Medicare Medical Home Demonstration Payment Contractor

Introduction: This SOURCES SOUGHT NOTICE is 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) to act as a Medicare Payment Contractor as per Sec. 204 Medicare Medical Home Demonstration Project of H.R. 6111, Tax Relief and Health Care Act of 2006. In addition, the Contractor will be responsible to verify beneficiary participant eligibility on a monthly basis and to provide customer service support and education to the Medical Home practices. The information from this market research will help CMS plan their acquisition strategy. Please be sure to indicate if you have a GSA schedule contract, a contract on GSA 8(a) STARS, or a contract on GSA VETS GWAC. THIS IS STRICTLY MARKET RESEARCH. THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) DOES NOT INTEND TO ISSUE A REQUEST FOR PROPOSAL. CMS WILL NOT ENTERTAIN QUESTIONS REGARDING THIS MARKET RESEARCH. BACKGROUND The Centers for Medicare and Medicaid Services (CMS) plans to conduct a Medical Home Demonstration as directed by Section 204 of the Tax Relief and Health Care Act of 2006 (TRHCA). The Act calls for the project to provide targeted, accessible, continuous and coordinated family-centered care to high-need populations through a Medical Home Demonstration. The Act also specifies that the demonstration will include Medicare beneficiaries who are deemed to be - high need (that is, with multiple chronic or prolonged illnesses that require regular medical monitoring, advising or treatment.) Current statistics reveal that 86 percent of the over 40 million Medicare beneficiaries have one or more chronic conditions and 23 percent have five or more chronic conditions. The current healthcare system is ill-equipped to handle a rapidly growing population of senior-aged baby boomers who will enjoy increased longevity, as well as increased chronicity. It is estimated that, by the year 2015, 150 million Americans will have at least one chronic condition. This wave of new chronically ill patients will further tax an already strained system of healthcare provision and payment. At a time of increased demand on the system, there is strong evidence that there is a countervailing force at work on the delivery side. Fewer newly educated physicians are entering primary care and seasoned physicians, feeling pressure to see more patients in less time, are retiring or moving to other fields. In a 1992 policy statement, the American Academy of Pediatrics (AAP) proposed a definition and model for the Medical Home. The AAP pioneered Medical Home in the early 1990's with children and their families. Since that time, their proposed model was generally accepted and implemented in pediatric practices throughout the nation. The AAP believes that all children should have a Medical Home where care is accessible, family-centered, continuous, comprehensive, coordinated, compassionate and culturally effective. There are few other practical examples of Medical Home care to observe and most involve medical care for children. Examples of other Medical Home models include the American Academy of Family Practice's (AAFP's) - TransforMED, and the Carolina ACCESS program which is a Medical Home for children under Medicaid managed care. Other professional and specialty and subspecialty groups, including the American Medical Association, American Academy of Family Practice (AAFP), the American Geriatrics Society, the American Osteopathic Association (AOA), the AIDS Healthcare Foundation, and the American Heart Association have also called for changes in the provision and payment for chronic care. Joint Principles of the Patient-Centered Medical Home, (March, 2007) a position paper developed by the AAP, AAFP, American College of Physicians, and AOA, calls for a physician-directed medical practice with a personal physician providing continuous and comprehensive care across all elements of the complex health care system, utilizing a whole person orientation. Response Information: In order to respond to this notice, contractors must be able to demonstrate capability to provide all of the numbered points below. Give enough detail so your response clearly indicates that you can provide the following: 1. Making timely and appropriate monthly payments to up to 400 qualified physician practices and including up to 200 physicians from the Medicare Part B Trust Fund; 2. Receiving and integrating 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. Monitoring 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. Making 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. 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 should also include the above-cited information and certifications for each entity on the proposed team. Teaming arrangements are encouraged. Responses must be submitted not later than July 30, 2008. Capability statements will not be returned and will not be accepted after the due date. The maximum number of pages for submission is 20 pages. This Sources Sought Notice is for information and planning purposes only and is no 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.