Zone Program Integrity Contract Cycle Two

Added: March 21, 2008 The Centers for Medicare & Medicaid Services' (CMS) mission is to ensure health care security to all beneficiaries. In carrying out this mission, CMS is dedicated to the highest integrity of its programs and has contracted with various entities for benefit integrity functions. Originally, program integrity efforts were aligned with CMS' fiscal intermediaries and carriers. The recent enactment of section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) changes CMS' current contracting structure by phasing out the fiscal intermediaries and carriers and phasing in the Medicare Administrative Contractors (MAC) for CMS Medicare claims processing. As a result of the MMA and the adoption of the MAC strategy, a realignment of the program integrity jurisdictions is necessary so that workloads align with the new MACs. In addition, the future intent of these realignments is to have one program integrity contractor be responsible for the detection, deterrence and prevention of fraud, waste, and abuse across all claim types.

CMS has established seven (7) jurisdictional zones to deal efficiently with fraud, waste and abuse issues which also align effectively with multiple MAC jurisdictions. CMS will be procuring the seven (7) zones in three (3) separate cycles.



CMS anticipates releasing a solicitation for two (2) zones as follows:



ZPIC Cycle Two

Zone 2: Alaska, Washington, Oregon, Montana, Idaho, Wyoming, Utah, Arizona, North Dakota, South Dakota, Nebraska, Kansas, Iowa and Missouri.



Zone 1: California, Nevada, Hawaii, American Samoa, Guam and the Mariana Islands.



It is anticipated that two (2) separate stand alone single IDIQ contracts will be awarded, one for each zone, with a base period plus 4 option years. CMS intends to solicit this requirement as a full and open competition. This announcement is not a request for proposal (RFP). CMS anticipates release of Request for Proposal in mid-April. The solicitation will be available on the Federal Business Opportunities (FedBizOpps) website. It is anticipated that this cycle will be awarded before December 31, 2008.



Points of Contact

Theresa Schultz, Contracting Officer, Phone 410-786-8496, Fax 410-786-9643, Email theresa.schultz@cms.hhs.gov

Gina Romano, Contract Specialist, Phone 410-786-8645, Fax 410-786-9643, Email gina.romano@cms.hhs.gov