Sources-Sought-Notice JG.pdf

Centers for Medicare & Medicaid Services

A/B & DME MAC Sources Sought Notice 1

Sources Sought Notice

Medicare Administrative Contractor (MAC) Services

Medicare Parts A & B (Medicare Fee-for-Service)

Jurisdiction G (JG)

August 20, 2025

Introduction

THIS SOURCES SOUGHT NOTICE IS STRICTLY MARKET RESEARCH. CMS WILL

NOT ENTERTAIN QUESTIONS REGARDING THIS MARKET RESEARCH.

The purpose of this SOURCES SOUGHT NOTICE is to conduct market research to determine the availability and capability of potential small businesses (e.g., 8(a), service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business, and women-owned small business) that can provide specific fee-for-service (FFS) health insurance benefit administration services, including Medicare claims processing and payment services, in support of the “traditional” Medicare program (also known as the Medicare Fee-for-Service, or FFS program) in accordance with the Statements of Work (SOW) provided with this notice as attachments.

The information obtained through this market research will assist the Centers for Medicare & Medicaid Services (CMS) in determining the appropriate acquisition procedures for obtaining the Medicare health insurance benefit services described in the attached SOWs. This market research will aid CMS in its determination whether a full and open competitive acquisition is appropriate, or if the acquisition should be set aside for small businesses or a specific socio-economic category of small businesses such as 8(a), service-disabled veteran-owned small business, HUBZone small business, or women-owned small business.

A/B & DME MAC Sources Sought Notice 2

Please note that CMS will rely on the results of this market research, in part, when conducting acquisitions for MAC services in multiple geographical jurisdictions over multiple years, including JG.

Background and Purpose of Acquisition

Prior to 2015, §1874A under Title XVIII of the Social Security Act (the Act) required CMS to re-compete its Medicare FFS benefit and claims administration (MAC) contract at least once every five years. As of April 16, 2015, the Medicare Access and CHIP Reauthorization ACT of 2015 revised Section 1874A (b)(1)(B) of the Social Security Act (42 U.S.C. 1395kk–1(b)(1)(B)), increasing the five-year term limit to up to ten years.

The purpose of this acquisition is to procure a Medicare Part A and Part B (A/B) MAC to provide Medicare FFS benefit and claims administration services and to perform numerous Medicare Program functions. These functions include making healthcare claims-related payments on behalf of Medicare beneficiaries and establishing relationships with institutional and professional providers and suppliers of healthcare services for the defined geographic areas shown below. MACs must perform the requirements of these contracts in accordance with applicable laws, regulations, Medicare manuals, and CMS’s financial and program integrity requirements. The attached Statements of Work (SOW) for the JG MAC provides a current snapshot of contract requirements. While this sources sought notice is targeted to the JG A/B MAC jurisdiction, CMS may consider the results of this market research when determining the acquisition approach for these services for other MAC jurisdictions.

• Part A/B JG is a combination of J5 and J6 and is comprised of the following states:

Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, and Wisconsin

Response Information

Responses to this notice shall demonstrate the capability to perform the specific A/B MAC functions provided in the list below, assuming the given workload volumes and performance standards. Responses based upon anticipated teaming arrangements and Joint Ventures may be acceptable. The capability of each team member (prime contractor and subcontractors) shall be demonstrated relative to the anticipated functions/roles to be performed by each. Potential small businesses shall also include the business information outlined in the section below as part of their response.

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1. In accordance with CMS’s technical specifications, potential offerors must demonstrate capability to receive, control, and pay Medicare claims from providers, suppliers, and beneficiaries within its jurisdiction. Potential offerors must demonstrate the ability to perform edits on claims to determine whether the claims are complete and should be paid.

2. Potential offerors must demonstrate capability to determine the need for locality-driven edits in their jurisdiction as well as those included in the Standard and Supplemental systems. Offerors must demonstrate the ability to develop the logic for local coverage determinations. For purposes of this notice, an edit is logic within the Standard Claims Processing Systems or Program Integrity Supplemental Edit Software that selects certain claims; evaluates or compares information on the selected claims or other accessible source; and depending on the outcome of the evaluation, acts on the claims such as pay in full, pay in part, or suspend for manual review.

3. In accordance with CMS’s technical specifications for JG, potential offerors must demonstrate capability to enroll Medicare providers and suppliers (receive, process, and make final determinations on initial provider enrollment applications) and execute the ongoing revalidation process for providers and suppliers to maintain their Medicare billing privileges.

4. Potential offerors must demonstrate capability to calculate Medicare payment amounts and remit these payments to appropriate parties.

5. Potential offerors must demonstrate capability to conduct a variety of Medicare provider and supplier outreach and response services such as answering written inquiries and providing education on Medicare rules, regulations, and billing procedures.

6. Potential offerors must demonstrate capability to operate Medicare toll-free lines across the country to answer a wide range of provider and supplier questions.

7. Potential offerors must demonstrate capability to conduct redeterminations on appeals of claims, respond to complex beneficiary inquiries referred from Call Center Operations (CCO), conduct Medical Review on selected claims, and conduct rigorous quality control on the millions of claims processed each year.

8. Potential offerors must demonstrate capability to utilize or interact with certain CMS-required payment systems, equipment, and/or operational capabilities in the performance of its functions.

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9. Potential offerors must demonstrate capability to coordinate activities with CMS and a broad range of other agencies at the Federal, state, and local levels of government.

Potential offerors must demonstrate capability to coordinate with other CMS partners, contractors, and a diverse range of health care stakeholders within the United States.

10. Potential offerors must demonstrate capability of reviewing, accounting for, adapting to, and implementing up to 425 contractual Change Requests (CRs) issued by CMS each year. This requirement includes the ability to track the impact of the CRs on contract performance from both cost and technical perspectives.

11. Potential offerors must demonstrate capability to obtain and/or maintain an Authority to Operate (ATO) from CMS and have policies, procedures, and practices for fulfilling Department of Health and Human Services (HHS) and CMS information security requirements. These policies and procedures will be extensively audited and validated through an annual review cycle. Refer to the referenced SOWs and other information provided below regarding Systems Access and Security Considerations.

Jurisdiction Volumes

The workload volume estimates provided below are for mission essential operational areas only and are not intended to represent every operational area of a MAC contract. Also, included is performance requirement level information for the specific operational areas noted for ease of reference. The full set of program requirements and performance measures are provided in the attached Statements of Work.

Jurisdiction G (JG):

For each full year of the JG A/B MAC contract, the MAC is required to perform the same SOW program requirements at the level of the stated Performance Requirements. Estimated volumes specific to JG for CY 2025 are provided below:

• Processed approximately 140 million A/B claims.

• Processed approximately 1.9 million Medicare claims re-openings and approximately 250,000 Medicare claims redeterminations (1st level appeals).

• Processed approximately 75 million inquiries (telephone, written, and electronic/web) from Medicare providers.

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• Processed approximately 480,000 provider enrollment actions (various types of providers and enrollment actions).

• Received, analyzed, desk review, and settle (or tentatively settle) approximately 84,000 provider cost reports.

• Conducted approximately 45,000 clinical medical records reviews to determine medical necessity for Medicare claims.

The performance requirement summaries below apply to the JG MAC contract:

PERFORMANCE REQUIREMENTS: CLAIMS

• Claims processing is successful when claims are paid with acceptable accuracy as evidenced by a contractor-specific Comprehensive Error Rate Testing (CERT) error rate not to exceed the Government Performance Results Act (GPRA) national paid claims error rate goal for the year (the goal for each year is published in the “Report on Improper Medicare Fee-for-Service Payments” at CERT Reports (https://www.cms.gov/Research- Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance- Programs/CERT/CERT-Reports.html).

• Clean claims are processed timely when 95% of the Part A and Part B of A claims processed in the Fiscal Intermediary Standard System (FISS) are processed within the claims payment floor and ceiling specified in the Internet Only Manuals (IOM) Pub. 100- 04, Chapter 1, §80.2.1.1 and §80.2.1.2. The contractor must meet this standard monthly.

• Clean claims are processed timely when 95% of the Part B claims processed in the Multi- Carrier System (MCS) are processed within the claims payment floor and ceiling specified in IOM Pub. 100-04, Chapter 1, §80.2.1.1 and §80.2.1.2. The contractor must meet this standard monthly.

• Clean claims are processed timely when 95% of the DME claims processed in the ViPS Medicare System (VMS) are processed within the claims payment floor and ceiling specified in IOM Pub. 100-04, Chapter 1, §80.2.1.1 and §80.2.1.2. The contractor must meet this standard monthly.

https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/CERT-Reports.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/CERT-Reports.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/CERT-Reports.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/CERT-Reports.html

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• Other-Than-Clean claims are processed timely when 100% of the claims are processed within 45 days of the receipt specified in IOM Pub. 100-04, Chapter 1, §80.3.3. The contractor must meet this standard monthly.

• Re-openings: Where appropriate, the Contractor shall reopen an initial determination or a redetermination to review a decision in accordance with 42 Code of Federal Regulations (CFR) §405.980 and IOM Pub. 100-04, Chapter 34.

• Reopening Decisions: The Contractor shall issue its revised determination or decision to the parties to the initial determination or redetermination in accordance with 42 CFR §405.982.

PERFORMANCE REQUIREMENTS: APPEALS

• Redetermination Requests: The Contractor shall process requests for redetermination of Medicare initial claims determinations in accordance with 42 CFR §405.940-958 and IOM Pub. 100-04, Chapter 29, §310.

• Conduct and Notice of the Redetermination: Contractors shall prepare a notice of the redetermination in accordance with 42 CFR §405.956 and IOM Pub. 100-04, Chapter 29, §310. Contractors shall process and mail all redeterminations within 60 calendar days of the date the Contractor receives a timely filed request for redetermination.

• Appeal Decision Effectuation: The Contractor shall take all necessary payment actions on all levels of appeal (redeterminations, reconsiderations, ALJ decisions, Medicare Appeals Council reviews, and decisions issued in the federal district court). Payment should be made timely and in accordance with instructions specified in IOM Pub. 100-04, Chapter 29.

PERFORMANCE REQUIREMENTS: CORRESPONDENCE AND INQUIRIES

• Electronic Correspondence Referral System Status Inquiries: Status inquiries are performed in accordance with IOM Pub. 100-05, Chapter 5, §10.2 and §10.5.

• Responses to Congressional Inquiries: Congressional written inquiries are timely when

100% are answered within 10 business days, including any that may be received from a CMS Regional Office. For those Congressional inquiries that cannot be answered in final within 10 business days the Contractor shall issue an interim response within 10 business days explaining the reason for the delay. Any interim responses sent to Congressional

A/B & DME MAC Sources Sought Notice 7 inquiries shall count toward the Contractor’s overall allowance of no more than 5% of interim responses for the universe of written inquiries.

• Telephone Inquiries – Quality: Of all telephone calls monitored for the quarter, the percentage of calls scoring as “YES” for Knowledge Skills, Customer Skills and for Adherence to Privacy Act using the Quality Call Monitoring tool shall be no less than 93% (cumulative for the quarter).

• Telephone Inquiries – Call Completion Rate: The provider contact center shall complete at least 95% of incoming calls on an Interactive Voice Response (IVR)-only line, 80% of incoming calls on a CSR-only line, and 80% of incoming calls on an IVR/CSR combined line as measured on a quarterly basis.

• Telephone Inquiries – Average Speed of Answer: The provider contact center shall maintain an average speed of answer of 60 seconds or less when measured on a quarterly basis.

• Written Inquiry Responses – Timeliness: All (100%) written provider general inquiries and provider PRRS shall be responded to within 45 business days of receipt with either a final response or an interim response, and no more than 5% of the universe of written responses to provider inquiries shall be interim responses.

• Inquiries Specific to Debt Collection Efforts for Providers, Physicians, and other

Suppliers: Inquiries specific to debt collection efforts are successful when 95% of all providers, physician, and other supplier MSP inquiries shall be acknowledged or responded to within 45 days of receipt absent IOM instructions to the contrary.

• Medicare Secondary Payer (MSP) Claims Inquiries: The Contractor shall respond to inquiries and correspondence from insurers and other interested parties (e.g., attorneys and/or beneficiaries, etc.) on MSP billing requirements to assist with resolving claims inquiries accurately, timely, and responsively in accordance with IOM Pub. 100-05, Chapter 5, §10 and IOM Pub. 100-09, Chapter 6, §60. Contractors are expected to meet a 95% accuracy and timeliness standard. Note: Responses can include adjustments, offsets, and redeterminations.

PERFORMANCE REQUIREMENTS: PROVIDER ENROLLMENT

• Process Initial and Change Enrollment Applications and Opt Out Affidavits (Paper): The applications described in this SOW will be considered accurately processed when 95% of

A/B & DME MAC Sources Sought Notice 8 applications are processed in accordance with all the instructions in IOM Pub. 100-08, Chapter 10.

• Process Initial and Change Enrollment Applications (Web-based): The Contractor shall process all initial and changed web-based enrollment applications in accordance with all the instructions found in the timeliness standards in Pub. 100-08, Chapter 15.

• Process Initial and Change Enrollment Applications (Paper): The contractor shall process all initial and change CMS-855/20134 applications in accordance with all the instructions found in the timeliness standards in IOM Pub. 100-08, Chapter 10.

• Process Revalidations: Paper applications described in this SOW shall be processed in accordance with all the instructions found in the timeliness standards in IOM Pub. 100- 08, Chapter 10.

• Process Revalidations: Web-based applications described in this SOW shall be processed in accordance with all the instructions found in the timeliness standards in IOM Pub. 100- 08, Chapter 10.

• Process Revalidations: The applications described in this SOW will be considered accurately processed when 80% of applications are processed in accordance with all the instructions in IOM Pub. 100-08, Chapter 10 except for the timeliness standards identified in the SOW.

• Revocations/Deactivations: The Contractor shall process 100% of all revocation actions in accordance with the revocation instructions in IOM Pub. 100-08 Chapter 10.

• Revocations/Deactivations: The Contractor shall deactivate Medicare billing privileges in accordance with the deactivation instructions in IOM Pub. 100-08 Chapter 10.

• Provider Enrollment Appeals: The Contractor shall process 100% of all provider enrollment appeals in full accordance with all appeals instructions in IOM Pub. 100-08 Chapter 10.

PERFORMANCE REQUIREMENTS: DEBT MANAGEMENT AND COST REPORTS

• Cost Report Acceptance: Cost report acceptance is timely if it is completed within 30 days from the receipt date of the provider’s cost report.

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• Cost Report Acceptance: Cost report reminder letters are timely when a CMS review indicates that they are performed in accordance with IOM Pub. 100-06, Chapter 8, §10.3.

• Cost Report Acceptance: Suspension/reduction of a provider’s payments due to untimely filing of a cost report is accurate when a CMS review indicates they are performed in accordance with IOM Pub. 100-06, Chapter 8, §10.2.

• Cost Report Acceptance: Suspension/reduction of a provider’s payments due to a rejected cost report is accurate when a CMS review indicates they are performed in accordance with IOM Pub. 100-06, Chapter 8, §10.2.

• Tentative Settlements: Tentative settlements are timely when they are completed within 90 days of the acceptance of the provider’s cost report.

• Tentative Settlements: Tentative settlements are accurate when a CMS review indicates that they are performed in accordance with IOM Pub. 100-06, Chapter 8, §10.5.

• Tentative Settlements: Cost-to-Charge Ratios are calculated accurately when a CMS review indicates that they follow IOM Pub. 100-04, Chapter 3, §20.1.2.1, §140.26, §150.24, and §190.7.2.2, IOM Pub. 100-04, Chapter 4, §10.7.2, and IOM Pub. 100-06, Chapter 8, §10.5.

• Desk Reviews/Provider Permanent Files: A provider’s permanent file is considered properly maintained when a CMS review indicates that it is maintained in accordance with CMS Pub. 100-06, Chapter 8, §130.

• Desk Reviews/Audits: Desk Reviews/Audits of cost reports are settled accurately when a CMS review determines compliance with Medicare rules and regulations.

• Audits of Home Office Cost Statements: Audited home office cost statements are properly distributed to servicing contractors if the designated home office contractor accurately distributes the audited home office cost statements and audit adjustments to all servicing contractors at the completion of the audit in accordance with IOM Pub. 100-06, Chapter 8, §120.5.Final Settlement: Cost reports that do not require an audit are settled timely when the Notice of Program Reimbursement (NPR) is issued within 12 months of the acceptance of a cost report or within timeframes specified in a TDL Final Settlement: Cost reports are settled accurately when a CMS review determines

A/B & DME MAC Sources Sought Notice 10 compliance with Medicare payment policy as defined in the Medicare Provider Reimbursement Manuals.

• Final Settlement: Cost reports that are audited shall have an NPR and final adjustment report issued within 60 days of the exit conference or 60 days after the adjustments are finalized if the exit conference is waived.

• Final Settlement: Outlier reconciliations are considered accurate when a CMS review indicates that they follow IOM Pub. 100-04, Chapter 3, §20.1.2.5, §140.2.4.4, §150.26, and §190.7.2.3 and IOM Pub. 100-04, Chapter 4, §10.7.2.4.

• Cost Report Re-openings: Revised NPRs are timely when they are issued within 180 days of receipt of all information and documentation necessary to resolve the reopening issue.

• Cost Report Re-openings: Revised NPRs are accurate when a CMS review determines compliance with IOM Pub. 100-06, Chapter 8, §100.

• Cost Report Re-openings: Notices or denials of cost report re-openings are accurate when a CMS review determines compliance with IOM Pub. 100-06, Chapter 8, §100.

• Cost Report Re-openings: Cost report re-openings are accurate when a CMS review determines compliance with Medicare payment policy as defined in the Medicare Provider Reimbursement Manuals.

• Appeals: Provider Reimbursement Review Board cases resolved by mediation or administrative resolution are considered accurate when a CMS review indicates the issues are resolved in accordance with Medicare reimbursement principles.

• Exception Requests - Tax Equity and Fiscal Responsibility Act (TEFRA): Target Limits are timely when applications are processed to completion within 75 days after receipt by the Contractor or returned to the hospital as incomplete within 60 days of receipt.

• Exception Requests - Tax Equity and Fiscal Responsibility Act (TEFRA): Target Limits are accurate when they comply with TEFRA payment policy.

• System for Tracking Audit and Reimbursement (STAR): The STAR database is maintained accurately and timely when a CMS review indicates that it complies with the STAR manual.

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• S-10 Audits: Worksheet S-10 are accurate when a CMS review determines compliance with Medicare rules and regulations.

• Provider Based Determinations: Provider-Based determinations are considered accurate when a CMS review indicates the MAC submitted provider-based determination package contains accurate findings based on criteria in 42 CFR 413.65.

PERFORMANCE REQUIREMENTS: DEBT MANAGEMENT – NON-MEDICARE

SECONDARY PAYMENT

The MACs have responsibility for collection of debts. The Debt Collection Improvement Act of 1996 (DCIA) requires federal agencies to refer eligible delinquent debt to a Treasury-designated Debt Collection Center (DCC), for cross-servicing and offset through the Treasury Offset Program (TOP). The Contractor will shall collect debts in accordance with the Federal Claims Collection Act and IOM Pub. 100-06, Chapters 3 and 4. The Data Act of 2014 requires all eligible debt must be referred to Treasury by the 120th day of delinquency.

• Non-Medicare Secondary Payer Debt Referral: Cumulative dollar amount of recoveries is reported to CMS Central Office up to four times per year.

• Non-Medicare Secondary Payer Debt Referral: Debt referral procedures are considered in all cases.

• In all cases, the Intent to Refer (ITR) is sent in enough time to allow the debtor 60 days’ notice prior to referral to Treasury. In accordance with provisions of the Digital Accountability and Transparency Act of 2014 (DATA Act) which amended the Debt Collection Improvement Act of 1996 (DCIA), eligible delinquent debts must be referred to Treasury by the 120th day of delinquency. (Refer to IOM Pub. 100-06, chapter 4, §70 for further detail.

• Non-Medicare Secondary Payer Debt Referral: Debt referrals are considered timely when debtor disputed requests are responded to on or before 30 days after the date of receipt.

• Non-Medicare Secondary Payer Intent to Refer Letter: Intent to Refer Letters are considered timely when issued on or before the debt is 30 to 61 days delinquent (60 to 91 days from the determination date).

• Non-Medicare Secondary Payer Intent to Refer Letter: Intent to Refer Letters are considered timely when returned and researched for a better address has been completed or before the 10 days after the date of receipt.

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PERFORMANCE REQUIREMENT: MEDICAL REVIEW

• Potential offerors must demonstrate data source variety, proficiency and timely analysis techniques and reporting is of high quality and consistently and effectively identify, monitor, and document data analysis activities performed in support of all Medical Review (MR) potential improper program payment prioritization and intervention activities in accordance with Provider Integrity Manual (PIM) 100-8 manual requirements. Offerors are expected to direct efforts to decrease the CERT error rate to meet the GPRA national paid claim error rate goals.

• Potential offerors must demonstrate proficiency with implementation, revision and timely follow up assessment and documentation of MR Targeted Provider and Service Specific pre-payment, post-payment system edit results, progress and quality assurance activities are in place to ensure MR program edits are preventing inappropriate payment, monitor appeal outcomes and operate in accordance with CMS PIM 100-8 requirements.

• Potential offerors must demonstrate proficiency with claim sample selection, medical record development procedures, timely review, and documentation of the clinical review staff assessment of provider medical records. Medical records contain detailed feedback to the provider/supplier in the form of clinical written rationale. Offerors MR claim adjudication and clinical staff determinations are monitored for clinical accuracy and consistency through PIM 100-8 manual and established quality assurance processes.

• Potential offerors must demonstrate effective systems that track and monitor MR collaboration and coordination with other review entities and provider/supplier activities.

Consistent activity documentation and development of high-quality provider/supplier written correspondence, telephone interventions and quality assurance processes are in place for all MR activities to ensure MR identified issue/vulnerabilities are properly communicated, through education, resources, description of future expectations to promote swift initiation of corrective actions to prevent future improper payments in accordance with PIM 100-8 requirements.

SYSTEMS ACCESS & SECURITY CONSIDERATIONS

CMS systems that the JG A/B MAC contractors will utilize (to access, create, revise, update, store, and archive data) include but are not limited to:

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• The Fiscal Intermediary Standard System (FISS) for processing Medicare claims from institutional providers (e.g., hospitals, skilled nursing facilities, etc.).

• The Multi-Carrier System (MCS) for processing Medicare claims from practitioners and suppliers.

• The Common Working File system (CWF) for additional processing and authorization of all claim types.

• The Provider Enrollment Chain and Ownership System (PECOS) for processing Medicare provider enrollment applications that also interfaces with numerous other systems to deliver its functionality.

• The Healthcare Integrated General Ledger Accounting System (HIGLAS) to post and maintain Medicare accounts payable and receivable and to support other fiscal and accounting functions.

• The System for Tracking Audit and Reimbursement (STAR) to manage and control Medicare provider audit and reimbursement workload.

• The Medicare Appeals System (MAS) to manage and control its claims appeals workload.

• The Integrated Data Repository (IDR) to support A/B MAC data analytics responsibilities.

• The Contractor Reporting of Operational and Workload Data (CROWD) and/or the MAC Data Exchange Portal (MDX) systems for reporting of MAC claims and other workload data and other CMS reporting systems.

The MACs will not only access and read data in these CMS systems, but will also (as specified by its SOW, the Medicare program manuals, and in CMS technical direction letters) create, revise, update, store, and archive Medicare program data including Protected Health Information (PHI) and Personally Identifiable Information (PII) on Medicare beneficiaries, Medicare providers, primary and supplementary payers, and other entities.

CMS may create additional Information Technology (IT) systems in the future to support the ongoing development of the Medicare FFS program, and the A/B MAC may be required to develop processes and/or interfaces with such additional CMS systems to perform its duties.

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In addition to serving as a user of numerous CMS systems, the JG MAC will provide additional IT systems and capabilities, particularly systems and capabilities to support its Medicare provider customer service program responsibilities that will process and store PHI and PII. Generally, existing software will be modified or enhanced. These contractor-provided IT systems and capabilities (for instance, Medicare provider portals) must conform to CMS IT architecture and security requirements and receive CMS approval before being put into production. Any Medicare data housed in contractor-furnished systems is CMS program data.

All MAC-provided IT is required to be compliant with Section 508 of the Rehabilitation Act of 1973 as amended by Congress in 1998 to require Federal agencies to make their electronic and information technology accessible to people with disabilities.

Due to their enormous responsibilities as custodians of Medicare data, Medicare law (at §1874A

(e) of the Act) specifically applies the requirements of the Federal Information Security Management Act (FISMA) and related government-wide systems security requirements to the MACs. HHS and CMS have also applied many additional information security and critical infrastructure directives to the MACs, including Homeland Security Presidential Directive No.

12 (HSPD-12).

Business Information

1. Unique Entity Identifier (UEI). DUNS can be provided, if UEI has not been assigned:

2. Company Name:

3. Company Address:

4. Do you have a government approved accounting system? If so, please identify the agency that approved the system:

5. Type of Company (i.e., small business, 8(a), woman-owned, veteran-owned, etc.) as validated via the System for Award Management (SAM) at System for Award Management (https://sam.gov/content/home). Registration via (https://sam.gov/content/home) is a requirement for qualifying as a prime contractor with CMS. Furthermore, the small business size standard for the North American Industry Classification System (NAICS) listed above will be applicable:

6. Company Point of Contact, Phone, and Email address:

https://www.sam.gov/portal/SAM/ https://www.sam.gov/portal/SAM/ https://sam.gov/content/home https://sam.gov/content/home

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Teaming Arrangements

All teaming arrangements should include the above-cited information and certifications for each entity on the proposed team. Teaming arrangements are encouraged.

Response Due Date

Responses must be submitted electronically not later than 11:00AM Eastern Standard Time, Friday, September 12, 2025. Submit responses to the Contracting Officer and Contract Specialist per the contact information below. Capability statements will not be returned and will not be accepted after the due date. The maximum number of pages for submission is 10 pages.

This Sources Sought Notice is for information and planning purposes only and is not to be construed as a commitment by the Government. This Notice is not a pre-solicitation notice, solicitation, or request for proposals; no contract will be awarded from this Notice. No reimbursement will be made for any costs associated with providing information in response to this Notice. Respondents will not be notified of the results of CMS’s review of any submission.

Contact Information

Contracting Officer:

Mark Smolenski Centers for Medicare and Medicaid Services Office of Acquisition and Grants Management Phone: 410-786-0175 mark.smolenski@cms.hhs.gov

Contract Specialist:

Alyssa Jones Centers for Medicare and Medicaid Services Office of Acquisition and Grants Management Phone: 410-786-1535 alyssa.jones@cms.hhs.gov mailto:mark.smolenski@cms.hhs.gov mailto:alyssa.jones@cms.hhs.gov

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Contracting Office Address:

7500 Security Blvd.

Baltimore, Maryland 21244-1850

ATTACHMENTS

Attachment 1: JG Part A/B MAC Statement of Work

ATTACHMENTS