Solicitation - 75FCMC26R0022.pdf

31b. NAME OF CONTRACTING OFFICER (Type or print) 30c. DATE SIGNED

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

NOTE: OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30. 1. REQUISITION NUMBER PAGE 1 OF

2. CONTRACT NUMBER 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE

DATE

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME b. TELEPHONE NUMBER (No collect calls)

8. OFFER DUE DATE/

LOCAL TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

11. DELIVERY FOR FREE ON 12. DISCOUNT TERMS

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

(SDVOSB)

13a. THIS CONTRACT IS A

WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY

DISADVANTAGED

WOMEN-OWNED SMALL

BUSINESS (EDWOSB)

8(A)

13b. RATING

NORTH AMERICAN

INDUSTRY CLASSIFICATION

STANDARD (NAICS):

SIZE STANDARD:

BOARD (FOB) DESTINATION RATED ORDER UNDER 14. METHOD OF SOLICITATION

REQUEST

SAL

17a. CONTRACTOR/

OFFEROR

CODE FACILITY

CODE

18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NUMBER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK

OFFER BELOW IS CHECKED SEE ADDENDUM

19.

ITEM NUMBER

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Government Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3

AND 52.212-5 ARE ATTACHED. ADDENDA

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE ARE NOT ATTACHED

ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH

AND DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND

ON ANY ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS

SPECIFIED

29. AWARD OF CONTRACT: REFERENCE OFFER

DATED . . YOUR OFFER ON SOLICITATION

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR

30b. NAME AND TITLE OF SIGNER (Type or print)

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 11/2021)

Prescribed by GSA - FAR (48 CFR) 53.212

UNLESS BLOCK IS MARKED

SEE SCHEDULE

THE DEFENSE PRIORITIES

AND ALLOCATIONS

SYSTEM - DPAS (15 CFR 700)

REQUEST

FOR QUOTE

(RFQ)

INVITATION FOR

FOR BID PROPO

(IFB) (RFP)

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

Solicitation/Contract Form

ClaimsCore

(End Of Section)

Supplies or Services and Prices/Cost

Item Supplies/Service Dates Quantity Unit

Proof of Concept

Severability: Yes Firm Fixed Price

Period of Performance From

05 MAY 2026

To

04 NOV 2026

1.0 Dollars, U.

S.

(Option

Period 1) Option Year 1 Software

Severability: Yes Firm Fixed Price

Period of Performance From

05 NOV 2026

To

04 NOV 2027

1.0 Each

(Option

Period 1) Option Year 1 Services

Severability: Yes Firm Fixed Price

Period of Performance From

05 NOV 2026

To

04 NOV 2027

1.0 Dollars, U.

S.

(Option

Period 2) Option Year 2 Software

Severability: Yes Firm Fixed Price

Period of Performance From

05 NOV 2027

To

04 NOV 2028

1.0 Each

(Option

Period 2) Option Year 2 Services

Severability: Yes Firm Fixed Price

Period of Performance From

05 NOV 2027

To

04 NOV 2028

1.0 Dollars, U.

S.

(Option

Period 3) Option Year 3 Software

Severability: Yes Firm Fixed Price

Period of Performance From

05 NOV 2028

To

04 NOV 2029

1.0 Each

(Option

Period 3) Option Year 3 Services

Severability: Yes Firm Fixed Price

Period of Performance From

05 NOV 2028

To

04 NOV 2029

1.0 Dollars, U.

S.

(Option

Period 4) Option Year 4 Software

Severability: Yes Firm Fixed Price

Period of Performance From

05 NOV 2029

To

04 NOV 2030

1.0 Each

(Option

Period 4) Option Year 4 Services

Severability: Yes Firm Fixed Price

Period of Performance From

05 NOV 2029

To

04 NOV 2030

1.0 Dollars, U.

S.

(Option

Period 5) Option Year 5 Software

Severability: Yes Firm Fixed Price

Period of Performance From

05 NOV 2030

To

04 NOV 2031

1.0 Each

(Option

Period 5) Option Year 5 Services

Severability: Yes Firm Fixed Price

Period of Performance From

05 NOV 2030

To

04 NOV 2031

1.0 Dollars, U.

S.

(Option

Period 6) Option Year 6 Software

Severability: Yes Firm Fixed Price

Period of Performance From

05 NOV 2031

To

04 NOV 2032

1.0 Each

(Option

Period 6) Option Year 6 Services

Severability: Yes Firm Fixed Price

Period of Performance From

05 NOV 2031

To

04 NOV 2032

1.0 Dollars, U.

S.

(Option

Period 7) Option Year 7 Software

Severability: Yes Firm Fixed Price

Period of Performance From

05 NOV 2032

To

04 NOV 2033

1.0 Each

(Option

Period 7) Option Year 7 Services

Severability: Yes Firm Fixed Price

Period of Performance From

05 NOV 2032

To

04 NOV 2033

1.0 Dollars, U.

S.

Additional Information/Notes

Ordering Agency Points of Contact (POC): Candace Straker, Contracting Officer (CO), Candace.straker@cms.hhs.gov; Lauren Holsey, Contract Specialist (CS), Lauren.holsey@cms.hhs.gov

Contract Type: Firm Fixed Price (FFP)

Schedule of Contract Line Items (CLINs): Respondents should include in its proposal a value for any priced CLIN/SLIN listed above.

For Software CLIN 0004, CLIN 0006, CLIN 0008, CLIN 0010, CLIN 0012, and CLIN 0014, refer to the True-Up Clause in the Special Contract Requirements section for additional details pertaining to true-up requirements related to these specified CLINs.

(End of Section)

Description/Specifications/Statement of Work

Requirements

The Centers for Medicare & Medicaid Services (CMS) seeks to replatform its Medicare Fee-for-Service (FFS) claims adjudication environment by replacing four legacy COBOL-based systems -- the Multi-Carrier System (MCS), Fiscal Intermediary Shared System (FISS), ViPS Medicare System (VMS), and the Common Working File (CWF). The ClaimsCore program will acquire a Commercial-Off-The-Shelf (COTS), configurable, interoperable claims processing platform capable of sub-second adjudication, improved real-time fraud prevention, and transparent interoperability through HIPAA X12 and FHIR /REST APIs. The program supports CMS strategic goals for cost deflation, transparency, and policy agility. This platform will form the basis for all future Medicare FFS claims processing and consolidate what are currently separate systems (Part A, Part B, DME) into a unified solution.

Additional Information/Notes

See Attachment 1 - Statement of Objectives (SOO)

Regarding submission of deliverables, CMS may provide comment in response to any artifact produced during performance of the order and require revisions to such work products. If such an artifact is resubmitted in response to such feedback, an accompanying red-lined document illustrating the changes made to the previous version should be included with each subsequent iteration delivered to CMS. Unless specifically denoted as workday(s), all timeframes are in calendar days, weeks, or months after the effective date of the contract. All deliverables should be provided not later than close of business on their due date(s) unless specifically noted otherwise. If the deliverable due date falls on a non-business day at CMS, the deliverable should be provided to CMS no later than Start of Business on the first business day after the scheduled due date.

Any requirement specified in the SOO that is not the subject of an exception or clarification in the response is incorporated into any resultant PWS by reference.

(End of Section)

Packaging and Marking

Deliverables shall be marked with reference to the contract number specified herein and packaged in accordance with industry best practices.

(End of Section)

Inspection and Acceptance

Additional Information/Notes

All work under this contract is subject to inspection and final acceptance by the Contracting Officer or a duly authorized representative of the Government. All items to be delivered to the COR will be deemed to have been accepted 30 calendar days after date of delivery, except as otherwise specified in this contract, if disapproval has not been given within such period. The COR's acceptance or revision to the items submitted shall be within the general scope of work stated in this contract.

FAR Clauses Incorporated by Reference

Number Title Effective Date

52.246-4 Inspection of Services-Fixed-Price. Aug 1996

(End of Section)

Deliveries or Performance

Line Item 0001

Performance

Period of Performance

From

05 MAY 2026

To

04 NOV 2026

Line Item 0002 (Option Period 1)

Performance

Period of Performance

Period of Performance From

05 NOV 2026

To

04 NOV 2027

Line Item 0003 (Option Period 1)

Performance

Period of Performance

Period of Performance From

05 NOV 2026

To

04 NOV 2027

Line Item 0004 (Option Period 2)

Performance

Period of Performance

Period of Performance From

05 NOV 2027

To

04 NOV 2028

Line Item 0005 (Option Period 2)

Period of Performance

Period of Performance From

05 NOV 2027

To

04 NOV 2028

Line Item 0006 (Option Period 3)

Performance

Period of Performance

Period of Performance From

05 NOV 2028

To

04 NOV 2029

Line Item 0007 (Option Period 3)

Performance

Period of Performance

Period of Performance From

05 NOV 2028

To

04 NOV 2029

Line Item 0008 (Option Period 4)

Performance

From

05 NOV 2029

To

04 NOV 2030

Line Item 0009 (Option Period 4)

Performance

Period of Performance

Period of Performance From

05 NOV 2029

To

04 NOV 2030

Line Item 0010 (Option Period 5)

Performance

Period of Performance

Period of Performance From

05 NOV 2030

To

04 NOV 2031

Line Item 0011 (Option Period 5)

Performance

Period of Performance

Period of Performance From

05 NOV 2030

To

04 NOV 2031

Line Item 0012 (Option Period 6)

Period of Performance From

05 NOV 2031

To

04 NOV 2032

Line Item 0013 (Option Period 6)

Performance

Period of Performance

Period of Performance From

05 NOV 2031

To

04 NOV 2032

Line Item 0014 (Option Period 7)

Performance

Period of Performance

Period of Performance From

05 NOV 2032

To

04 NOV 2033

Line Item 0015 (Option Period 7)

Performance

From

05 NOV 2032

To

04 NOV 2033

(End of Section)

Contract Administration Data

Department of Health and Human Services Acquisition Regulations (HHSAR) Clauses Incorporated by Reference

Number Title Effective Date

352.232-71 Electronic Submission of Payment Requests Feb 2022

Additional Regulation or Supplement Clauses Incorporated by Full Text

CONTRACTOR PAST PERFORMANCE EVALUATION(S) (OCT 2014)

a. General:

In accordance with Federal Acquisition Regulation (FAR) 42.15, Contractor Performance Information, past performance evaluations shall be prepared at least annually and at the time the work under a contract or order is completed. Additional interim performance evaluations may be prepared at Contracting Officer discretion, as necessary.

CMS will utilize the Contractor Performance Assessment Reporting System (CPARS), the Government-wide evaluation reporting tool for all past performance reports on contracts and orders, as appropriate. CPARS is a secure Internet website located at . https://www.cpars.gov

b. CPARS Process:

1. CPARS Training: Contractors may obtain CPARS training material and register for on-line training https://www.

. cpars.gov

2. Post-Award Contract Registration: CMS is responsible for registering the contract in CPARS within 30 calendar days of contract award. The Contractor shall:

i. Designate at least one (1) point of contact that will be responsible for serving as the Contractor's Representative (CR). Additional CRs may also be identified; and,

ii. Provide the CMS Contract Specialist with the name(s) and email address(es) of the CPARS point(s) of contact.

Once CMS registers the contract in CPARS, the CR(s) will receive an automated CPARS email message that contains User IDs and instructions for creating a password for future past performance evaluation processing.

3. Interim, Annual and Final Past Performance Evaluation Reports:

https://www.cpars.gov https://www.cpars.gov https://www.cpars.gov

a. Issuing the Evaluation: Once the CMS Assessing Official (AO) issues an evaluation to the Contractor in CPARS, the CR(s) will receive an email instructing them to login to CPARS to review the evaluation.

b. Contractor Comments: The CR has the option to provide comments on the evaluation, indicate if they concur or do not concur with the evaluation, sign, and then return the evaluation to the AO. The CR has a total of 60 days following the AO's evaluation signature date to submit comments. If the CR submits comments within the first 14 days following the AO's signature date and the AO closes the evaluation, the evaluation will become available in CPARS within 1 day.

On day 15 following the AO's evaluation signature date, the evaluation will become available in CPARS with or without CR comments and whether or not it has been closed by the AO. If no CR comments have been sent and the evaluation has not been closed, it will be marked as "Pending" in

CPARS.

If the CR sends comments at any time prior to 61 days following the AO's evaluation signature date, those comments will be reflected in CPARS within 1 day. On day 61 following the AO's evaluation signature date, the CR will be "locked out" of the evaluation and may no longer send comments.

Contractor Work Performed Outside the United States and its Territories (January 2021)

To comply with requirements of Homeland Security Presidential Directive -12 (HSPD-12) and Personal Identity Verification (PIV) of Federal Employees and Contractors, CMS must achieve appropriate security assurance for multiple CMS information systems by efficiently verifying the claimed identity of individuals working on the contract. The Contractor and its subcontractor

(s) shall not perform any activities under this contract, including the transmission of data or other information, outside of the United States (U.S.) and its Territories without the prior written approval of the Contracting Officer. If work must be performed outside the U.S., the Contractor shall submit a request to the Contracting Officer, in writing, at least 45 calendar days prior to the work beginning.

The Contracting Officer will consider the following factors in making a decision whether to authorize the performance of work outside the U.S. and its Territories:

1. The necessity of the work to be performed outside the United States and its territories;

2. The Statement of Work under contract that will be performed outside the U.S. and its Territories;

3. Total projected dollar value of the work to be performed outside the U.S.;

4. Total projected number of labor hours and length of time to be performed for each individual employee working outside the U.S.;

5. The desired country/location where the work will be performed;

6. FAR Part 25, Foreign Acquisitions, and all other laws and regulations applicable to the performance of work outside the U.S.;

7. The contractor and/or its subcontractor(s) plans to adequately protect and secure CMS data, as well as abide by all applicable laws and regulations when work is performed outside of the U.S. and its Territories. Plans shall include -

a. Adequate contract terms regarding system security;

b. Adequate contract terms regarding the confidentiality and privacy requirements for information and data protection;

c. Adequate contract terms that are otherwise relevant, including the requirements of the Statement of Work;

d. The Contractor's corporate compliance plan and internal policies and procedures designed to prevent and detect violations of applicable law, regulations, rules and ethical standards by employees, agents and others; and,

8. The necessity of Government Furnished Equipment (GFE) or Contractor Owned/Contractor Operated (COCO) devices to be used outside the U.S. and verification of a secure VPN access.

9. Compliance with Executive Order 13940 Aligning Federal Contracting and Hiring Practices With the Interests of American Workers. Determine if approval will reduce opportunities for the United States contractor workers performing in the United States and if this would cause any potential effects to national security.

10. Conformance with Section 889 "Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment", of Public Law115-232.

11. Determination that approval is in best interest of the Government.

The Contractor's request for authorization to perform work outside the U.S. shall include supplemental information to demonstrate that the performance of the work outside the U.S. satisfies all of the above factors. Contracting Officer approval to perform work outside the U.S. may require additional Statement of Work requirements, additional contract terms and conditions and/or Federal Acquisition Regulation (FAR) clauses to be incorporated into the contract.

GOVERNMENT REPRESENTATIVES AND RESPONSIBILITIES (NOV 2024)

Following are the Government Representatives and their respective roles and responsibilities on this contract:

a. Contracting Officer

As defined in Federal Acquisition Regulation (FAR)2.101, Definitions, and in accordance with FAR 1.602-1, Authority, "Contracting officers have authority to enter into, administer, and/or terminate contracts and make related determinations and findings." There is no other authorized representative or any other Administrative Contracting Officer assigned to this contract to carry out a Contracting Officer's duties, except for technical direction assigned to the Contracting Officer's Representative, if applicable.

The Contracting Officer is:

Centers for Medicare & Medicaid Services

Office of Acquisition & Grants Management

Information Technology Contracts Group

Division of Data Center Contracts

ATTN: Candace Straker

7500 Security Blvd.

Baltimore, MD 21244-1850

Phone: 410-786-8174

Email Address: Candace.straker@cms.hhs.gov

b. Contract Specialist

Notwithstanding any of the other provisions of this Contract, the Contract Specialist will assist the Contracting Officer with his/her responsibilities as defined in the FAR.

The Contract Specialist is:

Centers for Medicare & Medicaid Services

Office of Acquisition & Grants Management

Information Technology Contracts Group

Division of Data Center Contracts

ATTN: Lauren Holsey

7500 Security Blvd.

Baltimore, MD 21244-1850

Phone: 410-786-3746

Email Address: Lauren.holsey@cms.hhs.gov

c. Contracting Officer's Representative

The Contracting Officer's Representative (COR), as defined in FAR 2.101, Definitions, is:

Centers for Medicare & Medicaid Services

Office of Information Technology

Applications Management Group

Division of Shared Systems Management

ATTN: Kirk Puepke

7500 Security Blvd.

Mail-stop:

Baltimore, MD 21244-1850

Phone: 410-786-1021

Email Address: Kirk.puepke@cms.hhs.gov

In accordance with FAR 1.602-2(d), Responsibilities, the COR's delegated responsibilities are identified in the Contracting Officer's appointment memorandum, a copy of which will be furnished to the contractor.

The COR will serve as the primary liaison between the Contractor and the Contracting Officer and perform duties within the limitations of the COR's responsibilities in accordance with FAR 1.602-2(d).

Technical direction must be within the general scope of the work stated in the contract. The term "technical direction" is defined to include, without limitation, the following:

(1) Directions to the Contractor which direct the contract effort, shift work emphasis between work areas or tasks, require pursuit of certain lines of inquiry, fill in details or otherwise serve to accomplish the contractual technical requirements as identified in the Statement of Work or Performance Work Statement; or

(2) Provision of information to the Contractor, which assists in the interpretation of drawings, specifications, or technical portions of the work description.

Technical direction within the scope of the contract, shall be "in writing" whenever possible and routed through the CO prior to release to the Contractor. If technical direction is verbally communicated, the COR must immediately confirm its direction in writing. Where doubt exists as to whether proposed technical direction is within or outside the scope of the contract, the CO shall be contacted.

If, in the opinion of the Contractor, any instruction or direction issued by a Government representative constitutes a change to the contract or constitutes a "Change Order" as defined in FAR 2.101, Definitions, the Contractor shall follow the instructions identified in FAR 52.243-7 Notification of Changes.

The COR "has no authority to make any commitments or changes that affect price, quality, quantity, delivery, or other terms and conditions of the contract nor in any way direct the contractor or its subcontractors to operate in conflict with the contract terms and conditions." See FAR1.602-2(d)(5). The COR's authority is not re-delegable and the COR may be personally liable for unauthorized acts in accordance with FAR 1.602-(d)(7)(iv) and (v). For example, the COR does not have the authority to:

1. Make changes to contract terms and conditions;

2. Direct the contractor to perform work or make deliveries not specifically required under the contract;

3. Waive or relax the Government's rights with regard to the Contractor's compliance with the specifications, price, delivery or any other terms or conditions of the contract;

4. Make any commitments or approve any actions that would create any financial obligation on the part of the Government; or

5. Issue direction that constitutes a "change" as defined in:

FAR 52.243-1, Changes - Fixed Price;

FAR 52.243-2, Changes - Cost-Reimbursement;

FAR 52.243-3, Changes - Time-and-Materials or Labor-Hours;

FAR 52.243-4, Changes; or, FAR 52.243-5, Changes and Changed Conditions.

In addition to the above responsibilities, the COR and/or Contractor shall immediately notify the Contracting Officer of any contractual concerns related to the following:

1. Personal Services: FAR37.104(a) provides that, "[a] personal services contract is characterized by the employer-employee relationship it creates between the Government and the contractor's personnel. The Government is normally required to obtain its employees by direct hire under competitive appointment or other procedures required by the civil service laws. Obtaining personal services by contract, rather than by direct hire, circumvents those laws unless Congress has specifically authorized acquisition of the services by contract."

Under this contract, the services to be performed do not require the Contractor or the Contractor's personnel to exercise personal judgement and discretion on behalf of the Government. Rather, the Contractor's personnel will act and exercise personal judgement and discretion on behalf of the Contractor. The services to be performed under this contract are not for personal services as defined by FAR 37.104.

Both the Government and the Contractor have a responsibility to monitor contract activities. The CO must be notified immediately if at any time during contract performance the interaction between the Government representative and Contractor personnel constitutes or is perceived to constitute personal services. Both the Government and Contractor personnel must exercise caution to ensure that service contracts not personal in nature avoid even the appearance of a personal services contract.

2. Inherently Governmental Functions: The agency shall not use contractors for the performance of inherently governmental functions unless issued under statutory authority See FAR 7.5 Inherently Governmental Functions. As defined in FAR 2.101, "Inherently Governmental Function" means, as a matter of policy, a function that is so intimately related to the public interest as to mandate performance by Government employees. An inherently governmental function includes activities that require either the exercise of discretion in applying Government authority, or the making of value judgments in making decisions for the Government. Inherently governmental functions DO NOT normally include gathering information for or providing advice, opinions, recommendations, or ideas to Government officials.

FAR 7.503(c) provides a list of examples of functions considered to be inherently governmental functions or which shall be treated as such.

To this effect, during contract performance, care should be taken to ensure that any change or expansion in scope of the requirement does not include inherently governmental functions. Further, due to the nature of a given requirement, there is a potential for close working relationships to develop between Government and Contractor personnel; however, care should be taken to ensure that any familiarity established between the Government and Contractor personnel never promotes or fosters an environment that allows for the assignment of inherently governmental functions to contractor employee(s).

3. Unauthorized Commitments: In carrying out your duties, you are reminded that in accordance with FAR (d)(5), the COR "[h]as no authority to make any commitments or changes that affect price, 1.602-2 quality, quantity, delivery, or other terms and conditions of the contract, or in any way direct the Contractor, or its Subcontractors, to operate in conflict with the contract terms and conditions." Doing so constitutes an "unauthorized commitment." The Contracting Officer is the only individual with the authority to enter into an agreement on behalf of the Government. An unauthorized commitment is defined as "an agreement that is not binding solely because the Government representative who made it lacked the authority to enter into that agreement on behalf of the Government." FAR 1-602-3(a). Examples of unauthorized commitments include, but are not limited to, the following:

• Orders placed with a Contractor without a valid contractual instrument in place.

• Directing any Contractor to do additional work, in excess of the contract value, or work beyond the Period of Performance.

• Authorize new work to a contract without notifying the Contracting Officer (CO) or Contract Specialist(CS) and having a modification in place for the new work.

• Directing the Contractor, in any way that could change the terms and conditions of the contractual instrument or be deemed outside the Scope of the Statement of Work.

Unauthorized commitments are a serious matter and may result in personal liability on the part of the employee who committed the unauthorized commitment. Ratification, is "the act of approving an unauthorized commitment by an official who has the authority to do so." FAR 1.602-3(a).

PAYMENTS - INVOICES - ( September 2024 )

a. GENERAL: Effective August 31, 2020, the Contractor/ Vendor shall create an invoice within the Invoice Processing Platform (IPP), a secure Web-based service for federal agencies and their vendors to manage government invoicing from purchase order (PO) through payment notification. Note: All invoice terms and conditions are contract specific and may vary from contract to contract.

b. CONTENT OF INVOICE: FAR 32.905 Payment Documentation and Process, provides the required content for a proper invoice. In addition to the requirements of FAR 32.905, the following items shall also be included on the invoice to be considered proper:

• Line item number (i.e. CLIN/SLIN as applicable)

• Contractor /Vendor's Unique Entity Identifier (UEI) Number;

• Period of Performance (PoP) or delivery date of goods or services provided;

• Attachments and applicable support documentation requested by the CO ;

• The first page of the PDF invoice or PDF SF-1034 shall include :

1. Contractor /Vendor name and address;

2. Bill to: CMS, P.O. Box 7520, Baltimore, MD 21207;

https://www.acquisition.gov/far/part-1

3. Full CMS contract number and task order number;

4. Summary of charges by CLIN/SLIN (if applicable) with a grand total. CLIN/SLIN( S) on the PDF shall be identical to what is entered in IPP;

5. Invoice number shall be identical to what is entered in IPP. Each Contractor/Vendor invoice number must be unique across all CMS contracts awarded to the Contractor /Vendor. For example, If Contractor /Vendor A has 5 CMS contracts, Contractor /Vendor A cannot use the same invoice number on any of the 5 contracts they have with CMS. If using a dash in IPP then the dash must be used on the PDF. IPP does not allow any special characters (i.e.*, # , _ );

6. Within IPP, the " Bill Period Start " and "Bill Period End " dates should align with the " Service From " and " Service To " dates (this is not the entire POP dates);

7. Date of Delivery or Service dates shown on the PDF should: ( i ) F all within the contract POP (unless contract indicates otherwise) ( ii ) Align with the " Bill Period Start " and "Bill Period End " dates and " Service From " and " Service To " dates, and ( iii ) Note when the work was performed;

8. Date invoice was prepared;

9. The total invoice amount on the first page of the invoice or SF-1034 must be a debit. A credit may be shown on the first page of the invoice or SF-1034 if the credit falls within the Period Of Performance and is for the same CLIN as the debit. CMS does not accept credit vouchers or process refunds in IPP or the Invoice Submission Box. Credits in excess of $5.01 must be submitted via Pay.gov (For questions surrounding Pay.gov, contact pay.gov.

clev@clev.frb.org or 1-800-624-1373 (Option 2)). Credits sent to Pay.gov shall be copied to the CO, CS and COR. Credits valued at or less than $5.01 must be submitted via Credit Gateway; however, it is preferred that the Contractor/Vendor wait until a dollar amount is accumulated in order to submit the refund through Pay.gov (For questions surrounding Credit Gateway, contact customer.care@usbank.com or 1-877-815-1206);

• When an invoice has been resubmitted, an "R" should be added after the invoice number on the PDF and in IPP; this will ensure that the original invoice number is not duplicated in IPP. If a resubmitted invoice is rejected again, each subsequent resubmission requires an additional "R" added after the invoice number (i.e. "RR" );

• The " final " designation should only be used when the contract is being closed out by OAGM. Do not use for the end of POP or Option Year;

• Contractor/ Vendor must maintain active registration in SAM .gov. If your SAM account is about to expire, wait until it is updated before submitting your invoice; and,

• Banking or address changes must be submitted via email to CCRchanges@cms.hhs.gov.

c. INVOICE SUBMISSION: The Contractor/ Vendor shall create an invoice from the Purchase Order (PO)/Contract via the IPP website http://www.ipp.gov/. For questions, call IPP Customer Support at (866) 973-3131 or email the IPP Customer Support at IPPCustomerSupport@fiscal.treasury.gov. Only one PDF invoice per submission is allowed in IPP.

d. PAYMENTS: The Government shall make payment of all proper invoices in accordance with the following clauses, as applicable and included in the respective TO/PO/contract:

• FAR 52.232-33 Payments by Electronic Funds Transfer - System for Award Management,

• FAR 52.232-1 Payments

• FAR 52.212-4 Contract Terms and Conditions - Commercial Items (If applicable)

• FAR 52.216-7 Allowable Cost and Payment

• FAR 52.232-7 Payments under Time-and-Materials and Labor-Hour Contracts

Payment shall be made upon acceptance by the Contracting Officer's Representative (COR) in accordance with the applicable FAR Inspection and Acceptance clause and the Contracting Officer's approval, as appropriate.

Reimbursement for invoices submitted under this contract shall be made no later than 30 calendar days after receipt of a proper invoice from the Contractor requested at the paying office designated above.

Contracts with a 15- day payment term are not subject to interest payments until after day 30.

e. INTEREST ON OVERDUE PAYMENT: The Prompt Payment Act, Public Law 97-177 (96 Stat.85.31 U.S.C.

1801) is applicable to payments under this contract and requires the payment of interest on payments made more than 30 calendar days after receipt of a proper invoice in IPP. Determinations of interest due will be made in accordance with the provisions of the Prompt Payment Act and 5 CFR 1315.

(End of Section)

Special Contract Requirements

The Medicare claims processing software services being performed by the Contractor are described in the True Up Clause:

Performance Work Statement (PWS) associated with this order. The beneficiary quantities and their associated unit prices are detailed in Attachment 6 - Beneficiary Quantities and Unit Pricing. Fixed unit prices represent a monthly price per beneficiary to provide software services for the period of performance associated with CLIN 0004, CLIN 0006, CLIN 0008, CLIN 0010, CLIN 0012, and CLIN 0014.

Once annually, the firm fixed price of must be CLIN 0004, CLIN 0006, CLIN 0008, CLIN 0010, CLIN 0012, and CLIN 0014 prospectively adjusted to reflect changes between actual and estimated quantity of beneficiaries expected to be served by the Contractor's software in the forthcoming option period.

In support of this process, the Contractor shall deliver to CMS a report 90 days prior to the end of the current period of performance of CLIN 0002, CLIN 0004, CLIN 0006, CLIN 0008, CLIN 0010, and CLIN 0012. The report must indicate changes between the estimated quantity of beneficiaries, as set forth in the Task Order Attachment referenced above, and the actual number of beneficiaries processed through the software system during the current period of performance. The actual quantity of beneficiaries cited in the report should be based on unique beneficiaries per month as tracked in the Contractor's system and verified against CMS records.

The report must then calculate the estimated value of the price adjustment to CLIN 0004, CLIN 0006, CLIN 0008, CLIN 0010, CLIN 0012, and CLIN 0014 in the subsequent option period using the unit rates from the Attachment cited above. The report must include:

A revision to the Attachment formatted in MS Excel Supporting basis of estimate for projected beneficiary volumes Historical beneficiary volume trends from the current period Any anticipated changes in beneficiary population that may impact pricing

Following review of the report, the Contracting Officer may then adjust the price of CLIN 0004, CLIN 0006, CLIN 0008, CLIN 0010, CLIN 0012, and CLIN 0014 for the subsequent option period via unilateral modification to the task order. All adjustments will be prospective in nature; retrospective adjustments for differences between estimated and actual beneficiary quantities will not be considered under this clause. will not be subject to an adjustment under this clause; the first CLIN subject to CLIN 0002 adjustment will be .CLIN 0004

Department of Health and Human Services Acquisition Regulations (HHSAR) Clauses Incorporated by Full Text

352.239-71 Security Requirements for Information Technology Resources (Feb 2024) Deviation

(a) . As used in this clause— Definitions has the same meaning in FAR 2.101. Information technology information technology (see FAR 2.101 for definitions). Information and communication technology (ICT) also means means a formal document that provides an overview of the security requirements for an Information system security plan information system or an information security program and describes the security controls in place or planned for meeting those requirements.

(b) . The Contractor shall be responsible for information technology security for all systems connected to a Responsibilities Department of Health and Human Services (HHS) network or operated by the Contractor for HHS, regardless of location. This clause is applicable to all or any part of the contract that includes information technology resources or services in which the Contractor has physical or other system access to HHS information that directly supports the mission of HHS. Examples of tasks that require security provisions include—

(1) Hosting of HHS e-Government sites or other information technology operations;

(2) Acquisition, transmission, or analysis of data owned by HHS with significant replacement cost should the contractor's copy be corrupted; and

(3) Access to HHS general support systems/major applications at a level beyond that granted the general public, e.

g., bypassing a firewall.

(c) . The Contractor shall develop, provide, implement, and maintain an Information System Information system security plan Security Plan. HHS information system and platform information technology systems must have a security plan that provides an overview of the security requirements for the system and describes the security controls in place or the plan for meeting those requirements. Generally, this plan shall describe the processes and procedures that the Contractor will follow to ensure appropriate security of information system resources developed, processed, or used under this contract. The security plan should include implementation status, responsible entities, resources, and estimated completion dates. Security plans may also include, but are not limited to, a compiled list of system characteristics or qualities required for system registration, and key security-related documents such as a risk assessment, privacy impact assessment (PIA), system interconnection agreements, contingency plan, security configurations, configuration management plan, incident response plan, and the system privacy plan, as determined by the Contracting Officer's Representative. The plan shall address the specific contract requirements regarding information systems or related support or services included in the contract, to include the PWS or SOW. The Contractor's Information System Security Plan shall comply with applicable Federal Laws that include, but are not limited to, 40 U.S.C.

11331, the Federal Information Security Modernization Act (FISMA) of 2014 and the E-Government Act of 2002. The plan shall meet information technology security requirements in accordance with Federal and HHS policies and procedures, and as amended during the term of this contract, and include, but are not limited to the following:

(1) OMB Circular A-130, Managing Information as a Strategic Resource;

(2) National Institute of Standards and Technology (NIST) Guidelines;

(3) Federal Information Processing Standard (FIPS) 200; and

(4) HHS Cybersecurity Program related to HHS information (including HHS sensitive information and information systems security and privacy), as well as those set forth in the contract specifications, statement of work, or performance work statement. These include, but are not limited to, the Cyber Security Checklist and Cyber Security Infographic at , which https://www.hhs.gov/hipaa/for-professionals/security/guidance/cybersecurity/index.html provides HHS procedures, responsibilities, and processes for complying with current Federal law, Executive Orders, policies, regulations, standards and guidance for protecting HHS information, information systems (see 302.101, Definitions), information technology, and ICT, security and privacy, and adhering to personnel security requirements when accessing HHS information or information systems.

(d) . Within 60 days after contract award, the Contractor shall submit the Information System Security Plan to Submittal of plan the Contracting Officer for review and approval.

https://www.hhs.gov/hipaa/for-professionals/security/guidance/cybersecurity/index.html

(e) . As required by current HHS policy, the Contractor shall submit written proof of information Authority to Operate (ATO) technology security accreditation with a valid ATO to the Contracting Officer. Such written proof may be furnished either by the Contractor or by a third party. Accreditation shall be in accordance with HHS policy available from the Contracting Officer upon request. The Contractor shall submit for acceptance by the Contracting Officer along with this ATO a final security plan, risk assessment, security test and evaluation, privacy threshold analysis or privacy impact assessment, and a disaster recovery plan /continuity of operations plan.

(f) . On an annual basis, the Contractor shall verify in writing to the Contracting Officer that the IT Security Annual validation Plan remains valid.

(g) . The Contractor shall ensure that the official HHS banners are displayed on all HHS systems (both public and Banners private) operated by the Contractor that contain Privacy Act or other sensitive information before allowing anyone access to the system. The Office of Information Technology will make official HHS banners available to the Contractor.

(h) . The Contractor shall screen all personnel requiring privileged access or limited privileged access to Screening and access systems operated by the Contractor for HHS or interconnected to an HHS network in accordance with HHS policies referenced in paragraph (c).

(i) . The Contractor shall ensure that its employees performing services under this contract complete HHS security Training awareness and privacy training on an annual basis. This includes signing an acknowledgment on an annual basis that they have read, understand, and agree to abide by the HHS Rules of Behavior for the Use of HHS Information and IT Resources Policy as required; FAR 39.105, Privacy; clause 352.204-71, Information and Information Systems Security, and this clause.

(j) . The Contractor shall provide the Government access to the Contractor's and subcontractors' facilities, Government access installations, operations, documentation, information systems, databases, and personnel used in performance of the contract. The Contractor shall provide access to enable a program of information technology inspection (to include vulnerability testing), investigation and audit (to safeguard against threats and hazards to the integrity, availability and confidentiality of HHS data or to the function of information technology systems operated on behalf of HHS), and to preserve evidence of computer crime.

(k) . The Contractor shall immediately notify the Contracting Officer when an employee Notification of termination of employees who has access to HHS information systems or data terminates employment.

(l) . The Contractor shall incorporate and flow down the substance of this clause to all Subcontract flow down requirement subcontracts that meet the conditions in paragraph (a) of this clause.

(End of clause)

352.239-79 Information and Communication Technology Accessibility (Feb 2024) Deviation

(a) Pursuant to Section 508 of the Rehabilitation Act of 1973 (29 U.S.C. 794d), as amended by the Workforce Investment Act of 1998, all information and communication technology (ICT) supplies, products, platforms, information, documentation, and services support developed, acquired, maintained or delivered under this contract or order must comply with the Revised 508 Standards, which are located at 36 C.F.R. 1194.1 and Appendices A, B, and C, and are available at https://www.access-board.gov

. Information about Section 508 is available at . /ict/ https://www.hhs.gov/web/section-508/index.html

(b) Additional Section 508 accessibility standards applicable to this contract or order may be identified in the specification, statement of work, or performance work statement. If it is determined by the Government that ICT supplies, products, platforms, information, documentation, and services support provided by the Contractor do not conform to the described accessibility standards in the contract, remediation of the supplies, products, platforms, information, documentation, or services support to the level of conformance specified in the contract will be the responsibility of the Contractor at its own expense.

(c) In the event of a modification(s) to this contract or order, which adds new ICT supplies or services or revises the type of, or specifications for, supplies, products, platforms, information, documentation, or services support, the Contracting Officer shall require that the Contractor submit a completed HHS Section 508 Accessibility Conformance Checklist (see https://www.hhs.gov

) or an Accessibility Conformance Report (ACR) (based on the Voluntary /web/section-508/accessibility-checklists/index.html Product Accessibility Template (VPAT) see ), and any other additional information https://www.itic.org/policy/accessibility/vpat necessary to assist the Government in determining that the ICT supplies or services conform to Section 508 accessibility https://www.access-board.gov/ict/ https://www.access-board.gov/ict/ https://www.hhs.gov/web/section-508/index.html https://www.hhs.gov/web/section-508/accessibility-checklists/index.html https://www.hhs.gov/web/section-508/accessibility-checklists/index.html https://www.itic.org/policy/accessibility/vpat standards. If it is determined by the Government that ICT supplies, products, platforms, information, documentation, and services support provided by the Contractor do not conform to the described accessibility standards in the contract, remediation of the supplies, products, platforms, information, documentation, or services support to the level of conformance specified in the contract will be the responsibility of the Contractor at its own expense.

(d) If this is an Indefinite-Delivery type contract, a Blanket Purchase Agreement or a Basic Ordering Agreement, the task /delivery order requests that include ICT supplies, products, platforms, information, documentation, or services support will define the specifications and accessibility standards for the order. In those cases, the Contractor shall be required to provide a completed HHS Section 508 Accessibility Conformance Checklist (see https://www.hhs.gov/web/section-508/accessibility-

) or an ACR (based on the VPAT see ), and any other checklists/index.html https://www.itic.org/policy/accessibility/vpat additional information necessary to assist the Government in determining that the ICT supplies, products, platforms, information, documentation, or services support conform to Section 508 accessibility standards. If it is determined by the Government that ICT supplies and services provided by the Contractor do not conform to the described accessibility standards in the provided documentation, remediation of the supplies, products, platforms, information, documentation, or services support to the level of conformance specified in the contract will be the responsibility of the Contractor at its own expense.

(e) The contractor shall identify to the Contracting Officer any perceived exception or exemption to Section 508 requirements.

(End of clause)

Additional Regulation or Supplement Clauses Incorporated by Full Text

HIPAA BUSINESS ASSOCIATE CLAUSE (OCT 2014)

All Protected Health Information (PHI), as defined in 45 C.F.R. 160.103, that is relevant to this Contract, shall be administered in accordance with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA," 42 U.S.C. 1320d), as amended, as well as the corresponding implementing regulations and this HIPAA Business Associate Clause.

a. Definitions:

All terms used herein and not otherwise defined, shall have the same meaning as in HIPAA, as amended, and the corresponding implementing regulations. Non-HIPAA related provisions governing the Contractor's duties and obligations, such as those under the Privacy Act and any applicable data use agreements, are generally covered elsewhere in the Contract.

The following definitions apply to this Contract Clause:

"Business Associate" shall mean the Contractor (and/or the Contractor's subcontractors or agents) if/when it uses individually identifiable health information on behalf of CMS, i.e. PHI, to carry out CMS' HIPAA-covered functions.

"Covered Entity" shall mean the portions of CMS that are subject to the HIPAA Privacy Rule.

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

b. Obligations and Activities of Business Associate:

Except as otherwise provided in this Contract, Business Associate, as defined above, shall only use or disclose PHI on behalf of, or to provide services to, Covered Entity in accordance with this Contract and the HIPAA Privacy and Security Rules.

Business Associate shall document in writing the policies and procedures that will be used to meet HIPAA requirements. The policies and procedures shall include the following, at a minimum:

1. Business Associate shall not:

https://www.hhs.gov/web/section-508/accessibility-checklists/index.html https://www.hhs.gov/web/section-508/accessibility-checklists/index.html https://www.itic.org/policy/accessibility/vpat

i. Use or disclose PHI that is created, received, maintained or transmitted by Business Associate from, or on behalf of, Covered Entity other than as permitted or required by this Contract or as required by law;

ii. Sell PHI; or,

iii. Threaten, intimidate, coerce, harass, discriminate against, or take any other retaliatory action against any individual for:

A. Filing a complaint under 45 CFR 160.306;

B. Testifying, assisting or participating in an investigation, compliance review, proceeding or hearing under 45 CFR Part 160; or

C. Opposing any act or practice that is unlawful under HIPAA, provided there is a good faith belief that the practice is unlawful, the manner of opposition is reasonable, and the opposition does not involve the disclosure of PHI in violation of subpart E of Part 164.

2. Business Associate shall:

i. Have a security official who will be responsible for development and implementation of its security policies and procedures, including workforce security measures, to ensure proper security awareness and training (including security incident response and reporting), and security incident procedures, in accordance with this Contract, including this HIPAA Business Associate Clause and the Contract's clause entitled "CMS Information Security."

ii. Use administrative, physical and technical safeguards to prevent use or disclosure of PHI created, received, maintained or transmitted by Business Associate from, or on behalf of Covered Entity only as provided for by this Contract.