| R -- Quality Assurance Oversight of MCOs |
| Program Summary |
 |
| Title: |
R -- Quality Assurance Oversight of MCOs |
| GovCB Opps ID : |
ADP12058355370000670 |
| Document Type: |
Sources Sought Notice |
| FSC Code: |
R - Professional, Administrative and Management Support Services
|
| NAICS Code: |
541611 - Administrative Management and General Management Consulting Services |
| SIC Code: |
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| Solicitation No.: |
QAMCO2008 |
| Source: |
http://www1.fbo.gov/spg/HHS/HCFA/AGG/QAMCO2008/SynopsisR.html |
Posted Date:
|
Mar 17, 2008 |
| Last Update: |
Mar 17, 2008 |
| Due Date: |
Mar 31, 2008 |
|
| Description |
|
General Information
| Document Type: |
Sources Sought Notice |
| Solicitation Number: |
QAMCO2008 |
| Posted Date: |
Mar 17, 2008 |
| Original Response Date: |
Mar 31, 2008 |
| Current Response Date: |
Mar 31, 2008 |
| Original Archive Date: |
Apr 15, 2008 |
| Current Archive Date: |
Apr 15, 2008 |
| Classification Code: |
R -- Professional, administrative, and management support services |
| Naics Code: |
541611 -- Administrative Management and General Management Consulting Services |
Contracting Office Address
Department of Health and Human Services, Centers for Medicare & Medicaid Services, Office of Acquisition and Grants Management, 7500 Security Blvd. C2-21-15, Baltimore, MD, 21244-1850, UNITED STATES
Description
Quality Assurance Oversight of Managed Care Organizations
Performed by
The Centers for Medicare and Medicaid Services (CMS)
and its Agents
THIS IS NOT A FORMAL REQUEST FOR PROPOSAL (RFP) AND DOES NOT COMMIT THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) TO AWARD A CONTRACT NOW OR IN THE FUTURE.
This is a SOURCES SOUGHT NOTICE to determine the availability of potential small businesses on the GSA MOBIS Schedule (e.g., 8(a), service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business, and women-owned small business) that can provide assistance in the review of completed routine and focused program compliance audits of CMS participating Managed Care Organizations..
History: In December 2003, the President signed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). MMA expanded the role of private plans in providing benefits to Medicare beneficiaries. The law added a new section to the Social Security Act; 1860D (Part D) that offered prescription benefits beginning in 2006 through Prescription Drug Plans (PDPs). Secondly, the statute allowed for payments to MA,local plans, (formerly Medicare Plus Choice (M+C) plans) and created a new type of private plan, regional, MA plans (RPPOs). The Program of All Inclusive Care for the Elderly (PACE) became a permanent program under the Balanced Budget Act of 1999 (PubLNo 105-33) and a state option for the Medicaid program. PACE was created to help community-based organizations provide health and long-term care services on a capitated basis to frail elderly persons at risk of being institutionalized.
Oversight of Managed Care Organizations
CMS is responsible for providing oversight of its participating Managed Care Organizations (MAOs). CMS's oversight of MAOs is a monitoring control designed to ensure MAOs are in compliance with regulations established within applicable Medicare law, and therefore eligible to participate in the Managed Care program.
CMS developed a risk-based approach for their oversight of the Managed Care organizations. The risk-based approach was used to identify which plans would be selected for review in the annual audit strategy and to determine what organizational eligibility elements would be audited.
CMS has ten Regional Offices that perform the program compliance audits. Upon the completion of the audit, CMS management is required to communicate noncompliances identified to the organizations which are then required to submit corrective action plans. CMS Management is required to evaluate the corrective action plans in order to make a final determination of each plan's eligibility.
CMS has the responsibility to: (i) ensure program compliance audit findings, corrective action plans, and acceptance of the provider's corrective action plans are provided, reviewed, and released within the proposed time frames, and (ii) ensure that relevant data are updated timely in order to provide the information necessary for adequate management oversight.
Oversight Tracking
The Health Plan Management System (HPMS) is used by CMS to monitor the execution and status of managed care organization oversight. This system lies at the core of CMS's management process for MAOs. The Monitoring Review Module in HPMS enables management to monitor the MAOs by tracking the progress of the program compliance audits. Results are updated, including exceptions, corrective action plans, and CMS's acceptance of CAPS from MAO's.
Purpose
CMS is seeking the services of a contractor to provide quality assurance of the MAO program compliance audits. The contractor's focus is to ensure that strong program oversight controls remain in place and are adhered to so that Medicare program stakeholders maintain confidence that CMS properly oversees the programs it administers.
Routine audits serve as one of the primary mechanisms that CMS uses for ensuring and documenting compliance with Medicare program requirements. Audits are necessary to identify irregularities, validate self-reported data, and to ensure the Agency is managing Medicare programs effectively.
CMS? oversight strategy is to identify program vulnerabilities and ensure sponsors? strict adherence to regulatory requirements. This strategy focuses the Agency's oversight efforts on auditing Part C and D MAO's and PACE providers, and program attributes that the program business owners identify as representing the utmost harm to beneficiaries and CMS. Regularly scheduled routine and focused program compliance audits are necessary for ensuring sponsor compliance and for documenting the Agency?s program oversight activities.
Task Descriptions: The tasks under this contract shall focus on the management, performance and quality of the Program compliance audits performed by CMS. The audits are performed according to the CMS 2008 Audit Strategy Paper (or the most current version). MAOs are selected and audited in a consistent manner and according to the appropriate 2008 Audit Process paper (2008-AP) and 2008 RO Audit Workload List spreadsheet (2008 RO-AWL). The Audit Populations includes all Medicare Advantage Only (MA), Medicare Advantage Prescription Drug Plans (MA-PD), Prescription Drug Plans (PDP), Regional Preferred Provider Plans (RPPO), and Program of All Inclusive Care of the Elderly (PACE).
CMS plans to conduct approximately 84 program compliance audits as outlined in the 2008 RO-AWL, and to include all the elements of the chapters as outlined in the 2008-AP paper. The contractor shall ensure the audits are performed timely and according to CMS Standard Operating Procedures and Audit Guides. The tasks will include the following:
1. Ensure that existing policies and procedures for the monitoring of organizations within the Managed Care program are consistently applied and that the monitoring of these organizations is documented in accordance with appropriate standards and guidelines.
2. Perform quality assurance on the program compliance audits performed by the Regional Office staff and the auditor assistance contractor to ensure developed detailed policies and procedures outlining the minimum documentation requirements that must be maintained as part of the program compliance audits appropriately support the audit outcome.
3. Report to CMS on compliance with regulations for the monitoring of specific chapters and/or elements for organizations. For example, PACE organizations are required to be monitored every year for the first three years of acceptance into the program, and every other year thereafter.
4. Ensure findings, corrective action plans, and acceptance of the provider's correction action plans are provided, reviewed, and released within the proposed time frames.
5. Ensure that relevant data are updated timely within HPMS in order to provide the information necessary for adequate management oversight.
6. Validate completeness of audit files in accordance with document retention standards, the audit checklist, and the model audit file.
7. Provide CMS management with detailed information reports that summarize relevant findings and results from the reviews of the compliance documentation.
Contractor Requirements:
PLEASE NOTE: Any potential offeror must discuss the ability to provide the following:
1. Specified knowledge and experience working with and understanding the Medicare Prescription Drug Improvement Act of 2003.
2. Current knowledge with the Health Plan Management System (HPMS) and those modules related to the Program compliance audits. If prior experience of the HPMS is not possessed, then the contractor shall possess experience using large benefit data bases to examine and manipulate data and issue reports to management.
3. Experience with developing quality assurance programs in tracking and monitoring the completed compliance audits and ensure they are performed according to the current Audit Strategy and schedule. Perform validation of tests completed and other audit procedures.
4. Experience in preparing and giving technical presentations before small and large audiences.
5. Knowledge concerning benefits-related topics such as Medicare Prescription Drug Improvement and Modernization Act of 2003.
6. Experience in performing and reviewing audits involving managed care experience, and familiarity with health insurance terminology.
7. Please include the following in your response:
Business Information --
a. DUNS:
b. Company Name
c. Company Address
d. Current GSA Schedules appropriate to this Sources Sought
e. Do you have a Government approved accounting system? If so, please identify
the agency that approved the system.
f. Type of Company (i.e., small business, 8(a), woman owned, veteran owned, etc.)
as validated via the Central Contractor Registration (CCR). All offerors must
register on the CCR located at http://www.ccr.gov/index.asp.
g. Company Point of Contact, Phone and Email address
Teaming Arrangements: All teaming arrangements shall also include the above-cited information and certifications for each entity on the proposed team. Teaming arrangements are encouraged.
This Sources Sought Notice is information and planning purposes only and is not to be construed as a commitment by the Government. This is not a solicitation announcement for proposals and 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 this evaluation. Capability statements will not be returned and will not be accepted after the due date.
It is essential that the offeror be free of all perceived, potential or actual conflicts. Specifically, the offeror must not have any relationships or arrangements through its business operations or its employees that could be considered as possibly lessening the company's objectivity concerning any aspect of this action. If such relationships or arrangements exist, offerors would be required, during the potential procurement process, to identify potential conflicts of interest and discuss how the conflicts will be addressed and mitigated.
Capability Submission:
Specify the name and telephone number of a point of contact and indicate your size standard under the following North American Industry Classification System (NAICS) (formerly known as the SIC code): 541611-Administrative Management and General Management Consulting Services. (Size Standard: $6.5 million). Additional information on NAICS codes can be found at www.sba.gov.
The synopsis is for information and planning purposes and is not to be construed as a commitment by the Government. This is not a solicitation announcement for proposals and no contract will be awarded from this announcement. No reimbursement will be made for any costs associated with providing information in response to this announcement and any follow-up information requests. Respondents will not be notified of the results of the evaluation. All information submitted in response to this announcement must arrive on or before the closing date.
Responses must be submitted not later than March 31, 2008. Responses shall be limited to fifteen (15) pages. Resumes of key people are limited to 2 pages and may be submitted as an attachment, which will not count towards the page limit.
Documentation should be sent to:
Centers for Medicare & Medicaid Services
Attn: Kevin Pope, Contract Specialist
Office of Acquisitions and Grants Management
Acquisitions and Grants Group
Division of Beneficiary Support Contracts
Mailstop: C2-21-15
7500 Security Boulevard
Baltimore, MD 21244
Please refer any questions to:
Point of Contact
Name: Kevin Pope, Contract Specialist
Phone: 410-786-5794
Fax: 410-786-9088
Email: kevin.pope@cms.hhs.gov
Point of Contact
Kevin Pope, Contract Specialist, Phone 410-786-5794, Fax 410-786-9088, Email Kevin.Pope@cms.hhs.gov - Mark Smolenski, Contract Specialist, Phone 410-786-0175, Fax 410-786-9088, Email MSmolenski@cms.hhs.gov
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