Commercial Banking Services for the Centers for Medicare and Medicaid Services: Medicare Claims Processing Contractors and Demonstration Projects

THIS IS A SOURCES SOUGHT NOTICE TO DETERMINE THE AVAILABILITY OF POTENTIAL SMALL BUSINESSES (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) IN ACCORDANCE WITH FAR 7.104(D). THE POTENTIAL SMALL BUSINESS WILL NEED TO DEMONSTRATE THE ABILITY TO PROVIDE COMMERCIAL SERVICES AS SPECIFIED BELOW. History: CMS uses commercial banks to perform payment services in two different arenas: 1) to process Medicare payments authorized by the Medicare Administrative Contractors (MACs) 2) to process payments for CMS demonstration projects. A. Medicare Payments Authorized by the MACs Title XVIII of the Social Security Act authorizes CMS to use claims processing contractors to authorize and make payments for Medicare services. A Medicare Administrative Contractor (MAC) is an organization that has entered into an agreement with the CMS to perform specified functions under the Hospital Insurance Program (Part A) and/or under the Supplemental Medical Insurance Program (Part B). These functions include, but are not limited to: making payments to providers of Part A and Part B services and making payments to beneficiaries, physicians and suppliers furnishing Part B medical services. Currently, these Medicare claims processing contractors include Part A and B Medicare Administrative Contractors (MACs), Part B Durable Medical Equipment Regional Carriers (DMERCs)/Durable Medical Equipment MACs (DMACs), Part A Fiscal Intermediaries (FIs), and Part B Carriers. Currently there are 12 A/B MACs and 4 DMACs. CMS will utilize two commercial banks meeting our requirements to process Medicare payments. Using a Letter of Credit authorized by CMS in coordination with the U.S. Department of the Treasury, the designated commercial banks will draw funds from the Medicare Trust Fund utilizing a U.S. Department of the Treasury Letter of Credit and deposit these funds into Part A and Part B Medicare bank accounts. The amount deposited into these accounts is used to fund the electronic and paper check Medicare payments that are authorized and disbursed by the MAC and presented for payment each day. EFT files are transmitted daily and funded with a draw from the letter of credit. The dollar value of funds for payments from a single financial institution exceeds $5 billion daily. Separate accounts are required for Part A, Part B and DMAC claims payment. In general, a single funding account is established with separate disbursement accounts for each geographic jurisdiction. The banks are required to conduct both weekly and monthly reconciliations of each account as well as invoice CMS on a monthly basis for the fees associated with servicing these accounts. The MACs, in turn, receive a volume of services report provided by the bank to verify that the account services were provided using reports supplied to them by the bank. B. CMS Demonstration Projects CMS sponsors a variety of demonstration programs under legislation and/or research requirements which serve to study a variety of health care applications and concepts; currently CMS has 18 operational demonstration projects to be paid through commercial banking services. While the subject of the studies differs among the demonstration projects, the fundamental payment process is universal to these programs. In all cases, a payment file is created and forwarded to the financial institution for processing. Funding is provided separately from specially designated and appropriated funds. Each demonstration project is unique and requires a certain amount of individual attention. Payment processing is universal and consistent between demonstration projects. Demonstration projects are currently operational and are anticipated to grow in number during the term of this contract. Work Description: The selected financial institution will be expected to perform the following responsibilities: The U.S. Department of Health and Human Services (DHHS)/CMS intends to contract with commercial banks to provide commercial banking services for CMS to pay claims processed through Medicare Administrative Contractors (MAC) and demonstration project payments. A. The basic functions required of the banks for MACs claim processing include: communicating and coordinating with the MAC; drawing funds from Medicare Trust Fund using a Letter of Credit authorized by CMS in coordination with the U.S. Department of the Treasury; processing and paying electronic fund transfers (EFTs) and paper checks authorized by the MAC; providing on line access to the MAC for daily information, reconciling Medicare bank accounts, preparing reports, keeping records, providing customer services as well as implementation and closing activities. B. The basic functions required of the banks for demonstration projects include: communicating and coordinating with demonstration payment authorization contractors, receiving deposits of funding for payments, processing electronic fund transfers (EFTs) and paper checks disbursed by the demonstration payment authorization contractors, reconciling relevant bank account, preparing reports, keeping records, providing customer services as well as implementation and closing activities. The Financial Institution selected must be currently designated as a Financial Agent of the U.S. Department of the Treasury as defined at 31 CFR PART 202 - DEPOSITARIES AND FINANCIAL AGENTS OF THE FEDERAL GOVERNMENT. The Treasury authority to designate financial agents is found at 31 CFR 202.2. The designated financial institutions will be provided funds for payments to be used solely for payment of items and services covered under the Program of Health Insurance for the Aged and Disabled established by Title 18 of the Social Security Act (commonly known as "Medicare"), Medicare demonstration programs or other Medicare programs as required. These are Federal program funds. Such funds must be deposited in a specified and segregated account. This account must be within a member bank of the Federal Reserve System or any "insured bank" within the meaning of the Act creating the Federal Deposit Insurance Corporation (FDIC) Act of August 23, 1935 49 Stat. 684 as amended; 12 U.S.C 264) separate from the Contractors other accounts and that have been designated as a Financial Agent of the U.S. Department of the Treasury. The Banking Contractor will be expected to perform the following activities. - Claims Payments - Payment funding - Reconciliation - Provision for Ach Risk Exposure - Imaging of documentation - Internet banking services - Daily transmissions between the contractor/bank/CMS - Technical assistance and customer service - Technical connections and file transmissions to and through CMS - Establishment of accounts and ownership - Testing of Non-base jobs - Invoicing and billing in specified format - Daily/weekly/monthly reporting as defined - Provide references of comparable transaction volume processing, functionality and responsibility - Provide certification of U.S. Treasury designation as a Financial Agent REQUIREMENTS The commercial banking services required must be provided by a financial institution with experience in large scale commercial banking transactions; management of substantial government funding/deposits, Electronic Funds Transfer, and government reporting functions, and that is currently a designated Financial Agent of the U.S. Department of the Treasury. There are no exceptions to the requirements listed below; offerors who do not clearly demonstrate such capabilities, assets and experience will not be given further consideration. Give enough detail so your response clearly indicates that you can provide all of the following: - Capability to perform over 2 million claims payments monthly representing over $32 billion in Federal funds. This represents half of the payment volume anticipated for claims payments. 10% of these transactions are paper check clearances and 90% are EFT transactions. - Capability to provide ACH risk exposure coverage that equals the draw from the government letter of credit averaging $5 billion daily. This represents half of the payment risk exposure for total claims payments. - Capability to maintain 24X7 customer service data transmission support, and handle a volume of over 100 incoming and 200 outgoing files per day. This represents half of the data transmission volume for total claims payments. - Capability to perform 7,500 demonstration payments monthly representing over $160 million in Federal funds. This represents half of the demonstration payments anticipated monthly. All demonstration payments are anticipated to be made through Electronic Funds Transfer. - Capability to manage and perform payment funding utilizing a separate government backed letter of credit for each of over 25 payment streams. Payment funding capabilities include reporting as well as maintaining the integrity and segregation of the funding as defined. - Capability to perform reconciliation and report weekly and monthly for over 20 different payment streams funded through separate letters of credit as well as over 6 different demonstration projects individually funded. - Capability to provide over the counter imaging and processing of deposits and Imaging of documentation as required. - Capability to provide Internet banking for daily financial management at multiple end points including the Medicare Administrative Contractors and demonstration project management locations. - Capability to provide daily technical assistance and customer service in support of 12 Medicare Administrative Contractor's and 4 DMEs, as well as demonstration programs. - Capability to provide resources and technical connections/file transmissions in designated file formats to insure security, integrity and timeliness of information transmissions. - Capability to provide technical connection for transmission to and through CMS and to perform Daily transmission between the contractor/bank/CMS representing over 100 incoming files and over 200 outgoing files. - Capability to use to utilizes TIBCO MFT which covers Platform Server and Internet Server within the Enterprise File Transfer infrastructure. The MFT Internet server requires a Secure File Transfer Protocol (SFTP) server at the business partners' site as CMS shall push files to their site. - Capability to provide positive pay file reconciliation daily allowing the payment authorizer to make the final payment determination. - Capability to establish accounts and ownership through a tripartite agreement. - Capability to coordinate and test changes in file transmissions in response to changes in the CMS data transmission formats including testing of Non-base jobs changes. - Capability to provide Invoicing and billing in specified format. - Capability to provide Daily/weekly/monthly reporting to CMS, MACs and Demonstration program management. - Capability to provide references of comparable transaction volume processing, functionality and financial responsibility. - Capability to provide certification of U.S. Treasury designation as a Financial Agent. Anticipated Contract Type: CMS anticipates issuance of a Firm-Fixed-Price type contract for Commercial Services 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 Capability Statement: Please provide a brief capability statement for our organization, tailored to demonstrate your relevant experience and/or ability to provide requirements of this magnitude. CAPABILITY STATEMENTS MUST DEMONSTRATE THE MINIMUM REQUIREMENTS OUTLINED ABOVE. Please address each in order listed above. Teaming Arrangements: All teaming arrangements shall include the above-cited information. Teaming arrangements are encouraged. This is not an invitation for bid, request for proposal or other solicitation and in no way obligates CMS to award a contract. The sole intent of this Sources Sought Notice is to obtain capabilities for set-aside and procurement planning purposes. The capability statement shall be limited to 3 pages and include the following information: 1. Business Information and Identification 2. DUNS No. 3. Company Name & Address 4. Company Point of Contact, phone number and email address. 5. Type of company under NAICS, as validated via the Central Contractor Registration (CCR). Additional information on NAICS codes can be found at www.sba.gov. All offerors must be registered on the Central Contractor Registration system, located at http://www.ccr.gov. 6. Corporate structure (corporation, LLC, sole proprietorship, partnership, limited liability partnership, professional corporate, etc.); 7. Point of Contact, names, phone numbers, and emails of references who can verify the capabilities/experience identified in the responses. All capability statements can be submitted via email to Mary.Kerner@cms.hhs.gov and Phillip.Smith@cms.hhs.gov. Responses shall be limited to 3 pages. Responses must be submitted no later than 3:00 PM EST, October 12, 2018. They should clearly reflect the respondent's ability to meet the requirements included in this notice. Capability statements will not be returned and will not be accepted after the due date. Respondents will not be notified of the results of the review of their submissions. Information received will be considered solely to make informed decisions regarding a potential small business set-aside. Disclaimer and Important Notes: This notice does not obligate the Government to award a contract or otherwise pay for the information provided in response. The Government reserves the right to use information provided by respondents for any purpose deemed necessary and legally appropriate. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed to allow the Government to determine the organization's qualifications to perform the work. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted. After a review of the responses received, a pre-solicitation synopsis and solicitation may be published in Federal Business Opportunities.