Process,, at bgnlkr*1ngffiX-L:.1:,,s-ejZ*?!pfrE1;tpfo5?t4*41j.11rle9li.*KSp**kS*diu:te:J-_H*:ZltR.#eii (See also Section J, List of Attachments). In addition, the Business Associate will also notiff the CMS Contracting Officer and Contracting Officer's Representative (COR) by email within one (1) hour of identifliing such violation or incident.

5. Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides PHI received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity, agrees to the same restrictions and conditions that apply through this Contract to Business Associate with respect to such information.

Furthermore, Business Associate agrees to ensure that its agents and subcontractors implement reasonable and appropriate safeguards for the PHI received from or on behalf of the Business Associate.

6. Business Associate agrees to provide access, at the request of Covered Entity, to pHI received by Business Associate in the course of contract performance, to Covered Entity or, as directed by Covered Entity, to an Individual in order to meet the requirements under 45 CFR S 164.524.

7. Business Associate agrees to make any amendment(s) to PHI in a Designated Record Set that Covered Entity directs or agrees to pursuant to 45 CFR 5 164.526 upon request of Covered Entity.

8. Business Associate agrees to make intemal practices, books, and records, including policies and procedures and PHI, relating to the use and disclosure of PHI received from, or created or received by Business Associate on behalf of Covered Entity, available to Covered Entity, or to the Secretary for purposes of the Secretary determining Covered Entity's compliance with the various rules implementing the HIpAA

9. Business Associate agrees to document such disclosures of PHI and information related to such disclosures as would be required for Covered Entity to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 45 CFR $ 164.528.

10. Business Associate agrees to provide to Covered Entity, or an individual identified by the Covered Entity, information collected under this Contract, to permit Covered Entity io respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 45 CFR $ 164.528.

RFP-CMS-2O12-0005

A/B MAC Jurisdiction K

Permitted Uses and Disclosures by Business Associate

Except as otherwise limited in this Contract, Business Associate may use or disclose pHI on behalf of; or to provide services to, Covered Entity for purposes of the performance of this Contract, if such use or disclosure of PHI would not violate the HIPAA Privacy or Security Rules if done by Covered Entity or the minimum necessary policies and procedures of Covered Entity.

Obligations of Covered Entify

1. Covered Entity shall notify Business Associate of any limitation(s) in its notice of privacy practices of Covered Entity in accordance with 45 CFR $ 164.520, to the extent that such limitation may affect Business Associate's use or disclosure of PHI.

2. Covered Entity shall notiff Business Associate of any changes in, or revocation of, permission by Individual to use or disclose PHI, to the extent that such changes may affect Business Associate's use or disclosure of pHI.

3. Covered Entity shall notifli Business Associate of any restriction to the use or disclosure of PHI that Covered Entity has agreed to in accordance with 45 CFR $ 164.522,to the extent that such restriction may affect Business Associate's use or disclosure of PHI.

Permissible Requests by Covered Entity

Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would not be permissible under the HIPAA Privacy or Security Rules.

Term of Provision

1 . The term of this Provision shall be effective as of date of contract award, and shall terminate when all of the PHI provided by Covered Entity to Business Associate, or created or received by Business Associate on behalf of Covered Entity, is destroyed or returned to Covered Entity, or, if it is infeasible to return o:r destroy PHI, protections are extended to such information, in accordance with the termination provisions in this Section.

2. Upon Covered Entity's knowledge of a material breach by Business Associate, Covered Entity shall either:

i. Provide an opportunity for Business Associate to cure the breach or end the violation consistent with the termination terms of this Contract. Covered Entity may terminate this Contract for default if the Business Associate does not cure the breach or end the violation within the time specified by Covered Entity; or,

ii. Consistent with the terms of this Contract, terminate this Contract for default if Business Associate has breached a material term of this Contract and cure is not possible; or,

iii. If neither termination nor cure is feasible, Covered Entity shall report the violation to the Secretary.

d.

(t

Amendment 000001

A/B MAC Jurisdiction K

3. Effect of Termination.

i. Except as provided in paragraph f.2 of this section, upon termination of this Contract, for any reason, Business Associate shall return or destroy all PHI received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity. This provision shall apply to PHI that is in the possession of subcontractors or agents of Business Associate. Business Associate shall retain no copies of the PHI.

ii. In the event that Business Associate determines that returning or destroying the PHI is infeasible, Business Associate shall provide to Covered Entity notification of the conditions that make return or destruction infeasible. Upon such notice that retum or destruction of PHI is infeasible, Business Associate shall extend the protections of this Contract to such PHI and limit further uses and disclosures of such PHI to those pu{poses that make the return or destruction infeasible, for so long as Business Associate maintains such PHI.

Miscellaneous

1. A reference in this Contract to a section in the Rules issued under HIPAA means the section as in effect or as amended.

2. The Parties agree to take such action as is necessary to amend this Contract from time to time as is necessary for Covered Entity to comply with the requirements of the Rules issued under HIPAA.

3. The respective rights and obligations of Business Associate under paragraph f.3 of the section entitled "Term of Provision" shall survive the termination of this Contract.

4. Any ambiguity in this Contract shall be resolved to permit Covered Entity to comply with the Rules implemented under HIPAA.

PART III _ LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS

A. sECTroN J - LIST oF ATTACHMENTS, is amended as follows:

ATTACHMENT J-01 STATEMENT OF WORK (SOIY) is deleted and replaced with the SOW dated June2l,20l2, provided as an attachment to this amendment.

ATTACHMENT J-08 PAST PERFORMANCE QUESTIONNAIRE is deleted and replaced with the Past Performance Questionnaire dated June 18, 2}I2,provided as an attachment to this amendment.

ATTACHMENT J-09 COST PROPOSAL INSTRUCTIONS is deleted and replaced with the Cost Proposal lnstructions dated May 29,2\l2,provided as an attachment to this amendment.

III. PART IV _ REPRESENTATIONS AND INSTRUCTIONS

A. SECTION L - INSTRUCTIONS, CONDITIONS AND NOTICES TO OFFERORS,

is amended as follows:

il.

A/B MAC Jurisdiction K

1. Sutrsection L.7, PROPOSAL SUBMISSION AND DELIVERY, is deleted in its entirety and replaced with the following:

The Offeror shall deliver to the address below on or before Monday, July 23, 2012 by 11:00AM Local Prevailing Time:

o One (1) original and eight (8) copies of the Written Technical Proposal - Volume I in hard copy and2 CD-ROMs;

o One (1) original and four (4) copies of Volume IIA Business Proposal Cost Templates and2 CD-ROMs (this will also include an electronic copy the Basis of Estimate document, Attachment J-7 oneach CD ROM);

o One (1) original and eight (8) copies of Volume IIB Written Proposal Narrative in hard copy and2 CD-ROMs;

o One (1) original and two (2) copies of the Conflict of Interest - Volume III in hard copy and 2 CD-ROMs.

o Each of the Proposal Volumes (I, IIA, IIB, and III), is submitted in their entirety in both hard copy and on CD-ROM, as stated above, in Microsoft Office Word or Excel

- Version 2007. The 8 CD-ROMs shall be placed in the box of "originals" as stated under L.8.h.

Signed annual reports and corporate policies may be submitted in Adobe Acrobat or pDF format. Orgarrizational charts may be submitted in Microsoft PowerPoint or Adobe version 2003 or 2007. Microsoft Project Files are acceptable (version 2003 or 2007).

Consistent with FAR 52.404-4, the Offeror should submit its proposal PRINTED and COPIED DOUBLE-SIDED on RECYCLED PAPER to the greatest extent practicable to:

Centers for Medicare & Medicaid Services Office of Acquisitions and Grants Management Attn: Tash a Lo gan Contract Specialist 7500 Security Boulevard Baltimore, Maryland 21244 - 1 I 5 0 (4t0) 786-0219

Offerors are hereby advised that the place for submission of proposals (*CMS Single Site at7500 Security Blvd, Baltimore (Woodlawn), Maryland), is a secure building. Proposal delivery must be made to the exact location stated in this solicitation on or before the date and time specified. Offerors are also advised to make sure that the proposal is clearly marked as to:

A/B MAC Jurisdiction K

A. The RFP number;

B. Jurisdiction Designation;

C. The date and time for receipt;

D. The intended room location;

E. The intended recipient, and

F. The telephone number of the intended recipient

*See Attachment I-24 for directions to CMS Central Office Qr{orth Gate-Dogwood Road).

Offerors shall enter the CMS single site facility through the North Gate-Dogwood Road. For security pu{poses Offerors shall contact the Contract Specialist or the Contracting Officer with the following information at least 24 hours prior to delivery of the proposal:

A. Delivery personnel name

B. Year, make, and model of delivery vehicle

C. Vehicle license plate number

D. Approximate number of boxes

If the above information is unknown24 hours prior to delivery, the Offeror shall provide the information as soon as it becomes available, but no later than3 hours before proposal drop-off. Personnel will be asked to verify the above information at the North Gate- Dogwood Road prior to entering the CMS complex. Upon verification, the delivery vehicle will be directed to the CMS warehouse, where proposals will be received.

For logistical purposes only, Offerors shall contact the Contract Specialist or the Contracting Officer to schedule a drop-off appointment. CMS will give Offerors preference for proposal delivery based on the number of boxes to be received. That is, CMS anticipates that an Offeror with a large number of boxes will be scheduled for proposal delivery early in the day. All appointments will be scheduled prior to proposal delivery time, (Monday, July 23,2012 by 1 1:00 am).

Offerors are cautioned that proposals are considered 'received' by CMS when the Offeror receives a signed receipt by the Contract Specialist or Contracting Officer or their designees indicating the time and date of proposal receipt; which, if following the above guidance, will take place at the CMS warehouse.

A/B MAC Jurisdiction K

Proposal delivery by a mail carrier service other than the U.S. Postal Service are not accepted in the CMS mailroom and therefore the Offeror assumes the risk of an untimely delivery.

2. Subsection L.9, PROPOSAL ASSUMPTIONS, L.g.i,is amended as follows:

(i) Medical Review Workload for JK A/B MAC. (Offeror may adjust the MR workloads based on its proposed Medical Review strategy).

The unadjusted national overall 2011 Medicare fee-for-service payment error rate is 9.9%. This error rate is unacceptable to CMS. In the FY 2012 Online Performance Appendix, cMS has a stated program goal to "Reduce the Percentage of Improper Payments Made Under the Medicare Fee-for-Service Program". The FY 2012 goal is to reduce the national overall Medicare FFS payment error rate (unadjusted) to 6.2%;

moreover, CMS aims to reduce the national overall (unadjusted) Medicare FFS payment error rate to 5.8o/o by FY 2013, and to achieve further reductions in payment errors in FY 2014. A November 15, 2011 press release on the 2011 Medicare FFS payment error rate can be found at:

r.lr.ord'l'3.'11-*:Ali&q:llk:{e 1,r,s'l'},'pe:6& iU-tj}age:&sl}ilrvAll:_&JlYl*itr:&,v*fir:&iJ*s*-&*l}q {:t:;is;$m

CMS has intentionally displayed the Medical Review workloads below (separate from the other Jurisdiction K workloads presented in L.9.h, L.9j, L.9.s andL.g.tthat are mandatory for proposal assumptions) to emphasize to Offerors the importance of this payment error rate reduction objective. The MR workloads depicted below reflect the current pattern of medical review activity in Jurisdiction K, and CMS has also used these workloads for its internal Government Cost Estimate. However, the Medical Review workloads presented below are not mandatory for proposal purposes; rather, CMS expects Offerors may derive and propose its Medical Review workloads based on its Medical Review Strategy for reducing the error rate. If the Offeror proposes workloads that differ from those in the table below, the Offeror shall provide its rationale and assumptions to support the change in workloads as part of its Medical Review Strategy (see section L.12.c, TAB C.4: Medical Review Strategy for additional instructions).

Offerors are advised that the Basis of Estimate (Attachment J-7) shall mirror their proposed workloads to support its proposed Medical Review Strategy. Further, the Offeror shall ensure that its proposed Staffing Plan under Tab C.2.1of its Technical Proposal reflects its proposed Medical Review Strategy. Moreover, the Offeror shall

A/B MAC Jurisdiction K ensure that all cost and/or level of effort is accounted for in its Business Proposal and clearly identified in its Business Proposal narrative and/or Tab F.1 Business Proposal Assumptions of Volume IIB.

Routine Manual Medical Reviews 2,624 4,498 *"T- 4,4s8 4,498

Existing LCDs Revised 67 776 176 176 176

New LCDs Developed 2 7 7 7 7

Complex Probe Reviews (Prepay and Postpay) 24,1I7 44,656 44,656 44,656 44,656

Prepay Complex Reviews 23,238 56,102 56,102 56,rO2 56,102

Postpay Complex Reviews 879 1,,677 1,677 1,,671 1,,677

Medical Review Reopenings 3,804 10,234 1.0,234 10,234 L0,234

Medical Review Claims Overturned on First LevelAppeal (This workload category is for i nfo rm ation al pu4Doses o n ly. Offe ro rs shall not bid a level of effort for Medical Review Claims Overtumed on First Level Appeals. The level of effort for this workload category should be captured in within the Ap p e a I s Redete rm i n ati on wo rkloads. ) 463 L,201 r,201 I,201 1,,207

Medical Review Data Requests 35 84 84 84 84

Medical Review Limited Education 42 100 100 100 100 s#&qs*s##.€# jN$seEe€1

Routine Manual Medical Reviews 0 0 0 0 0

Existing LCDs Revised 1 2 2 2 2

New LCDs Developed 0 0 0 0 0

Complex Probe Reviews (Prepay and Postpay) 62 149 149 I49 1,49

Prepay Complex Reviews 3,7s0 9,000 9,000 9,000 9,000

TPL/Demand Bills 20,333 48,800 48,800 48,800 48,800

Page 10 of11

A/B MAC Jurisdiction K

Postpay Complex Reviews 0 0 0 0 0

Medical Review Reopenings 1, L50 2,760 2,760 2,760 2,760

Medical Review Claims Overturned on First LevelAppeal- (This workload category is for info rmation al pulposes only. Offerors shall not bid a level of effort for Medical Review Claims Overtumed on First Level Appeals. The level of effort for this workload category should be captured in within the Ap peal s Redete rm i n ati on wo N o ads. ) 5 12 12 12 1,2

Medical Review Data Requests 3 6 5 6 6

Medical Review Limited Education 6 15 15 1-5 15

Routine Manual Medical Reviews 21,,770 64,479 64,479 64,479 64,479

Existing LCDs Revised 73 176 776 176 176

New LGDs Developed 3 7 7 7 7

Complex Probe Reviews (Prepay and Postpay) L2,8r5 26,660 26,660 26,660 26,660

Prepay Complex Reviews 38,700 91,801 91,80L 91,801 91,801

Postpay Complex Reviews r,577 3,309 3,309 3,309 3,309

Medical Review Reopenings 6,16s 20,358 20,358 20,358 20,358

MR claims Overturned on First Level Appeal (This worktoad category is for informational purposes only. Offerors shall not bid a level of effort for Medical Review Claims Oveftumed on First Level Appeals.

The level of effort for this workload category should be captured in within the Appeals Redetermination workloads.) i.50 600 600 600 600

Medical Review Data Requests 30 ro2 1,02 ro2 702

Medical Review Limited Education 19 75 75 75 75

3. subsection L.17, ORAL PRESENTATIONS, L.l7.b, schedule, is amended as follows:

RFP-CMS-2012-0005 A/B MAC Jurisdiction K

Page 11 of11

(b) Schedule: The Contracting Officer will schedule the oral presentations after receipt of proposals. The Offeror will be notified by electronic mail of the scheduled date, time and location of its presentation. It is anticipated oral presentations will begin on or about August 20r2012. The Government reserves the right to reschedule any Offeror's presentation at the discretion of the Contracting Officer. Oral presentations are not subject to the rules for the late submission of proposals in FAR 52.215-l(cX3). However, if the Offeror, due to its own fault, is delayed in starting its oral presentation at the allotted time, there will be no extension of the time period for the oral presentation. Offeror delays go against the allotted time period. For example, if an Offeror is scheduled to begin its 2.5 hour presentation at 9:00 a.m. and is delayed in starting because of traffic or doesn't allocate sufficient time for passing through building security, etc, and does not begin until 9:15 a.m., the Offeror will have 2 hours and 15 minutes to complete their oral presentation.

Attachments AB MAC JK RFP-CMS-2012-0005 Amendment 000001redline

AB MAC JK RFP-CMS-2012-0005 Amendment 000001 final J-01 Statement of Work dated6.21.12 Redline

J-01 Statement of Work dated 6.2l.l2Final J-08 Past Performance Questionnaire JK 6.18.12 redline

J-08 Past Performance Questionnaire JK 6.18.12 final J-09 Cost Proposal Instructions 5.29.I2 redline J-09 Cost Proposal Instructions 5.29.12 final AB MAC JK Solicitation Question Responses 6.2I.12

All other terms and conditions of this solicitation remain unchanged.