Amendment_A-2_RRB01R001_Q A FINAL.docx

Amendment A-2 to Solicitation RRB11R001 RRB SMAC (Part B Medicare Services) Page # 24 of 25

A. The purpose of this amendment is to provide RRB answers to potential Offeror questions submitted regarding the solicitation and to provide revisions to the RFP, the statement of work, and other attachments where applicable.

B. Potential offeror questions and RRB answers follow:

Regarding Section C – Statement of Work (Attachment J-01)

1. SOW Section C.5.4, Administrative Requirements, contains a listing of the Key Personnel to be assigned to the resulting RRBSMAC contract. The majority of those key personnel may be dedicated to the Medicare lines of business. However, the Project Manager (C.5.4.1.1) and the Claims Processing Manager (C.5.4.1.2) are required to be fully dedicated to the RRBSMAC contract. Given the relatively moderate volume of workload emanating from Medicare services rendered to Railroad beneficiaries, to require that these two positions be fully dedicated would not result in the most cost efficient administration of the contract. Since there is no distinction or differences in the basic administration of the Medicare benefits for RRB beneficiaries than for SSA beneficiaries, if an offeror can demonstrate that effective management of the RRBSMAC contract can occur by allowing the RRB workload to be merged with other Medicare workloads would the RRB consider amending the dedication requirement from fully dedicated to dedicated to Medicare Lines of Business?

A – The SOW specifically requires that the Claims Processing Manager and the Project Manager be fully dedicated to the RRB SMAC. The RRB workload is not to be merged with other Medicare workloads.

2. SOW Section C.5.11.2.4, Functional Requirements, provides on page 101 that the contact center shall provide operations 7.5 hours a day 5 days a week in all US (contiguous 48 states) time zones. Are there core hours of operation expectations in each time zone (e.g., 9:00 – 4:30 in pacific, Mountain, Central and Eastern time zones) that the RRB requires?

A - The RRB requires that the contact center provide operations 7.5 hours per day, 5 days per week in all U.S. time zones. The offerors should plan to ensure that this coverage is achieved and can address their proposed core hours in the proposal.

3. Regarding section C.1.4.3 Jurisdiction-Specific Requirements The Comparability of Payment Provision of Delegation of Authority by Centers for Medicare & Medicaid Services (CMS) to the Railroad Retirement Board (RRB) appears to state that Contractors will need to have a mechanism in place to assume the Local Coverage Determinations (LCDs) associated with each Medicare Administrative Contractor (MAC) nationally. Is this assumption correct?

A - This is a correct assumption.

4. Regarding C.5.3.2 Telecommunications If the Offeror is an existing Part A/B MAC Contractor connected to CMSnet, would a new connection be required for the RRB SMAC, or would the existing CMSnet connections/capacity be upgraded?

A - The existing CMSnet connection(s)/capacity would be upgraded.

5. Regarding C.5.3.2.1 - Telecommunications for Electronic Data Interchange 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 IACs loop?

A - Yes, the Contractor could use the existing translator.

6. Regarding C.5.3.2.1.1 - Electronic Data Interchange Enrollment Form Will a feed from the RRB Web-based EDI Enrollment application be available in order to update the Contractor’s trading partner files?

A - No. Currently the RRB web-based EDI enrollment application is available and can be completed online, but cannot be submitted online.

7. Regarding C.5.3.2.3.1 - Electronic Data Interchange Outreach Activities Would the requirement to maintain a directory of successfully tested software vendors and clearinghouses only apply to allowable ASC X12 837 versions in effect at time of contract implementation?

A - No. This requirement would be ongoing as the Contractor becomes aware of new vendor software that has been successfully tested, it would be added to the directory.

8. Regarding C.5.4.1.5 Medicare Benefit Integrity Manager Specific to the educational requirements for the Medicare Benefit Integrity Manager, is there an alternative to having a Bachelor’s Degree in Accounting (e.g., substitute for work experience)? It states “or a related field”; what would be considered a “related field”?

A - MIP Manager educational requirements is amended to read “a Bachelor’s degree, from a currently accredited post secondary educational institution”. The educational requirements for the Benefit Integrity Manager is a Bachelor’s or more advanced degree from a currently accredited post secondary educational institution. The RRB has no educational requirement for an accounting degree or minimum of 24 semester hours in accounting. The experience requirements remain as stated in the section.

9. Regarding C.5.8.2.1 - Communication of Claims Processing Problems Section C.5.8.2.1 states the communication regarding claims processing problems should occur “within seven (7) business days from identification”, while the Claims Processing Performance Standard noted under section C.7 states that notification is timely if it is received within three (3) business days. Please clarify.

A - Timely notification should be within three (3) business days.

10. Regarding C.5.8.3.4 - Paper Claims Adjustment Editing The SOW states: The contractor shall maintain all original and hard copy claims processing information in accordance with the Department of Justice (DOJ) instructions, which includes:

· Filing, removing, updating, refilling and general maintenance of electronic and paper claim/adjustment files;

· Maintain “Help desk” personnel for all above tasks as necessary.

We cannot find any references to the DOJ or a help desk in this section of the IOM. Please clarify. If the DOJ reference is regarding the freeze on destroying Medicare records, is this SOW instruction overriding the instructions in IOM 100-1, Chapter 7 that permits the destruction of paper claims that are imaged, provided other requirements are met?

A - Section C.5.8.3.4 of the SOW is retitled “Reserved” and the above cited paragraph (in italic) is deleted in its entirety from the SOW.

11. Regarding C.5.9.1.2.2 - Telephone Reopenings This SOW requirement states “The contractor shall complete the telephone reopening in the same manner as described under Section 3 above for Reopenings.” There is no section 3 above entitled “Reopenings”. Please clarify.

A - The reference in section C.5.9.1.2.2 that reads “section 3” shall read “C.5.9.1.”

12. Regarding C.5.10.1.2 - Document Imaging and Indexing C.5.10.1.2. 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).

A - Yes, using a single, reliable index to accomplish retrieval would meet the requirements of this SOW.

13. Regarding C.5.10.1.3.1 – Acknowledgement of Redetermination Requests 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”. The identification of the item/services/claims at issue will be difficult to identify without doing significant manual research, which will take resources away from processing the redetermination. Requiring the inclusion of the item/services/claims at issue will be difficult to automate, thus further increasing costs. In addition, providers often submit multiple claims in large volumes as one redetermination request. Would this requirement mean that all claims included in the redetermination request be acknowledged or would the RRB allow for acknowledgment at the HIC level?

A - Acknowledgement at the HIC level would be acceptable.

14. Regarding C.5.10.1.6 - Consolidation of Multiple Requests for Same Claim C.5.10.1.6 states the Contractor “shall inform the party that a decision has already been issued and send a copy of the redetermination notice”. This requires significant manual effort to generate copies of the letters and combined with the automated letter, as well as it will increase mail costs. Would the RRB consider only including the date of the redetermination letter and providing the information on how to obtain a copy of the redetermination letter and provide details on how to request reconsideration within the text?

A - The RRB would consider this approach.

15. Regarding C.5.10.6.1 - Supply of Appeals Case Files for QICs C.5.10.6.1 states, “the Contractor shall supply to the QIC all appeals case file information, within five (5) calendar days of request”. The IOM, Pub.4, Chapter 29, Section 320.4 states 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.

A - The timeframe requirement should follow the IOM, Pub.4, Chapter 29 of seven (7) calendar days.

16. Regarding C.5.11.1 - Provider Customer Service Program C.5.11.1 states, “Provider self-service technology (PSS), including Web, listserv, and interactive voice response (IVR) technology allowing access to Medicare information any time of the day”. Although certain IVR functions could be available ‘any time of day’, those that utilize specific systems (e.g., MCS, CWF) can only be used when the on-lines for those applications are available. It is recommended the time requirement be made more specific to include a statement regarding standard system availability.

The quoted sentence above in section C.5.11.1 is amended after the ending as now reads “…any time of the day.” To read as follows , “…any time of the day, subject to standard system availability.”

17. Regarding C.5.11.8.1 - Interactive Voice Response The RRB RFP requirement indicates that Interactive Voice Response (IVR) technology shall use the Medicare HIPAA Eligibility Transaction System (HETS) as the data source for response to provider eligibility inquiries. As eligibility data is available in other Medicare systems, could alternate Medicare system data sources be used to support response to eligibility inquiries through the IVR?

A - Yes, alternative Medicare systems data sources could be used to support eligibility inquiries through the IVR. The Offeror must explain such alternate Medicare systems data sources in their proposal when addressing this capability and requirement.

18. Regarding C.5.13 - Financial Management of Trust Fund Dollars The last sentence in paragraph four (4) of this section states “This includes, but is not limited to, underpayments resulting from cost report settlements, estimated Periodic Interim Payments (PIPs), PIP rate reviews, interim rate reviews, and adjustment bills.” This sentence seems to relate to Medicare Part A (e.g., cost reports and PIP). Should this sentence be eliminated from the RRB SMAC RFP?

A - The references to Part A activities quoted above from section C.5.13 are deleted from the SOW in their entirety.

19. Regarding C.5.13.2.2 – Bank Account Analysis C.5.13.2.2 states that the Contractor shall arrange to receive from the bank its account analysis which must include Bank Processing Charges. The Medicare banks do not provide bank processing charges to Contractors, but rather they provide volumes of services. Will this requirement be modified to reflect the current Medicare bank practices?

A - Yes. The RRBSMAC will be expected to follow current Medicare banking practices.

20. Regarding C.5.13.2.4 - Account Reconciliation C.5.13.2.4 states that the for non-HIGLAS transactions, the Contractor shall submit the Intermediary Benefit Payment Report (IBPR). This report is generally only submitted for Medicare Part A workloads. Considering the RRB SMAC is considered a Part B workload, will the reference to the IBPR report be eliminated?

A - The references to Part A activities cited above “Intermediary Benefit Payment Report (IBPR)” from section C.5.13.2.4 are deleted from the SOW in their entirety.

21. Regarding C.5.13.10 - Medicare Credit Balance Report Activities C.5.13.10 requirement states that the Contractor shall develop, maintain, and implement the Medicare Credit Balance Report and the Medicare Credit Balance Report Instructions in accordance with IOM Pub. 100-06, Chapter 12. This report is generally only submitted for Part A workloads. Considering the RRB SMAC is considered a Part B workload, will the reference to the Credit Balance report process be eliminated?

A - The references to Part A activities cited above regarding “Medicare Credit Balance Report and the Medicare Credit Balance Report Instructions” from section C.5.13.10 are deleted from the SOW in their entirety.

22. Reference Page 119 - Medicare Integrity Program (MIP) Requirements The fourth bullet under this heading states “MIP Provider Outreach and Education (MIP POE) (C.5.16) – see Provider Outreach and Education, section C.5.11.1 of this SOW.” However the MIP POE section falls under C.5.17 and the PM POE section is in C.5.11.1.2. Please correct or clarify.

A - The correct reference to the MIP POE section is C.5.17.

23. Regarding C.5.14 - Medical Review The RRB SMAC RFP requires that the Contractor decrease the paid claims error rate and address MR-related coverage, coding, and billing errors. Is the Contractor required to adopt the outgoing Contractor’s local coverage decisions (if any), and will any claims editing used by the outgoing Contractor be available for use by the incoming Contractor?

A – Yes, if any. Claims editing used by the outgoing contractor will be available for the incoming contractor.

24. Regarding C.5.14.3.2 - Medical Review Data: Edit Effectiveness C.5.14.3.2 states that the Contractor shall implement policies; however there is no direction within the RRB SMAC RFP or the SOW regarding Local Coverage Determinations (LCDs). Please clarify the policies that are referenced in this section.

A -The RRB SMAC contractor does not establish local coverage determinations (LCDs). Policy in this section refers to establishing automated edits based on data analysis of the MR program.

25. Regarding C.5.14.5 - CERT Program The SOW states “When the RRB becomes part of the CERT Program . . .” On what planned date will RRB SMAC become part of the CERT Program? Are error rates for RRB SMAC claims currently being calculated as part of another program or effort? If so, describe how the Offeror will need to support this program until RRB SMAC comes under CERT.

A - A definitive date is not currently planned. The RRB anticipates the SMAC being included into CERT by CMS during the base period.

26. Regarding C.5.16.9.5 - Misrouted MSP Checks and section C.5.16.9.6 - Misrouted MSP Correspondence Both C.5.16.9.5 and C.5.16.9.6 refer to a five (5) day timeframe for forwarding checks or correspondence to the MSPRC. However, Section C.7 (Key Performance Standards Summary) in the SOW, under the Business Function Area entitled MSP Post-Pay, indicates there is a seven (7) day timeframe referenced for forwarding checks or correspondence to the MSPRC. Please clarify the required timeframe.

A - The correct timeframe is five (5) days for sections C.5.16.9.5, C.5.16.9.6, and Section C.7 for the MSP Post-Pay activity of forwarding checks or correspondence to the MSPRC.

27. Regarding C.6.1.1- Execute a JOA There is no mention of a JOA with the Recovery Audit Contractor (RAC). Does the current RRB SMAC not work with the RAC? If not, are there any plans in the future in this regard?

A - The RRB SMAC does not work with the RAC nor are there any future plans in this regard.

28. Regarding Section C.6.1.2.1 - PSC and ZPIC C.6.1.2.1 indicates that a separate JOA with each PSC and ZPIC in the Contractor’s jurisdiction should be executed. Since the jurisdiction for RRB SMAC is nationwide and the Offeror will be performing its own benefit integrity activities, please clarify the extent of the PSC/ZPIC JOA requirement for the RRB SMAC (e.g., which PSCs/ZPICs would require a JOA with the RRB SMAC).

A - The RRB does not anticipate a JOA with each PSC and ZPIC, rather as stated in section C.6.1.2.1: “A separate JOA with each PSC and ZPIC in the Contractor’s jurisdiction should be executed, as appropriate, to promote prevention of Medicare program fraud and abuse. The JOAs with the PSCs and ZPICs shall address issues of sharing information at a minimum.” The RRBSMAC must determine which PSCs and ZPICs to execute a JOA with to accomplish the goal stated.

29. Regarding C.5.1.3.10 (sic) Medicare Credit Balance Report Activities Please confirm that this SOW requirement is applicable to the RRB SMAC contractor since Credit Balance Report activities are a Part A function. Part B does not process CMS 838 credit balance certification summaries.

A – Your request above regarding section C.5.13.10 is confirmed. See answer to question 21 above regarding this same issue.

30. Regarding C.5.4.1.5 Medicare Benefit Integrity Manager The Benefit Integrity Manager shall possess:

Education – Bachelors or more advanced degree in accounting or a related field with a minimum of 24 semester hours in accounting course.

· This requirement for C.5.4.1.5 is also listed in SOW C.5.15.2.1. The duties and experience stated in the SOW for this position are consistent with a clinical manager which is typically not an accounting graduate. Degree requirements for clinical staff do not generally require accounting courses.

· Please confirm the requirement is intended to be an accounting degree or a minimum of 24 semester hours in accounting with experience in detecting fraud, waste and abuse in medical claims processing.

A - See answer to question 8 above regarding this same issue.

31. Regarding C.5.4.2.8.6 Delinquent Debt Collection System (DCS) The second paragraph of this section states: “The Contractor shall report data in accordance with IOM Pub 100-6, Chapter 3, §180.2”.

· The IOM has not been updated with the revised requirements set forth in JSM 06233, dated January 31, 2006. This JSM gives instruction that only debts exceeding $600.00 and meeting specific criteria be entered into the PSOR. Will the SOW requirement be updated to reflect the January 2006 revised instruction?

Yes, the January 2006 JSM is incorporated into this requirement. For all performance or administrative matters under this SMAC RFP and the resultant contract, the Contractor shall comply with the requirements of the CMS Internet Only Manuals (IOMs) for each requirement, as well as any issued Joint Signature Memoranda (JSMs) and Change Requests (CRs) applicable to the IOM governing that functional requirement.

32. Regarding C.5.11.2.4 - Functional Requirements Contact Center Operations: Please elaborate on the expectation for the use of a “virtual contact center”.

The RRB’s use of the term “virtual contact center” is not to prescribe the contractor’s methodology of performance for beneficiary or provider customer service. The Contractor must achieve or exceed the performance standards set forth in this SOW, by use of best business practices. The word “virtual” is removed.

Operations Infrastructure: Does the reference to “Genesys call routing servers” refer to the use of CMS’s virtual call routing system from Verizon business for call routing to the contact center?

Yes. RRB SMAC will use the CMS call routing system(s).

33. Regarding C.5.14.1 - Medical Review of Claims This section stipulates skill sets, educational and licensure requirements for staff performing complex medical review which are inconsistent with the requirements set forth in the IOM 100-08, Chapter 3, § 3.4.5 C. and with the description of staff requirements cited in SOW code C.5.15.2.2.

· Please advise which educational and licensure requirements should be used to staff the RRB SMAC for performance of complex medical reviews.

The Contractor is required to adhere to the licensure and educational requirements in the applicable IOM for the medical review staff. The Lead Claims Review Analyst in the benefit integrity unit must meet the educational and licensure requirements in section C.5.15.2.2.

34. Regarding sections C.5.13.4 - Non Medicare Secondary Overpayment through C.5.13.8 - Overpayment Related to Bankruptcy The RFP assumptions stated the Non-MSP Collections workload as $2,915,800 for the base month period. This would equate to an annualized amount of $4,373,700. The SOW classifies many activities as Non-MSP Debt Collection. The activities associated with debt collection include items that may not translate to actual collections. These activities include in issuance of demand letters and the referral of debts to the DCS.

· Please provide clarification on how the workload provided corresponds to actual debt collection activities included in the SOW.

A - The referenced workload provided was actually based on debt collections accomplished in FY 2010. It was not intended to describe all activities involved. The RRB SMAC will be expected to follow guidelines and instructions in IOM Pub 100-6 Chapters 3 and 4.

Regarding Section L – Instructions, Conditions and Notices to Offerors

35. Section L.9, page 81-82, states that bidders shall submit “One (1) CD-ROM copy of Volume 1, Written Technical Proposal, Two (2) CD-ROM copies of the Volume IIA Business Proposal Cost Templates, Two (2) CD-ROM copies of the Volume IIB Written Business Proposal, and One (1) CD-ROM of the Volume III Conflict of interest and Compliance.” Section L.10 l on page 86 states that “each box should contain (d) Electronic copies/compact disks.” Finally, Section L.16.a, on page 104, states that the “business proposal spreadsheets shall also be required on CD-ROM (seven (7) copies).” Would the RRB clarify the number of CD-ROM copies required for each volume?

A - Section L.9 is corrected to read:

· Offerors shall provide originals and hard copies of Volumes as follows:

· Volume I - Written Technical Proposal - 1 Original and 8 Hard Copies

· Volume II.B - Written Business Proposal Narrative - 1 Original and 4 copies

· Volume III – Conflict of Interest and Compliance Program - 1 original and 3 copies

· Offerors shall provide the following numbers of CD-ROM copies by volume:

· Volume I - Written Technical Proposal - 6 CD-ROM copies

· Volume II.A - Cost Proposal templates - 4 CD-ROM copies

· Volume II.B - Written Business Proposal Narrative - 4 CD-ROM copies

· Volume III – Conflict of Interest and Compliance Program - 1 CD-ROM copy

Instructions in Section L.10 and L16.a are amended to comply with the revised section L.9 submission instructions above.

36. Section L.11, Proposal Assumptions, on page 89 lists the Provider Inquiries workload. The volume of provider inquiries (1,226,675) appears to be extremely high in relation to the number of claims (approximately 10,000,000). Additionally, the current IVR handle rate of 97.9% seems extremely high in relation to other Medicare inquiries history. Would the RRB confirm the accuracy of these numbers for proposal preparation purposes?

A – The correct Provider Inquiries workloads are:

Base 567,200

The current IVR handle rate is 24% for beneficiaries and 77.4% for providers.

37. Section L.11, proposal Assumptions, does not list the number of Standard Paper Remittances and the number of Medicare Summary Notices that are expected to be produced. Would the RRB provide that information?

A - The most current data available is 4,050,180 Standard Paper Remittances and 71,900 Medicare Summary Notices per year.

38. RFP Section L.14 provides instructions for submitting Written Technical Proposals. The heading states that the proposal is limited to 60 pages. However, the various subsections state that the page limit is 90 pages. Would the RRB confirm that the limit is 90 pages rather than 60 pages?

A - 90 pages is the correct page limit for the technical proposal.

39. RFP Section L.14 provides instructions for completion of the various Tabs and advises which Tabs are to be counted toward the page limitation. However, the following Tabs are silent as to whether they are included or not:

Would the RRB clarify which, if any, of the above Tabs are to be included in the page limitation?

A - The Tabs B.1.3, B.1.4, B.1.5, B.1.6, B.1.7, B.2.2, B.2.3, and B.2.4 submissions are included in the 90 Page Limit. Tabs C, E, F and G submissions are not included in the 90 page limit. Reminder to Offerors - the Tab F Subcontracting Plan template is provided at attachment J-08 and the Tab G attestations templates are provided at attachments J-20, J-21 and J-25.

40. RFP Section L.16.a, Business Proposal Cost Template (Attachments J11 – J15), appears to contain an inconsistency. SLIN-0002AC has a column entitled “C.5.11.2 Beneficiary Customer Service Program” which appears to cover the costs which are not fed costs from other Tabs. TAB C.5.4.3 has a column “C.5.4.5 Public Relations” which are fed costs from TAB C.5.11.5(3) and which has just one column, “C.5.11.2.5 – Responding to Complex Beneficiary Inquiries”. Should these costs be included in the C.5.11.2 costs? Additionally, where are the costs associated with SOW Section C.5.4.5.1 – Medicare Beneficiary Ombudsman, C.5.4.5.2 – RRB Regional and Local Office Liaison, and Urgent Need RRB Office Casework be accounted for?

A - Revised cost proposal templates (attachments J.11 through J.15) are furnished with this amendment. Tab C.5.11.5(3) is now linked to Tab C.5.11.2 Beneficiary Customer Service and not to Tab C.5.4.5 Public relations. Requirements in Section C.5.4.5.1 Medicare Beneficiary Ombudsman has been moved subordinate to section C.5.11.2 Beneficiary Customer Service and C.5.11.5(3) has been updated to include costs for these activities. C.5.4.5.2 RRB Regional and Local Office Liaison and subordinate function Urgent Need RRB Office Casework remain under Tab C.5.4.5 Public Relations for proposal submission.

41. RFP Section L.16.a, Business Proposal Cost Template (Attachments J11 – J15), contains two separate cost columns that refers to the same SOW sections. Both columns refer to C.5.11.1.8.2 – Web Technology. The first is entitled Web technology and the other is entitled Provider Internet Portal. As Provider Internet Portal is a component of Web Technology, is it the intention of the RRB to separate the costs for Provider Internet Portal from the rest of the Web Technology costs?

A – Yes.

42. RFP Section L.16.a, Business Proposal Cost Template (Attachments J11 – J15), requires the costs for C.5.11.1.6 – Provider Relations Specialists and C.5.11.1.7 – Inquiry Tracking System to be inserted into Tab C.5.11.1.5(2) where these costs are being totaled with C.5.11.1.5 and rolled up to C.5.11.1(3). Would it be more appropriate to insert them directly into C.5.11.1(3)?

A – No. Insert them on the separate tabs as provided. The RRB is supporting CMS Central Offices’ functional cost tracking efforts for these areas.

43. RFP Section L.16.a, Business Proposal Cost Template (Attachments J11- J15), requires the costs for C.5.11.1.9 – Provider Listserv to be inserted in C.5.11.1.8. Would it be more appropriate to insert these costs C.5.11.1(3)?

A – No. Insert them on the separate tabs as provided. The RRB is supporting CMS Central tracking costs for these technology–based functions versus personnel based functions supporting C.5.11.1 Provider Customer Service.

44. RFP Section L.16.a, Business Proposal Cost Template (Attachment J11 – J15), under SLIN-0002AD the cost column entitled C.5.11.2 – Beneficiary Customer Service Program is blank. Is this intentional? Additionally, on Tab C.5.4.5(4) the cost column entitled “C.5.11.2.5 – Responding to Complex Beneficiary Inquiries, rolls into the costs for C.5.4 – Administrative Requirements. Since Complex Beneficiary Inquiries are not generally considered administrative requirements, is the placement of these costs correct?

A - See answer to question 40 above.

45. RFP Section L.16.a, Business Proposal Cost Template (Attachments J11 – J16), requires the costs for C.5.14.3.1 – Medical review data: Data Analysis and C.5.14.3.2 – Medical Review data : Edit Effectiveness to be in Tab C.5.14.1(2), which then summarizes costs into column C.5.14.2 – Develop Medical Review Strategy. Should that cost be more appropriately inserted into C.5.14.3 – Medical Review data? Additionally, Should the costs for C.5.14.1 – Medical Review of Claims be inserted into C.5.14.1 rather than C.5.14.1(2)? Also wouldn’t it be more appropriate to remove the C.5.12.3.4 – Provider Tracking from the C.5.14(2) tab and make this a stand alone cost column on tab SLIN-0003AD.

A – Revised cost proposal templates (attachments J.11 through J.15) are furnished with this amendment (as stated in the answer to question 40 above). These following adjustments to capture of Medical review costs are included to the revised cost templates - Cost element C.5.12.3.4 Provider Tracking is renumbered to C.5.14.3.4 correctly aligned with the SOW section. Medical Review Strategy C.5.14.2 is now a standalone column on tab C.5.14.1 Medical Review. Tab C.5.14.1(2) captures all costs for the Medical Review functions under C.5.14.3 and C.5.14.4 and feeds them into Tab C.5.14.1 for a total Medical review cost.

46. RFP Section L19 B.3 addresses participation and attendance during the oral presentations. The requirement begins by stating that only members of the Offeror’s implementation team may participate. The implementation team is focused on the implementation activities and may or may not include the key personnel dedicated to the ongoing administration of the RRBSMAC contract. Since it is clear that the RRB intends for key personnel from business areas identified for the focused areas to make the oral presentation, would the RRB consider amending the first sentence of that paragraph to make it clear that key personnel beyond those identified for implementation be allowed to participate.

A – The Offeror’s members of the implementation team and/or key personnel may participate in the oral presentations.

47. Subsection L.9 - Proposal Submission and Delivery In section L.9, the RRB requests one (1) original and seven (7) copies of Volumes I, IIA, and IIB. However, Line 9 on the SF 33 requests one (1) original and eight (8) copies. Can the RRB please clarify the number of copies required for the proposal submission?

A - See answer to question 35 above.

48. Subsection L.9 - Proposal Submission and Delivery The RFP states the Offeror shall provide one (1) original and seven (7) copies of the Business Proposal – Volume IIA Business Proposal Cost Templates. In addition, two (2) CD-ROM copies of the Volume IIA Business Proposal Cost Templates shall be provided. However, in Section L.16 General Business Proposal Instructions, it states that “The business proposal spreadsheets shall also be provided on CD-ROM (seven (7) copies).” Please clarify the correct number of CD-ROM copies to be provided.

A - See answer to question 35 above.

49. Subsection L.11 - Proposal Assumptions Please confirm that MIP Medical Review workloads include medical review in support of Benefit Integrity. If not, please provide a separate workload for Medical Review in support of Benefit Integrity.

Does the Offeror have the flexibility to move Medical Review complex workloads between review categories (e.g., complex probes, pre-pay complex, and post-pay complex) as part of its proposed Medical Review strategy as long as the total number of reviews is within a certain percentage (e.g., 5%) of the total in the RFP?

A - Medical Review workloads include medical review in support of Benefit Integrity. Complex workloads can be moved between review categories.

50. Subsection L.11 - Proposal Assumptions Please clarify what the ALJ Hearings workload represents. Is the number of ALJ Hearings listed what the Offeror will be involved with as either a participant/party, or is it the number that the Offeror will need to assess for participation/party status? If it is the former, please provide an estimate for the latter and vice versa.

A – The ALJ Hearings workload represents effectuation of ALJ hearing decisions. The RRB has had limited participation in ALJ Hearings.

51. Subsection L.11 - Proposal Assumptions In Subsection L.11 states “Offerors shall use the following assumptions when developing their proposal . . . g. HIGLAS current environment”. Please clarify if the RRB anticipates that all Offerors are to assume they are in the HIGLAS environment for the full term of the RRB period of performance.

A - Offerors should assume that HIGLAS will be implemented during the first operational year/base period.

52. Subsection L.11 - Proposal Assumptions In Subsection L.11-j. Records Retention, the RFP states the records storage facility must be NARA compliant. Is the facility used by the current RRB SMAC NARA compliant?

A - The RRB does not currently have an RRB SMAC. The RRB’s current legacy Medicare Part B Services Carrier’s facility is working toward 100% NARA compliancy.

53. Subsection L.13 - Written Technical Proposal Organization Tab B.1.7 is entitled “Hearings and Appeals Program Plan”. Is this referring to SOW C.5.10.5 Administrative Law Judge Hearings?

A - No. The Program Plan refers to all SOW requirements in Section C.5.9. and Section C.5.10.

54. Subsection L.14 Written Technical Proposal Instructions (limit of 60 pages) The title of L.14 indicates a 60-page limit, but the remainder of this section indicates a 90 page limit. Please clarify the page limit for the written technical proposal.

A - 90 page limit is correct.

55. Reference Subsection L.14 Written Technical Proposal Instructions (limit of 60 pages) Section L.14 does not indicate in all instances what subsections are/are not included in the 90 page limit. Please clarify which of the subsections are/are not to be included in the 90 page limit of the written technical proposal.

Subsections impacted by this omission include:

· Tab B.1.3: Operation of Nationwide Customer Base

· Tab B.1.4: Customer Service Programs Plan

· Tab B.1.5: Provider Enrollment Plans

· Tab B.1.6: Claims Processing Plan

· Tab B.1.7: Hearings and Appeals Program Plan

· Tab B.2.2: Benefit Integrity Plan

· Tab B.2.3: Medicare Secondary Payer Post Payment/Quality Assurance Plan

· Tab B.2.4: Staffing Plan

· Tab C: Jurisdiction Transition/Implementation Plan

· Tab E: Trust Fund Management Plan

A – See answer to question 39.

55. Subsection L.14 Written Technical Proposal Instructions (limit of 60 pages) Please clarify if Tab B.1.1.1 is to include staffing plan information for PM functions only, or if it is to include staffing plan information for the entire RRB SMAC contract (PM and MIP).

A- Tab B.1.1.1 contains staffing information for PM only. However Tab B.1.1.4 the Cost Templates without Cost Data for the Implementation, the Base Period, and Option Period 1, shall include the proposed labor mix for both PM and MIP functions with clear delineation to functions.

56. Subsection L.14 Written Technical Proposal Instructions (limit of 60 pages) Tab B.2.4 indicates “the Offeror shall provide a staffing plan, position descriptions, and key personnel as set forth in Tabs C.1.1.1, C.1.1.2, and C.1.1.5 (for Program Management functions)”. Further, “the Offeror shall include in the Tab C.1.1.4 Cost Template submissions its proposed labor mix for MIP functions clearly marked as such to distinguish them from PM functions”. We assume that RRB intended to reference Tabs B.1.1.1, B.1.1.2, B.1.1.4, and B.1.1.5 in this subsection. Please confirm.

A – That is correct. The references in Tab B.2.4 instructions should be to Tabs B.1.1.1, B.1.1.2, B.1.1.4, and B.1.1.5 in this subsection

57. Reference Subsection L.14 Volume I – Written Technical Proposal Instructions Please clarify if Tab B.2.4 is to include staffing plan information for MIP functions only. Also, please clarify if this information is to include the information required in Tabs B.1.1.1, B.1.1.2, and B.1.1.4 for MIP functions only (assuming that RRB references to Tabs C.1.1.1, C.1.1.2, and C.1.1.5 in this subsection should actually be references to Tabs B.1.1.1, B.1.1.2, and B.1.1.4).

A – The Offeror is correct. The offeror shall provide in section B.2.4 for MIP functions the requirements of Tabs B.1.1.1, B.1.1.2, and B.1.1.5 (for PM functions). Tab B.1.1.3 covers facilities for all functions PM and MIP. Tab B.1.1.4 shall provide labor mix for both PM and MIP functions, clearly delineating the labor mix to the assigned PM or MIP function.

58. Reference Subsection L.14 - Written Technical Proposal Instructions (limit of 60 pages) Tab D (Past Performance Instructions) states that one of the elements to be included for each contract and subcontract is a copy of each reference’s PPQ identified above. Attachment J-8 (PPQ) instructs the completer of the PPQ to return the completed PPQs directly to RRB. As a result, please clarify if the Offeror is to obtain a copy of the completed PPQ and include it in its Technical Proposal.

A - Attachment J-8 is correct. A completed PPQ should be completed and returned directly to the RRB by each past performance reference.

59. Reference Subsection L.14 Written Technical Proposal Instructions (limit of 60 pages) Tab D lists information that should be included for each contract and subcontract. Specifically, it indicates that Offerors should include “information on problems encountered and Offeror’s corrective action (if applicable) – no more than ¼ page each”. Please confirm that the ¼ page each limit applies to each problem encountered.

A – Yes. A one quarter (¼) Page limit applies the Offeror’s description of each problem encountered.

60. Reference Subsection L.14 - Written Technical Proposal Instructions (limit of 60 pages) Tab G (Attestations) indicates that the Offeror shall submit two attestations with its Proposal, Information Security Attestation and Corporate Experience Attestation. However, this section also lists a third attestation, Compliance Attestation. Please confirm that all three attestations are required to be submitted with the Offeror’s proposal.

A- Yes. All three attestations are required with the proposal.

70. Reference Subsection L.19 Oral Presentation Instructions Section L.19 states the RRB will provide final instructions to Offerors 14 calendar days prior to the scheduled oral presentation. What, if any, information will the RRB request the Offerors provide in advance of the scheduled presentation date (e.g., copy of slide presentation)?

A - The RRB will communicate any specific requests for information no later than 14 calendar days prior to the scheduled presentation. Advanced copies of presentations are not required.

71. Reference L.9 - Proposal Submission and Delivery and L.10 - General Instructions Section L.9 of the RFP requests 1 CD of Volumes I and III, and 2 CDs of Volumes IIA and IIB. (Hard copies requested are 1 original and 7 copies.). Section L.9 appears to conflict with Section L.10.I. Section L.10.l of the RFP requires that each proposal "set" (e.g., Original all volumes, Copy 1 all volumes, etc.) be boxed separately and also states that each box contain "Electronic copies/compact disks (CD) of Volumes I, II, and III" resulting in 8 CDs of each volume. Do we follow the instructions in L.9 or those in L.10.l due to the conflict in requirements?

A – See answer to Question 35 above.

72. Reference Section L.11.a. - Proposal Assumptions – Implementation Cutover Date Implementation Cutover Date states the completion of movement to the incoming SMAC shall occur within six (6) months of award. L.11.d. reflects workloads that state Base Period is 8 months. Section F.2 Period of Performance states CLIN 0001 and CLIN 0002 shall be completed within 16 months after date of contract award.

· Please confirm the Implementation period is 6 months and the Base period is 8 months, and if so on what date will Option Year 1 begin?

A - RRB anticipates award of the contract during FY2011 with a maximum transition or implementation period of 6 months to conclude between December 2011 and February 2012. Given that contract award and implementation are executed as planned, the RRB anticipates the base period operational performance beginning on a date ranging from 1/1/2012 through 3/1/2012. The base period could be either longer or shorter than the estimated dates listed in the solicitation. Regardless, RRB anticipates that Option (Operational) period 1 will commence on 10/1/2012.

73. The RFP contains inconsistencies with labeling of CLIN periods.

· Are offerors to use AA and AB or AC and AD to reflect PM and MIP?

A – The CLIN numeration in RFP section B.6 has been revised, and synchronized with the Cost proposal template worksheets (attachments J11 though J16). All “AC” suffix CLINS are for Program Management (PM) functions and all “AD” suffix CLINS are for Medicare Integrity Program (MIP) functions.

74. Are the following sections in the Technical Proposal to be included in the 90-page limit?

· B.1.3. Operation of Nationwide Customer Base

· B.1.4. Customer Service Programs Plan

· B.1.5. Provider Enrollment Plans

· B.1.6. Claims Processing Plan

· B.1.7. Hearings and Appeals Program Plan

· B.2.2. Benefit Integrity Plan

· B.2.3. Medicare Secondary Payer Post Payment/Quality Assurance Plan

· B.2.4. Staffing Plan

· Tab C: Jurisdiction Transition/Implementation Plan

· Tab E: Trust Fund Management Plan

· Tab F: Sub Contracting Plan

· Tab G: Attestations

A – See answer to question 39 above.

75. Reference Section F - Deliveries or Performance - Subsection F.2 - Period of Performance

In subsection F.2 Period of Performance, the CLIN 0002 Period of Performance is stated as “Up to 10 months after exercise of option”. However, in Section L.11 for estimating purposes, the Offeror is instructed to utilize the workloads provided in the table, which for CLIN 0002 (Base Period) is only 8 months. Please clarify the actual number of months for the base period of operation.

A - The base period is not estimated to exceed 8 months. However see the answer to question no. 72 above.

76. Reference Section K: Representations, Certifications, and Other Statements of Offerors or Quoters - Subsection K.4 -FAR 52.204-8 Annual Representations and Certifications (Jan 2011)

Starting on page 68 of Subsection K.4, a listing of certifications that are applicable as indicated by the Contracting Officer are listed, and the Contracting Officer has checked those appropriate for the RRB RFP. Specifically, (2)(iv) 52.222.52, Exemption from Application of the Service Contract Act to Contracts for Certain Services-Certification is checked. However, FAR clauses (52.222-41, Services Contract Act of 1965 and 52.222-49, Services Contract Act – Place of Performance Unknown) are included in Section I- Contract Clauses, of the RFP. Please confirm if the RRB SMAC is exempted from the Service Contract Act.

A – This RFP is subject to the Service Contract Act per the cited clauses in section I of the solicitation The reference in section K under clause 52.204-8 section (2) (iv) is now unchecked by the RRB Contracting Officer.

77. Reference Section M - Evaluation Factors for Award - Subsection M.3 Evaluation of Attestations Section M.3 indicates the Offeror shall submit two (2) attestations with its initial RBB SMAC Proposal - Information Security Plan Attestation and Corporate Experience Attestation. However, this section also lists a third attestation - Compliance Program Attestation. Please confirm that all three (3) Attestations are required with the initial RBB SMAC Proposal.

A – All three (3) attestations are required with the initial proposal submission.

Reference Attachment J-02 – Deliverables

78. Section C.5.1.2 Jurisdiction Cutover Plan Deliverable The due date listed in Attachment J-2 for the Jurisdiction Cutover Plan is “initial within 45 calendar days after jurisdiction kickoff meeting”. However, the due date listed in Attachment J-01, SOW, Section C.5.1.2, Cutover Project Plan, is “at least 6 weeks before the RRB SMAC agreed upon cutover date”. Please clarify the due date for the Cutover Plan.

A – J-02 is correct. C.5.1.2 is corrected to read “initial (Jurisdiction Cutover Plan) is due within 45 calendar days after jurisdiction kickoff meeting.”

79. Section C.5.1.3 Risk Management Plan Deliverable The due date listed in Attachment J-02 for the Risk Management Plan is “due within 30 calendar days after jurisdiction kickoff meeting”. However, the due date listed in Attachment J-01, SOW, Section C.5.1.3, Risk Management Plan, is “immediately upon contract award” with a revised plan “within 30 calendar days of contract award”. Please clarify the due date for the Risk Management Plan.

A – Both Attachment J-02 and Section C.5.1.3 are corrected for submission of the Risk Management Plan as follows: The Contractor shall submit the Risk Management plan within 30 days of Contract award or by the kickoff meeting, whichever is earlier, and a revised Risk Management Plan within 30 days of the kickoff meeting. The Contractor shall maintain the plan current thereafter as specified in section C.5.1.3

80. Section C.5.1.4 Communications Plan Deliverable The due date listed in Attachment J-02 for the Communications Plan is “initial within 30 calendar days after Jurisdiction kickoff meeting”. However, the due date listed in Attachment J-01, SOW, Section C.5.1.4, Implementation Stakeholder Communication, is “submitted at contract award”. Please clarify the due date for the Communications Plan.

A – Both Attachment J-02 and Section C.5.1.4 are corrected for submission of the Communications Project Plan as follows: The Contractor shall submit the Communications Project Plan within 30 days of Contract award or by the kickoff meeting, whichever is earlier. The Contractor shall maintain the plan current thereafter as specified in section C.5.1.4.

81. Section C.6.1 - Initial Joint Operating Agreement Deliverable The list of parties with whom the RRB SMAC is required to initiate a JOA is not consistent with the list of required JOAs in Section C.6.1.1 of Attachment J-01, Execute a JOA. 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, SOW, lists the following parties: PSCs, ZPICs, QICs, BCC, CEDI, EDC, and MCARE. Please clarify which Attachment represents the appropriate reference for the required initial JOAs for the RRB SMAC.

A – Section C.6.1.1 is the correct reference for requirements for initial JOAs.

82. Section C.6.1 - Updated Joint Operating Agreement Deliverable The list of parties with whom the RRB SMAC is required to update JOAs is not consistent with the list of required JOAs in Section C.6.1.1 of Attachment J-01, Execute a JOA. 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, SOW, lists the following parties: PSCs, ZPICs, QICs, BCC, CEDI, EDC, and MCARE. Please clarify which attachment represents the appropriate reference for the required updated JOAs for the RRB SMAC.

A – The list in Section C.6.1.1, as confirmed in section C.6.1.3, is the correct reference for updating JOAs.

Reference attachment J-05 government Furnished property

83. General Question - Will the outgoing contractor be required to turn over procedures, training materials, Web site materials, non-base databases and applications to the incoming contractor as part of the Government Furnished Property?

A - The outgoing contractor will be required to turn over all non-proprietary material to the RRB SMAC.

84. Reference C.5.11.3 - Cost Reporting and Reimbursement Payment Policy The Government Furnished Property includes the Flash Report (Relating to the Medicare Cost Report) on page 4. Does this relate to the Medicare cost reports that Medicare Part A providers file annually with their FI/MAC? If so, this is a Part A activity and we believe this should be eliminated from the RRB SMAC RFP.

A – The Offeror is correct. Section C.5.11.3, as it pertains to Medicare Part A services, is deleted in its entirety from the SOW.

85. Reference section C.5.13 - Financial Management of Trust Fund Dollars It would appear the Government Furnished Property listed in C.5.13 relates to Medicare Part A and should be eliminated from the RRB SMAC RFP:

1. Healthcare Provider Cost Report Information System (HCRIS) - page 6

2. Interns and Residents Information System (IRIS) - page 6

3. Medicare Audit Program - page 6

4. Medicare Cost Report Desk Review Program - page 7

5. Provider Overpayment Reporting…