R -- EXPERT SERVICES FOR THE PROVIDER REIMBURSEMENT MANUAL

The Centers for Medicare and Medicaid Services (CMS) intends to award on a sole source basis, under the Simplified Acquisition Procedures in accordance with FAR Part 13 (Dollar Threshold of $100,000) a firm-fixed price purchase order to John R. Eppinger Jr., 943 Woolen Mill Road, Stewartstown, PA 17363-8083. Under the authority of FAR 6.301-1 10 U.S.C. 2304? only one responsible source and no other supplies or services will satisfy agency requirements. Section 1815 of the Social Security Act (the Act) requires that amounts paid to providers of services be based on reasonable cost for the services as determined under Section 1861(v) of the Act. Furthermore, by regulation, each provider must submit an annual Medicare Cost Report (MCR) setting forth all costs for which the provider claims reimbursement. The Provider Reimbursement Manual (PRM) is an extensive set of interpretive guidelines and policies published by the Centers for Medicare and Medicaid Services (CMS) to assist contractors and providers in applying the reasonable cost reimbursement principles. The Division of Cost Reporting (DCR) is responsible for publishing and updating the PRM and the MCR forms. DCR must update and rewrite numerous payment policy areas in the PRM and regulations based on legislative and policy changes as articulated in regulations such as the hospital Outpatient Prospective Payment System (OPPS) and related charge compression issues in both OPPS and the Inpatient Prospective Payment System (IPPS). Extensive revisions to the hospital MCR are also required to incorporate the policy revisions and items such as new technology cost and current industry practices. Major revisions to the hospital MCR have not occurred since 1996. At the present time, there is no one within CMS available who has the requisite expertise, knowledge, and skills to revise the PRM to incorporate the required policy revisions. John Eppinger possesses the experience, knowledge, and expertise that are required for this project. He has approximately 40 years of experience with Medicare reasonable cost principles and payment policy. During that time, John was a highly regarded senior analyst in DCR who was in constant demand by his peers and junior staff for guidance and direction on Medicare reimbursement issues. In any given day, John responded to many calls from fiscal intermediaries, policy analysts, and outside stakeholders on a variety of topics related to Medicare reimbursement. John worked countless hours providing guidance on numerous policy areas including reasonable cost, apportionment, periodic interim payments, and the uninsured. He also provided technical assistant to the policy components in the Center for Medicare Management (CMM), and with the OFM relating to various provisions of the Medicare Modernization Act (MMA) as related to cost reimbursement and cost reporting. The activities that John supported are extensive and his effort supported several of the themes characterized in CMS?s strategic statement including: paying appropriately, accurately and effectively for health care; managing the evolution of our programs strategically; and partnering with our stakeholders. The OGC and the Office of the Attorney Advisor (AA) utilized John's expertise on a regular basis. He was the Agency expert witness on many PRRB cases. John's comprehensive knowledge of the statutes, regulations and the PRM on the subject of cost reimbursement is invaluable asset to CMM and the Agency. As a result of this work, Mr. Eppinger has acquired an in-depth and unique knowledge of Medicare policy. He has vast knowledge and experience with the reasonable cost principle on which the PRM is based. Mr. Eppinger played a critical role in the development of the PRM used by contractors and providers in applying the reasonable cost reimbursement principles. He has expert knowledge of the extensive set of interpretive guidelines and policies in the PRM and regulations. Mr. Eppinger is the expert in understanding how policies inter-relate and how to revise it without unintentionally adversely affecting other policies which would result in inconsistent application of our policy.The agency is under significant pressure to make substantive changes to the MCR to expand numerous cost centers such as the supply cost center on the MCR. It is imperative that the revisions to the hospital MCR and PRM address the latest payment policy changes so that providers are paid appropriately. Mr. Eppinger retired on August 3, 2007 and many of his responsibilities were assumed by other CMS employees with less experience. However, due to the complexity of the PRM, sustained time, hands-on experience, and one-on-one tutelage are prerequisite to fully learning and comprehending the intricacies of the policies related to Medicare reimbursement. Since the PRM revisions relate to work the Mr. Eppinger performed exclusively while he was an employee at CMS, only he can train and transfer this information to his successors. Moreover, Mr. Eppinger's experience and unique expertise continue to be needed in the review and response to PRRB decisions, litigation, and policy settlement recommendations. Without Mr. Eppinger to train and transfer knowledge, and without his availability to ensure smooth integration of revisions to the PRM, updates to Medicare reimbursement and payment policies will be delayed indefinitely. All responsible sources may submit capability statements in consideration to the Agency at the above address and must be registered in the Central Contractor Registration (CCR) System. The Centers for Medicare and Medicaid Services, Program Officer shall make the determination of what would constitute equivalent expertise. The anticipated award date is no later than December 10, 2007 and the period of performance is one year from award date. NAICS CODE 923120.