PERM Eligibility Review Contract

SOURCES SOUGHT/REQUEST FOR INFORMATION PAYMENT ERROR RATE MEASUREMENT ELIGIBILITY REVIEW CONTRACTOR THIS IS NOT A FORMAL REQUEST FOR PROPOSAL (RFP) AND DOES NOT COMMIT THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) TO AWARD A CONTRACT NOW OR IN THE FUTURE Introduction: 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 541990 - All Other Professional, Scientific and Technical Services, 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. Your responses to the information requested 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. It is anticipated that CMS will award a one (1) year firm fixed price contract with two (2) option years. Contractors must be free of conflicts of interest or prepare an OCI mitigation plan to address any actual, potential or apparent organizational conflicts of interest that could arise. All contractual and technical questions must be submitted in writing (via e-mail). Telephone questions will not be accepted. The Government is not obligated or committed to award any contract as a result of this notice. Contractors must be registered in the System for Award Management (SAM) database prior to award, during performance, and through final payment of any contract resulting from this RFP. Contractors may obtain information on SAM registration by visiting: https://www.acquisition.gov. Contracting Office Address: 7500 Security Blvd Baltimore, Maryland 21244-1850 Primary Point of Contact: Samuel Gobrail Contract Specialist Samuel.Gobrail@cms.hhs.gov 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. 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. 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 re-determined correctly and collect payments associated with sampled cases. Moving forward, CMS anticipates 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: - Coordinating with CMS, states, and other PERM contractors - Collecting, updating, and maintaining all state and federal policies related to Medicaid and CHIP eligibility; - Obtaining access to state eligibility systems; - Conducting eligibility case reviews; - Reporting findings to the states and resolving any discrepancies between their findings and the states' expectations; and - Supporting states and CMS in the review and development of corrective actions related to PERM findings. 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 case reviews for the 17 states in each PERM cycle; 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 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 under new ACA requirements; 6) Communicating findings to the states and working with the states to resolve any disagreements about the findings; 7) Maintaining, enhancing, and hosting a PERM eligibility review website for the purposes of tracking findings and reporting; and 8) 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 systems and determination processes; - Demonstrated experience reviewing Medicaid and CHIP eligibility determinations under new Affordable Care Act requirements; - 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: Business Information: a) Dun & Bradstreet Number (DUNS) b) Company Name c) Company Address d) Small business status e) Current GSA Schedule(s) appropriate to this Sources Sought along with any other contracting vehicles applicable and relevant f) Do you have a Government approved accounting system? If so, please identify the Agency that approved the system. g) 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/ h) Company Point of Contact Name, Phone, and Email address i) Teaming Arrangements: All teaming arrangements should also include the above-cited information and certifications for each entity on the proposed team. Responses must be submitted not later than 11:00AM EST on Thursday, November 12th, 2015. Capability statements will not be returned and will not be accepted after the due date. The maximum number of pages for submission is 10 pages, not including the required business information and cover page. 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: Samuel Gobrail Contract Specialist Samuel.Gobrail@cms.hhs.gov Nicole Hoey Contracting Officer Nicole.Hoey@cms.hhs.gov