SS Notice IHS1466922 PRC Appeals.pdf

MARKET RESEARCH PURPOSES ONLY

NOT A REQUEST FOR PROPOSAL OR SOLICITATION

The Indian Health Service (IHS) is conducting market research to support the Purchased/Referred Care Medical Review of Purchased/Referred Care (PRC) Appeals.

This is a Sources Sought notice to determine the availability of small businesses capable of supplying the required services to coordinate and facilitate IHS activities to address food insecurity. This notice is for planning purposes only, and does not constitute an invitation for Bids, Request for Proposal or Request for Quotation or an indication the Government to award a contract, nor does the Government intend to pay for any information submitted as a result of this notice. Your responses to the information requested will assist the Government in determining the appropriate acquisition method, including whether a set‐aside is possible.

Description/Scope of Work (SOW):

Respondents to this notice shall have the capabilities to furnish the necessary personnel, materials, services, equipment, facilities, and otherwise do all things necessary for the performance of the work described below.

The contractor shall be required to independently and not as an agent of the Government perform services under the follow task areas:

Appeal Files Each PRC appeal file includes the initial PRC denial and subsequent appeal and denial letters from the first and second tiers of consideration, medical records for the episode of care, and Area medical reviews. Appeal files will be provided by ORAP to the contractor for medical review and recommendation to uphold or overturn a PRC denial.

Format Medical reviews will conform to the following format and include a handwritten signature of reviewing physician:

I. Patient Background Appeal Information

II. Second Level Medical Priority Determination

III. Third Level Assessment, Medical Priority Determination and Recommendation to Overturn or Uphold the PRC Denial

Deliverables and Schedule:

The PRC files will be sent by ORAP staff directly to the contractor. The expected turnaround time for a medical review is 14 days. The contractor is expected to review up to 50 appeal files during the base year and each option period.

Appeal files and final medical reviews will be transmitted through the IHS Secure Data Transfer system.

Tasks Date

Meet with ORAP program staff and OCPS COR to develop work plan Month 1

Receive IHS PRC Appeal Files and patient medical records Month 1 – 12

Review patient medical records to determine medical priority Month 1 – 12

Prepare medical reviews in accordance with IHS guidelines Month 1 – 12

Return files and medical reviews to ORAP in required format Month 1 – 12

Performance Standards and Quality Measurement:

IHS ORAP and OCPS will perform periodic reviews to ensure the review process and the written reports meets quality review standards. A random selection of medical reviews will also undergo quality review for medical priority assignment and recommendation status.

Commission Furnished Property (Facilities, Equipment, or Services):

Contractor will supply all property necessary to review medical records and write report.

Contractor Tasks/Responsibilities/Capabilities:

Contractor must have a Board Certified Licensed Physician review the medical records, determine the Medical Priority Level for the medical services requested, recommend whether to uphold or overturn the denial and write the report.

Deliverable Reporting and Communication:

If additional medical records are needed in order to complete the review, contractor will contact the ORAP program staff. ORAP program staff and OCPS COR will communicate as needed to address any issues related to the processes outlined in this SOW. Contractor will delete all medical records once the final medical review is complete and accepted by IHS.

Security Requirements:

The Contractor shall have a secure area to work on the medical reviews as they contained Protected Health Information. Contractor will perform reviews at a site of their choice not provided by the government.

Location of Work and Travel:

No travel is required for this SOW.

Special Considerations/Requirements:

None

This is a Sources Sought notice. This is NOT a solicitation for proposals, proposal abstracts, or quotations. Pursuant to 48 CFR Part 326, Subpart 326.603-3 and IHM 5.5-6, Indian Health Service must use the negotiation authority of the Buy Indian Act, 25 U.S.C. 47, to give preference to Indian Economic Enterprises (IEE) whenever the use of that authority is authorized and practicable.

The Government is seeking to identify Indian Small Business Economic Enterprises (ISBEEs) capable of performing the below Indian Health Services (IHS) requirement. Any vendor responding to this notice should submit their capability statement as well as the Buy Indian Act Indian Economic Enterprise Representation Form (attached). Instructions for submission are outlined below.

Indian Small Business Economic Enterprises (ISBEEs) and other small business are highly encouraged to respond to this notice. However, firms should understand that generic capability statements are not sufficient for effective evaluation of their capacity and capability to perform the work required. Responses must directly demonstrate the company’s capability, experience, and ability to provide Purchased/Referred Care Medical Review of Purchased/Referred Care (PRC) Appeals.

The Government requests interested parties submit a written response to this notice, which includes:

a. Company Name.

b. Company Socioeconomic Status.

c. Company System for Award Management (SAM) Unique Entity Identifier (UEI) number.

d. Company point of contact, mailing address, and telephone number(s), and website address

e. Name, telephone number, and e-mail address of a company point of contact who has the authority and knowledge to clarify responses with government representatives.

f. Date submitted.

g. Relevant Past Performance information inclusive of date of services, description, dollar value, client name, client address, client contact name, client point of contact mailing address (if different from that provided for client), client point of contact phone number, client point of contact email address, and name of company (to include DUNS number and size status) if not the respondent.

h. Descriptive literature, brochures, marketing material, etc. detailing the nature of services the responding firm is regularly engaged in providing. At a minimum, to be considered a potentially capable source this material should include information detailing the organizations ability to fulfil the capabilities required above.

i. Applicable company GSA Schedule number or other available procurement vehicle. If a large business, provide if subcontracting opportunities exist for small business concerns.

j. Company’s System for Award Management (SAM) registration status. All respondents must register on the SAM located at http://www.sam.gov/.

k. Submit Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form (attached)

Note: The Government is not responsible for locating or securing any information, not identified in the response.

Disclaimer and Important Notes. This notice does not obligate the Government to award contract. Any information provided by industry to the Government as a result of this sources sought synopsis is strictly voluntary. Responses will not be returned. No entitlements to payment of direct or indirect costs or charges to the Government will arise as a result of contractor submission of responses, or the Government's use of such information or otherwise pay for the information provided in response. The Government reserves the right to use information provided by respondents for any purpose deemed necessary and legally appropriate. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed to allow the Government to determine the organization’s qualifications to perform the work. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted. After a review of the responses received, a pre-solicitation synopsis and solicitation may be published on a government GPE. However, responses to this notice will not be considered adequate responses to a solicitation.

Confidentiality. No proprietary, classified, confidential, or sensitive information should be included in your response. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s).

How to respond: Please include the notice IHS1466922 PRC Appeals in the subject line.

Responses must be submitted via email to the Lead Contract Specialist, Valerie Heart Broker at Valerie.heartbroker@ihs.gov no later than 2:00 PM PST on February 2, 2023.

Capability statements will not be returned and will not be accepted after the due date. The maximum number of pages for this submission is ten (10) pages.