Medicare Part A Provider Cost Report Appeals (MPAPA)

Sources Sought Notice # SS-CMS-2013-130168 was posted on 8/31/2012 for this anticipated procurement. The Government intends to post the solicitation within 30-days of this posting.

History:

Section 1878 of the Social Security Act established that providers may request and receive a hearing before the Provider Reimbursement Review Board [PRRB] for a cost reporting period for which a provider filed a Medicare cost report. The contractor's Notice of Program Reimbursement [NPR] is final and binding unless a timely request for a hearing is filed with the PRRB [see 42 CFR §405.1835] or the Intermediary Hearing Officer [see 42 CFR §405.1811] and a decision is rendered, or unless one of the provisions for reopening in 42 CFR §405.1885 is exercised. Therefore, the NPR is the base determination for appealing a cost report.

Under 42 CFR §405.1835, individual providers may bring an appeal before the PRRB if the amount in controversy is $10,000 or more. Under 42 CFR §405.1811, providers may request an Intermediary hearing if the amount in controversy is at least $1,000 but less than $10,000. Under 42 CFR §405.1837, providers may request a group appeal of a single issue involving a question of fact or interpretation of law, regulations, or CMS ruling, which is common to all providers in the appeal as long as the aggregate claims in dispute total at least $50,000. Additionally, providers under common ownership or control which have an issue in common must file a group appeal if the amount in controversy is, in the aggregate, $50,000 or more. A request for hearing must be filed with Intermediary Hearing Office or the PRRB, as appropriate, within 180 calendar days from the date of receipt by the provider of the NPR.
This contractor will represent the Centers for Medicare and Medicaid Services (CMS) and it's Medicare Administrative Contractors (MACs) with respect to PRRB appeals.

Work Description:

The MPAPA Contractor will be expected to perform the following activities.

1. Coordinate Medicare Part A Cost Report individual and group appeals before the PRRB. This includes, but not limited to:
a. Managing the appeal workload
b. Working with MACs regarding appeals
c. Preparing and reviewing jurisdictional briefs
d. Reviewing and approving position papers
e. Communicating with the provider or provider's representative
f. Preparing and approving appeal resolutions when issues are resolved prior to a hearing
g. Preparing for hearings
h. Providing legal staff for hearings
i. Post hearing briefs
j. Working with Office of General Counsel when necessary

2. Provide a hearing officer and coordinate Medicare Part A Cost Report individual appeals before a hearing officer.

CMS anticipates issuance of a Cost Reimbursement-type contract under the forthcoming solicitation. However, CMS does reserve the option to use any other procurement instrument as deemed appropriate at the time of the official solicitation.

Disclaimer and Important Notes:

This notice does not obligate the Government to award a contract or otherwise pay for the information provided herein.