Added: Jul 15, 2008 4:51 pm
The Center for Medicare & Medicaid Services (CMS) intends to solicit proposals for a Payment Contractor for the Medicare Medical Home Demonstration, per Sec. 204 of H.R. 6111, Tax Relief and Health Care Act of 2006. The Payment Contractor will verify the eligibility of participating Medicare beneficiaries each month and make monthly Medical Home fee payments to qualified physician practices in up to eight states. Payments are made for Medical Home services in addition to claims submitted for any covered Medicare services for eligible Medicare beneficiaries who are matched to each participating practice. CMS estimates that the Demonstration will serve approximately 400,000 beneficiary participants across 400 physician practices in up to eight states. The Contractor will also provide customer service support and education to the Medical Home practices.
The Contractor must be able to:
1. Make timely and appropriate monthly payments to up to 400 qualified physician practices and including up to 2000 physicians from the Medicare Part B Trust Fund;
2. Receive and integrate physician practice and beneficiary participant data received from another CMS contractor;
3. Accurately match each beneficiary participant with the appropriate Medical Home practice and physician;
4. Correctly monitor physician practice eligibility throughout the demonstration period;
5. Monitor beneficiary participant eligibility monthly using the Medicare Common Working File (CWF) to verify the following criteria;
Has both Medicare Parts A & B;
Not in a Medicare Advantage plan;
Not enrolled in End Stage Renal Disease (ESRD) Program; and,
Not a hospice recipient.
6. Make timely and appropriate adjustments to payments;
7. Produce accurate monthly payment reports for participating practices; and,
8. Produce exception reports explaining payments that were not made for participating practices.
9. Provide ongoing technical and customer service support to Medical Home practices via telephone, internet, and email for all payment aspects of the demonstration.
The proposed period of performance is September 30, 2008, through
December 31, 2012. It is anticipated that CMS will award a contract for this work by September 30, 2008. We anticipate this solicitation to be posted to the FedBizOps in about fifteen (15) days. Please be advised that the set-aside strategy for this procurement has not yet been determined.
Points of Contact: John Webster, Contract Specialist, phone 410-786-7229, FAX 410-786-9643, email john.webster@cms.hhs.gov; Cathy Baldwin, Contracting Officer, phone 410-786-5719, FAX 410-786-9643, email cathy.baldwin@cms.hhs.gov
