Payment Error Rate Measurement Eligibility Review Contract

REQUEST FOR INFORMATION CMS-2015-RFI-PERM-ERC PAYMENT ERROR RATE MEASUREMENT ELIGIBILITY REVIEW CONTRACTOR 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. Introduction: This is a Request for Information (RFI) and is issued solely for the purpose of planning and market research. This is NOT a solicitation for proposals, proposal abstracts, or quotations and does not obligate the Government to award a contract. The purpose of this notice is to obtain information regarding the availability and capability of large businesses and qualified small businesses (e.g., 8(a), service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business and woman-owned small business) to support the Centers for Medicare and Medicaid Services (CMS), Office of Financial Management, Provider Compliance Group (PCG), Division of Error Rate Measurement (DERM), and Payment Error Rate Measurement (PERM) program. The information gathered from this market research will assist the Government in determining the appropriate acquisition strategy, including whether a set-aside is possible. The anticipated NAICS is 541990, All Other Professional, Scientific and Technical Services. Interested parties should submit a capability statement to demonstrate their ability to perform the requirements. Background: CMS is currently administering a payment error rate measurement program in the Medicaid and the Children's Health Insurance Program (CHIP) programs. CMS must estimate payment error rates in Medicaid and CHIP as directed by the Improper Payments Information Act (IPIA) of 2002, amended by the Improper Payments Elimination and Recovery Improvement Act of 2012 (IPERIA). The IPERIA directs each executive agency, in accordance with the Office of Management and Budget (OMB) guidance, to review all of its programs and activities annually, identify those that may be susceptible to significant improper payments, estimate the annual amount of improper payments, and submit those estimates to Congress. The IPERIA defines improper payments as: (a) any payment that should not have been made or that was made in an incorrect amount, including both overpayments and underpayments, under statutory, contractual, administrative, or other legally applicable requirements; and (b) payments made to an ineligible beneficiary, duplicate payments, payments for services not received, and payment that does not account for credit for applicable discounts. CMS implemented the Payment Error Rate Measurement (PERM) methodology to produce state and national error rates for fee-for-service claims, managed care capitation payments, and eligibility determinations. Currently, federal contractors perform the review of fee-for-service and managed care payments while states conduct their own review of eligibility determinations. The Affordable Care Act created significant changes to Medicaid and CHIP eligibility applicable to all states regardless of their decision to expand Medicaid. These program changes include: - Use of Modified Adjusted Gross Income (MAGI) methodologies for income determinations and household composition; - Use of a single streamlined application (or approved alternative) for intake of applicant information; - Availability of multiple channels to consumers for submitting application information (by mail, fax, phone or on-line); - Use of a HHS-managed data services hub for access to federal verification sources; - Need for account transfers and data sharing between the Marketplace, Medicaid, and CHIP to avoid rework or confusion by consumers; and - Reliance on data-driven processes for 12 month renewals. These changes required redesign of many Medicaid and CHIP business operations and systems, and interaction with other state and federal partners. Accordingly, the current methodologies applied to measurement of eligibility accuracy under PERM need to be updated to reflect the changes states are making to their eligibility policies and systems. Furthermore, the interaction of the Marketplaces with Medicaid and CHIP, including the cross-program interdependencies and coordination built to create an efficient system of coverage, will need special consideration in the planning of future program measurements and accountability. Traditionally, states have been responsible for the PERM eligibility component, which has required states to develop universes of active and negative cases, randomly sample cases, conduct case reviews to determine whether eligibility was determined or redetermined correctly and collect payments associated with sampled cases. CMS is considering using a federal Eligibility Review Contractor (ERC) to conduct the eligibility reviews for the PERM measurement in all states. Using an ERC will improve the consistency of reviews and reduce the workload for states. Moreover, it will provide CMS with increased oversight of the PERM eligibility component. The ERC will be responsible for: - Collecting, updating, and maintaining all state and federal policies related to Medicaid and CHIP eligibility; - Obtaining access to state eligibility systems; - Working with the states to develop a complete universe of eligible active and negative CHIP and Medicaid cases; - Drawing a sample of cases from the universe; - Conducting eligibility case and payment reviews; and - Reporting findings to the states and resolving any discrepancies between their findings and the states' expectations. Overview of the Requirements Interested parties should demonstrate that they possess the experience and/or the ability to provide the full range of services outlined below: 1) Conducting eligibility reviews for the 17 states in each PERM cycle, including assisting states with universe development, drawing a random sample of cases, conducting eligibility case reviews, and collecting payments associated with sampled cases; 2) Collecting, updating, and maintaining state and federal Medicaid and CHIP eligibility policies, which includes conducting research on state eligibility procedures and systems as it pertains to caseworker actions and systems interactions in making eligibility determinations; 3) Accessing state eligibility and payment systems, which may require onsite travel; 4) Requesting, obtaining, and storing eligibility data from state eligibility systems and case files; 5) Conducting eligibility review of sampled eligibility applicants to determine whether the state determined the applicants' eligibility in accordance with state and federal policies and procedures; 6) Collecting payments associated with sampled eligibility applicants; 7) Communicating findings to the states and working with the states to resolve any disagreements about the findings; 8) Designing, building, maintaining, enhancing, and hosting a PERM eligibility review website for the purposes of tracking findings and reporting; and 9) Serving as a consultant to the PERM program, assisting states/CMS in developing corrective actions, and collaborating with CMS and other contractors to compose cycle summary and PERM final reports. Capability Statement Information Interested parties should demonstrate that they possess the following capabilities in their capability statements: - Knowledge of IPERIA requirements and understanding of overall PERM goals; - Strong understanding of national and state Medicaid and CHIP eligibility policy and Affordable Care Act requirements and how such policies impact the eligibility review; - Documented working knowledge of state eligibility and payment systems and determination processes; - Demonstrated experience reviewing Medicaid and CHIP eligibility determinations; - Resource capacity to conduct case and payment reviews across 17 states in a given cycle within required timeframes, as outlined by CMS; and - Proven experience working with state Medicaid and CHIP agencies Please include the following in your response: Your Business Information - a) Dun & Bradstreet Number (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 as validated via the System for Award Management (SAM). All offerors must register in SAMs located at https://www.sam.gov/portal/public/SAM/ g) Company Point of Contact Name, 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. h) Responses must be submitted not later than May 20, 2015. Capability statements will not be returned and will not be accepted after the due date. The maximum number of pages for submission is 15 pages. This RFI is for 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. 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. 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). Documents should be sent to the following: Gina Romano Contract Specialist gina.romano1@cms.hhs.gov Nicole Hoey Contracting Officer nicole.hoey@cms.hhs.gov