Sources-Sought-Notice JB J15 JD Final.pdf

Parts A/B, DME and HH+H Sources Sought

Sources Sought Notice

Medicare Administrative Contractor (MAC) Services Medicare Parts A & B (A/B), Home Health + Hospice (HH+H), and

Durable Medical Equipment (DME) Jurisdictions B, 15, D

November 2021

INTRODUCTION

The purpose of this SOURCES SOUGHT NOTICE is to determine the availability and capability of potential small businesses (e.g., 8(a), service-disabled veteran-owned and veteran-owned small business, HUBZone small business, small disadvantaged 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 (SOWs) 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 as to 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.

Please note that CMS will rely on the results of this market research when conducting acquisitions for Medicare Administrative Contractor (MAC) services in multiple geographical jurisdictions over multiple years, including Jurisdiction B (JB), Jurisdiction 15 (J15) and Jurisdiction D (JD).

THIS SOURCES SOUGHT NOTICE IS STRICTLY MARKET RESEARCH. CMS WILL NOT

ENTERTAIN QUESTIONS REGARDING THIS MARKET RESEARCH.

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) contracts 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 a term of up to ten years.

The purpose of these acquisitions is to procure two Medicare Durable Medical Equipment (DME) MACs and one Part A/B MAC. The A/B MAC has a Home Health + Hospice (HH+H) component within the J15 jurisdiction. These MACs will provide Medicare FFS benefit and claims administration services and 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 SOWs for the JB, J15 and JD MACs provide a current snapshot of contract requirements. While this Sources Sought Notice is targeted to the JB and JD DME MAC jurisdictions and the J15 A/B MAC and HH+H jurisdiction, CMS may consider the results of this market research when determining the acquisition approach for these services for other MAC jurisdictions.

• DME Jurisdiction B (JB) is comprised of the following states: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin.

• Parts A/B Jurisdiction 15 (J15) is comprised of the following states: For Parts A and B, J15 processes claims for Kentucky and Ohio. J15 processes FFS Medicare HH+H claims for Colorado, Delaware, District of Columbia, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, North Dakota, Pennsylvania, South Dakota, Utah, Virginia, West Virginia and Wyoming.

• DME Jurisdiction (JD) is comprised of the following states: Alaska, American

Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington and Wyoming

RESPONSE INFORMATION

Responses to this notice shall demonstrate the capability to perform the specific A/B MAC (J15), DME MACs (JB and JD), and HH+H MAC (J15) functions provided in the list below, assuming the given workload volumes and performance standards. Responses based upon anticipated teaming arrangements and Joint Ventures are 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.

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, takes action on the claims such as pay in full, pay in part, or suspend for manual review.

3. 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 in order 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 Contact 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.

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 five hundred 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 and 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 B

For each full year of the JB DME MAC contract, the MAC is required to perform the same SOW program requirements at the level of the stated Performance Requirements. The volumes specific to JB for a calendar year (CY) are provided below:

• Process approximately 12,028,503 million Part B (supplier) claims.

• Process approximately 334,291 Medicare claims re-openings and 31,621 Medicare claims redeterminations (1st level appeals).

• Timely, accurately, and effectively respond to more than 1 million inquiries (telephone, written, and electronic) from Medicare providers.

• Timely and accurately conduct approximately 15,3213 clinical medical records reviews to determine medical necessity for Medicare claims.

Jurisdiction 15

For each full year of the J15 A/B and HH+H MAC contract, the MAC is required to perform the same SOW program requirements at the level of the stated Performance Requirements. The volumes specific to J15 A/B for a CY are provided below:

• Process approximately 10,873,605 Part A (institutional provider) and 40,000,000 Part B (practitioner and supplier) claims.

• Process approximately 200,000 Medicare claims re-openings and 142,000 Medicare claims redeterminations (1st level appeals).

• Timely, accurately, and effectively respond to more than 10 million inquiries (telephone,

• Timely and accurately process more than 111,000 provider enrollment actions (various types of providers and enrollment actions) (includes HH+H).

• Timely and accurately receive, analyze, desk review, and settle (or tentatively settle) several thousand provider cost reports (includes HH+H).

• Timely and accurately conduct approximately 52,051 clinical medical records reviews to determine medical necessity for Medicare claims

The volumes specific to HH+H for a CY are provided below:

• Process approximately 4,693,927 HH+H claims.

• Process approximately 27,962 Medicare claims re-openings and 11,819 redeterminations (1st level appeals).

• Timely, accurately, and effectively respond to more than 29,000 inquiries (telephone,

• Timely and accurately conduct approximately 10,000 clinical medical records reviews to

Jurisdiction D

For each full year of the JD DME MAC contract, the MAC is required to perform the same SOW program requirements at the level of the stated Performance Requirements. The volumes specific to JD for a CY are provided below:

• Process approximately 13,835,840 Part B (supplier) claims.

• Process approximately 364,235 Medicare claims re-openings and 71,619 Medicare claims redeterminations (1st level appeals).

• Timely, accurately, and effectively respond to more than 1 million inquiries (telephone,

• Timely and accurately conduct approximately 13,415 clinical medical records reviews to

The performance requirement summaries below apply to the JB, J15 and JD MAC contracts:

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 on a monthly basis.

• 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 on a monthly basis.

• 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 on a monthly basis.

• 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 on a monthly basis.

• 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 inquiries shall count toward the Contractor’s overall allowance of no more than 5% of interim responses for the universe of written inquiries.

• 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 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 provider, 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 Revalidation Enrollment Applications (Paper): The applications described in C.5.5.1 of this SOW will be considered accurately processed when 98% of applications are processed in accordance with all of the instructions in IOM Pub. 100-08, Chapter 15.

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

• Process Initial and Revalidation Enrollment Applications (Paper): The contractor shall process all initial and revalidation CMS-855 applications in accordance with all of the instructions found in the timeliness standards in IOM Pub. 100-08, Chapter 15.

• Process Changes, Updates, Reassignments, or Corrections: Paper applications described in C.5.5.2 of this SOW shall be processed in accordance with all of the instructions found in the timeliness standards in IOM Pub. 100-08, Chapter 15.

• Process Changes, Updates, Reassignments, or Corrections: Web-based applications described in C.5.5.2 of this SOW shall be processed in accordance with all of the instructions found in the timeliness standards in IOM Pub. 100-08, Chapter 15.

• Process Changes, Updates, Reassignments, or Corrections: The applications described in C.5.5.2 of this SOW will be considered accurately processed when 98% of applications are processed in accordance with all of the instructions in IOM Pub. 100-08, with the exception of the timeliness standards identified in C.5.5.2 of the SOW.

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

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

• 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.

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.

• 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 60 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 are in compliance with IOM Pub. 100-04, Chapter 3, §20.1.2.1, §140.26, 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.

• 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.

• Final Settlement: Cost reports are settled accurately when a CMS review determines 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 are in compliance with IOM Pub. 100-04, Chapter 3, §20.1.2.5, §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.

PERFORMANCE REQUIREMENT: MEDICAL REVIEW

• Medical Review: Medical Review is successful when claims are paid with acceptable accuracy as evidenced by a contractor-specific CERT error rate not to exceed the 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).

SYSTEMS ACCESS AND SECURITY CONSIDERATIONS

The A/B MACs access and use numerous CMS Medicare FFS systems to perform Medicare program functions. The MACs will not only access and read data in these CMS systems, but will https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/CERT-Reports 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 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 systems that the JB and JD DME MACs and J15 A/B & HH+H MAC contractors will utilize (to access, create, revise, update, store, and archive data) include but are not limited to:

• 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 ViPS Medicare System (VMS). VMS, a large, complex system containing approximately 8,500 elements and over 2 million lines of code, is the standard Medicare system for all DME claims.

• The Common Electronic Data Interchange (CEDI) contract will perform the required functions to operate as the “front end” processing of all HIPAA Medicare electronic transactions for DME claims processing, and to provide other related services, including providing an Electronic Data Interchange (EDI) Help Desk and Trading Partner management services.

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

• The Common Edit Module (CEM), which the A/B MAC will integrate into its electronic claims receipt capability.

• The Provider Enrollment Chain and Ownership System (PECOS) for processing Medicare provider enrollment applications that also interfaces with numerous other systems in order 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) system for reporting of A/B MAC claims and other workload data and other CMS reporting systems.

• 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 & HH+H MACs may be required to develop processes and/or interfaces with such additional CMS systems to perform its duties.

• In addition to serving as a user of numerous CMS systems, the JB, JD, and J15 MACs 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 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

Please provide the following with your submission:

1. DUNS

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 www.sam.gov.Registration via System for Award Management (www.sam.gov)is a requirement for qualifying as a prime contractor with CMS. Furthermore, the small business size standard for the North http://www.sam.gov/ https://beta.sam.gov/ http://www.sam.gov/

American Industry Classification System (NAICS) Code 524114, Direct Health and Medical Insurance Carriers, will be applicable.

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

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 5:00PM Eastern Standard Time, December 3, 2021. 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:

Jeannine Bohlen Centers for Medicare & Medicaid Services Email: Jeannine.Bohlen@cms.hhs.gov Office: 410-786-2864

Contract Specialist:

Primary:

Mary Kerner Centers for Medicare & Medicaid Services Email: Mary.Kerner@cms.hhs.gov Office: 410-786-8839 mailto:Mary.Kerner@cms.hhs.gov

Secondary:

Shawn Baer Centers for Medicare & Medicaid Services Email: Shawn.Baer@cms.hhs.gov Office: 410-786- 3294

ATTACHMENTS

Attachment 1: JB DME MAC Statement of Work Attachment 2: J15 Part A/B MAC Statement of Work Attachment 3: JD DME MAC Statement of Work mailto:Shawn.Baer@cms.hhs.gov