Program Integrity support

This is a 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 (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); and (2) their size classification relative to the North American Industry Classification System (NAICS) code for the proposed acquisition. 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. CMS is looking for, but not limiting to, small businesses that are currently on a GWAC or GSA Schedule, have experience in the commercial health insurance industry and Medicare as well as knowledge of Federal Information Security Management Act (FISMA) requirements. BACKGROUND: On March 23, 2010, the President signed into law H.R. 3590, the Patient Protection and Affordable Care Act (Public Law 11-148), hereafter referred to as the Affordable Care Act, as amended by the Health Care and Education Recovery Act of 2010 (Public Law 111-152). Section 1101 of the Affordable Care Act establishes a "temporary high risk health insurance pool program" (which has been named the Pre-Existing Condition Insurance Plan, or PCIP) to provide health insurance coverage to currently uninsured individuals with pre-existing conditions. The Affordable Care Act authorizes HHS to carry out the program directly or through contracts with States or private, nonprofit entities. The PCIP program is intended to remain in place from the time of its establishment until the Exchanges established under Sections 1311 or 1321 of the Act go into effect on January 1, 2014. PURPOSE AND OBJECTIVES: The purpose of this notice is to seek out small businesses interested in performing certain requirements that will support the Pre-Existing Condition Insurance Plan (PCIP). ANTICIPATED REQUIREMENTS: - Design and execute on-site health insurance claims audits (both medical and pharmaceutical) for 27 state PCIP contractors, one audit per contractor per calendar year in a chronological order specified by HHS. These audits shall evaluate whether PCIP contractors paid claims in accordance with approved plan coverage, benefits, and member cost sharing for eligible and enrolled subscribers. - Answer questions and concerns from PCIP contractors in response to claims audit findings and recommended adjustments/recoveries. - Audits include travel to state PCIP contractor locations throughout the country. CAPABILITY STATEMENT: Capability statements must include the following information: - Business Information 1. Company Name 2. Company Address 3. DUNS Number 4. Does your organization have a government approved accounting system? If so, please identify the agency that approved the system or provide a copy of the approval letter. 5. Type of company as validated in the Central Contractor Registration (CCR) 6. Company Point of Contact - Name, Phone and Email addresses. 7. Listing of current clients/customers - Provide a brief description of company experience with any of the following: 1. The Patient Protection and Affordable Care Act 2. The Early Retiree Reinsurance Program 3. T he Pre-Existing Condition Insurance Plan (PCIP) Program 4. Employer based group health plans 5. Medicare Part A 6. Medicare Part B 7. Medicare Part C 8. Medicare Part D - Please include information regarding the company: 1. Staff expertise, including their availability, experience, and formal and other training; 2. Current in-house capability and capacity to perform the anticipated requirements; 3. Prior completed projects of similar nature to the anticipated requirements; 4. Corporate experience and management capability; 5. Examples of prior completed Government contracts, references, and other related Information; and 6. DELETED INFORMATION SUBMISSION INSTRUCTIONS: Interested parties having the corporate capability and expertise necessary to perform the stated anticipated requirements outlined in this notice may submit capability statements via email to Georgette Vlangas (georgette.vlangas@cms.hhs.gov) and Desiree Wheeler (desiree.wheeler@cms.hhs.gov). Please email responses on or before 10:00 a.m. (Eastern Standard Time), April 29, 2011. Please limit responses to no more than 10 pages total. CMS software standard is MS Word, therefore, responses should be submitted in a Word or Word comparable document. Page size would be 8.5 by 11 inches. Proprietary Information and Disclaimers: All transmitted information marked proprietary shall be treated as such. Therefore, respondents should identify any proprietary information in its capabilities statement. Proprietary materials will neither be distributed, nor discussed, with any other organization or business. Further, the information submitted will remain confidential insofar as permitted by law, including the Freedom of Information and Privacy Acts. CMS reserves the right to utilize any non-proprietary technical information in the anticipated SOW or solicitation. THIS SOURCES SOUGHT NOTICE 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 SHALL BE AWARDED FROM THIS NOTICE. NO REIMBURSEMENT WILL BE MADE FOR ANY COSTS ASSOCIATED WITH PROVIDING INFORMATION IN RESPONSE TO THIS NOTICE. CAPABILITY STATEMENTS WILL NOT BE RETURNED AND WILL NOT BE ACCEPTED AFTER THE DUE DATE. CONTACT INFORMATION: Georgette Vlangas, Contract Specialist (georgette.vlangas@cms.hhs.gov) 410-786-8372 Desiree Wheeler, Contracting Officer (desiree.wheeler@cms.hhs.gov) 410-786-2404