THIS PRESOLICITATION NOTIFICATION IS FOR AN ACQUISITION SET ASIDE FOR 8(a) VENDORS ONLY. THIS NOTICE IS NOT A REQUEST FOR PROPOSALS. In accordance with FAR 5.203(a), this synopsis provides at least 15 days notification that the Centers for Medicare & Medicaid Services (CMS) intends to issue a solicitation to obtain Provider Screening services. The requirement is set aside for offerors expressly certified by the Small Business Administration (SBA) for participation in SBA's 8(a) Program. It is anticipated that the solicitation will be posted to the Federal Business Opportunities (FBO) web site in early July 2011. The Centers for Medicare & Medicaid Services' (CMS') Center for Program Integrity (CPI) is accountable for the prevention and detection of fraud, waste, abuse, and errors in the Medicare and Medicaid programs. CPI is implementing a National Fraud Prevention Program (NFPP) focused on prevention and detection that is integrated, risk-based, and measurable. The loss of taxpayer dollars through waste, fraud, and abuse drives up health care costs. CMS' program integrity mission also encompasses the operations and oversight necessary to ensure that CMS makes accurate payments to legitimate providers and suppliers for appropriate, reasonable, and necessary services and supplies for eligible Medicare beneficiaries. Reversing the traditional pay-and-chase approach to program integrity is the main goal of the National Fraud Prevention Program, a long-term, sustainable approach that incorporates innovative technologies in integrated solutions. CMS is planning improvements to its provider screening process with several goals: - To compile provider-related data needed to support the NFPP - To comply with CMS additional screening requirements provisions of CFR 42 Parts 405, 424, 447, 455, 457 and 498 and DHHS Office of Inspector General Part CFR 42 Part 1007 - To automate provider/supplier screening procedures using consistent techniques - To automate assessment of risk pre-enrollment CMS provider screening provisions affect all new applications and revalidations occurring after March 25, 2011 and require complete revalidation of all enrolled providers and suppliers in the Medicare fee-for-service (FFS) program by March 23, 2013. The purpose of this requirement is to obtain the following capabilities: 1) to perform automated screening on new and existing enrollments of providers/suppliers and 2) to conduct automated risk assessments for potential fraud, waste, and abuse on a pre- and post-enrollment basis, resulting in alerts and reporting to designated CMS business partners. The Contractor solution must have the capability to: - Verify enrollment and re-enrollment data for all provider/suppliers and output results of data checks, - Output risk-based vulnerability assessment and deliver risk screening alerts whenever providers or suppliers fail to meet the requirements established by CMS, or where other data checks create a risk of potential fraud, - Provide a screening results interface to pass results of enrollment data and risk screening back to CMS and CMS business partners, and - Support new/updated sources of data to improve the accuracy of data checks/risk identification. The verification and screening methods must be comprehensive, covering all Medicare provider/supplier categories and types, to include physicians and non-physician practitioners, and encompassing providers in all 50 states and 6 territories. The Contractor shall use both CMS data and appropriate external data sources to enhance risk screening. By December 2011, the Contractor shall implement a comprehensive verification/screening and risk assessment solution, for all Medicare provider/supplier categories and types, to include physicians and non-physician practitioners, and encompassing providers in all states and territories. The provider screening solution must determine a risk score, identify and prioritize providers that are high risk of being potentially fraudulent based on screening criteria, and return mismatches between enrollment and external data sources, as well as supplementary data from external sources that is relevant to the risk assessment and appropriate feedback reports to designated CMS business partners. A DRAFT Statement of Work (SOW) and deliverable schedule are attached for reference ONLY. The FINAL SOW and deliverable schedule will be issued with the solicitation. CMS intends to award a hybrid Cost-Plus-fixed Fee/Fixed Price contract to a firm expressly certified by the Small Business Administration (SBA) for participation in SBA's 8(a) Program. The period of performance is for a one (1) year base period, with four (4) one (1) year option periods to be exercised individually at the discretion of the government. The solicitation will be available on the FBO website. It is anticipated that this contract will be awarded in late September 2011. Any questions regarding this synopsis should be directed to Aaron Blackshire, Contract Specialist, via email at
contact@example.gov, and Phyllis Lewis, Contracting Officer, via email at
contact@example.gov.
