Indian Health Service - Implementing Purchased Referred Care Rates for Non-Hospital Medical Services

SOURCES SOUGHT NOTICE: Indian Health Service - Implementing Purchased Referred Care Rates for Non-Hospital Medical Services INTRODUCTION & PURPOSE This is a Small Business Sources Sought notice. This is NOT a solicitation for proposals, proposal abstracts, or quotations. The purpose of this notice is to obtain information regarding: (1) the availability and capability of qualified small business sources; (2) whether they are small businesses; HUBZone small businesses; service-disabled, veteran-owned small businesses; 8(a) small businesses; veteran-owned small businesses; woman-owned small businesses; or small disadvantaged businesses; and (3) their size classification relative to the North American Industry Classification System (NAICS) code for the proposed acquisition. Your responses to the information will assist the Government in determining the appropriate acquisition method, including whether a set-aside is possible. An organization that is not considered a small business under the applicable NAICS code should not submit a response to this notice. BACKGROUND The Indian Health Service (IHS), an agency within the Department of Health and Human Services, is responsible for providing federal health services to American Indians and Alaska Natives (AI/AN). IHS provides a comprehensive health service delivery system for approximately 1.9 million AI/AN who belong to 567 federally recognized tribes in 36 states. The Purchased/Referred Care (PRC) Program plays a major role in the IHS provision of care. Under the PRC program, primary and specialty health care services that are not available at IHS or tribal facilities are purchased from private health care providers. This request is made in accordance with final rule 42 CFR Part 136, RIN 0917-AA12, "Payment for Physician and Other Health Care Professional Services Purchased by Indian Health Programs and Medical Charges Associated with Non-Hospital-Based Care". The final regulation was published in the Federal Register on March 21, 2016, with an effective date of May 20, 2016, and a final implementation date of March 21, 2017. The rule amends the regulation at 42 CFR Part 136 subpart D, and adds a new subpart I "Payment for provider and supplier services purchased by Indian health programs" to apply the Medicare payment methodologies to all physician and other health professional services and non-hospital-based services purchased by an IHS or Tribal PRC program, or urban Indian organization (I/T/U) authorized to receive these services. It allows these programs to negotiate or pay non-I/T/U providers based on the applicable Medicare fee schedule, prospective payment system, Medicare Rate, Medicare waiver or most favored customer rate. The IHS contracts the services of a certified fiscal intermediary (FI) agent to provide a centralized medical and dental claims processing service, maintain reimbursement and reporting systems as well as calculate payment rates in accordance with MLR regulations, PRC rule and the IHS payment policy. The purpose of this announcement is to identify a potential trainer(s) to provide education and support for Tribal PRC program staff on implementing most favored customer (MFC) rates and computing PRC Rates for non-hospital medical services based on the Centers for Medicare & Medicaid Services (CMS) Part B payment systems: "Data Entry and Calculations" under the Inpatient Physicians Payment System (IPPS), and PC Pricer pricing methodologies in estimating charges for purchase order obligations on behalf of the health care providers and suppliers within the PRC program. Estimating charges for purchase orders ensures critical PRC budgets and spending plans reflect a close estimate of actual funds to maintain a consistent level of services throughout the year. The PRC Rates rule allows the amount negotiated by a repricing agent; or the provider or supplier's MFC. In the event that a Medicare rate does not exist for an authorized item or service, and no other payment methodology provided by the rule is applicable, the rule authorizes payment at 65% of authorized charges. Paying at the Medicare rates allows the PRC program to purchase more health care for AI/AN patients. The use of Medicare rates is necessary to coordinate patient benefits and process medical and dental claims, to ensure that the PRC program is the payor of last resort for services provided to patients and calculate Medicare rates in accordance with the PRC Rates regulations and the IHS payment policy. These services are also made available to tribes that contract and compact their PRC programs under the Indian Self-Determination Education and Assistance Act (P.L. 93-638). This final rule establishes reimbursements that are consistent across Federal health care programs and aligns payment with inpatient services, and enables the I/T/U to expand beneficiary and access to medical care. PROJECT REQUIREMENT The trainer will be expected to understand the mission of the IHS and its health care delivery system as well as the purpose and function of the PRC Program and the new PRC Rates regulation. The trainer must have a basic understanding of the IHS Financial Management System that interfaces claims through the IHS Resource and Patient Management System (RPMS) and Purchased Referred Care/Management Information System (PRC/MIS) as well as tribal financial management systems. The RPMS system is a decentralized integrated solution for management of both clinical and administrative information in the IHS healthcare facilities. RPMS software applications have been, and continue to be, customized and enhanced based on input from users throughout the entire Indian Healthcare system. Claims Processing System: Must have knowledge of the CMS Part B payment systems, compute charges using "Data Entry and Calculation for IPPS" and commercial PC Pricers and be able to determine the reimbursement rates for all the different fee schedules, but not limited to the following: - CMS Medicare Pricer - Provider Carrier/Locality Code - Medicare Fee Schedule (MFS) Pricer - Anesthesia Base Units - CMS Ambulance Fee Schedule - End Stage Renal Dialysis (ESRD) Pricer - Core Based Statistical Area (CBSA) & Wage Index File - Physician's fee schedule - Ambulatory Surgical Center (ASC) fee schedule - Drug fee schedule - Lab fee schedule - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) - Outpatient Prospective Payment System (OPPS) - Outpatient Code Editor (OCE) - Hospital Outpatient PPS - National Correct Coding Initiative Edits - Outpatient PPS Pricer Code - National Technical Information Service (NTIS) - ICD-10 Coding Basics - Transmittals SPECIAL SECURITY REQUIREMENTS: The contractor shall not photocopy, or in any way retain, any identification documents belonging to IHS personnel, including, but not limited to IHS documents, or personal driver's licenses. The contractor shall not use any personally identifiable information such as a home address for IHS personnel. Confidentiality. No proprietary, classified, confidential, or sensitive information should be included in your response. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s). Interested small business firms are highly encouraged to respond to this notice. However, firms should understand that generic capability statements are not sufficient for effective evaluation of their capacity and capability to perform the work required. Responses must directly demonstrate the company's capability, experience, and ability to marshal resources to effectively and efficiently perform the objectives described above. RESPONSE INFORMATION In order to respond to this notice, interested firms should address the depth and breadth of corporate and technical capabilities, and must be able to clearly convey its experience and/or ability to provide the services in the following areas, which are identified as core services. Interested respondents shall provide a capability statement to include the following core competencies: (a) Staff expertise, experience, and formal and other training; (b) Current corporate capability and capacity to perform the work; (c) Prior completed projects of similar nature; (d) Corporate experience and management capability; (e) Examples of prior completed Government contracts, references, and other related information. The Government requests interested parties submit a written response to this notice which includes: 1. Company Name and a brief description of the company's business size (i.e. annual revenues and employee size). 2. Company's DUNS number; point of contact, mailing address, telephone and fax numbers, and website address. 3. Name, telephone number, and e-mail address of a company point of contact who has the authority and knowledge to clarify responses with Government representatives 4. Business status (i.e., Small Business, SDB, 8(a), HUBZone, SDVOSB, WOB, etc.). Type of company is validated via the System for Award Management (SAM). All respondents must be registered on SAM located at https://www.sam.gov 5. Description of same/similar services offered to the Government and to commercial customers. Any responses involving teaming agreements should delineate between the work that will be accomplished by the prime and the work accomplished by the teaming partners. 6. Applicable company GSA Schedule number or other available procurement vehicle. 7. Do you have a Government approved accounting system? If so, please identify the agency that approved the system. 8. Date submitted. Responses must be submitted not later than Monday, January 23, 2016, 11:00 A.M. (EST). Capability Statements will not be returned and will not be accepted after the due date. The maximum number of pages for submission is ten (10) pages (excluding cover page). Capability statements should be e-mailed directly to the Primary Point of Contact (POC) listed below. SUBMISSIONS WILL ONLY BE ACCEPTED VIA ELECTRONIC MAIL. * TELEPHONE CALLS AND QUESTIONS WILL NOT BE ACCEPTED. * Disclaimer and Important Notes: This notice does not obligate the Government to award a contract. Any information provided by industry to the Government as a result of this sources sought synopsis is strictly voluntary. Responses will not be returned. No entitlements to payment of direct or indirect costs or charges to the Government will arise as a result of contractor submission of responses or the Government's use of such information 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 on a government GPE. However, responses to this notice will not be considered adequate responses to a solicitation. Confidentiality: No proprietary, classified, confidential, or sensitive information should be included in your response. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s). Primary POC: Vito Pietanza, Contract Specialist Division of Acquisition Policy/Indian Health Service Department of Health & Human Services vito.pietanza@ihs.gov Secondary POC: Reginald Lee, Contract Specialist Division of Acquisition Policy/Indian Health Service Department of Health & Human Services reginald.lee@ihs.gov