R -- Technical Support for Medicare Advantage Contracting and Business Process Improvements Related to Contracting Automation

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. This is a SOURCES SOUGHT NOTICE to determine the availability of potential small businesses on the GSA MOBIS Schedule (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) that can provide technical support for Medicare Advantage Contracting (i.e. Submitted applications and bid review) and business process improvements related to contracting automation. History: For over thirty years, managed care organizations have had the opportunity to participate in the Medicare program by offering Medicare beneficiaries original Medicare benefits (and generally additional benefits beyond that) in exchange for a monthly capitated payment from CMS. Managed care plan participation in Medicare has varied based upon a variety of factors, but has trended up for the last three years since the creation of the Medicare Advantage program. Barring substantial legislative change, managed care participation in Medicare through Medicare Advantage is expected to continue to increase. Since the passage of the Medicare Modernization Act (MMA) in 2003, prospective Medicare Advantage contractors have submitted applications and bids to CMS and received contract approval based upon an annual calendar rather than on a flow basis. The considerable growth in the Medicare Advantage program since the passage of MMA has substantially increased workload associated with processing, reviewing, and ultimately approving/disapproving applications. This workload increase has further been complicated by numerous new product types within the Medicare Advantage program - Regional Preferred Provider Organizations, Medical Savings Accounts, Private Fee for Service Plans, Employer Group Plans, and Religious and Fraternal Benefit Organizations. The workload associated with processing Notices of Intent (NOI), Applications, Bids, considering appeals of disapprovals, preparation for hearings, and issuing initial contracts and service area expansion notices spikes and dissipates throughout the contract year. CMS is seeking a contractor to assist with many facets of the contracting workload. In addition, for the first time in 2008, Medicare Advantage organizations will be submitting applications electronically, and CMS seeks a contractor to assist CMS with adjusting work processes to fully capitalize on this automation. Purpose: CMS is seeking to determine if there are small businesses capable of supporting CMS with its Medicare Advantage contracting (submitted applications and bid review) workload. In general, these services will be provided intermittently and for a short duration of time. Generally, CMS will be able to present the contractor with a calendar that will allow the contractor to ?ramp up? for work-spikes with reasonable notice. However, CMS will also need a contractor that can augment or decrease resources on short notice. In particular, the contractor shall need to provide CMS with: 1. Highly skilled individuals with necessary skills including but not limited to actuarial, clinical, legal, and statistical; 2. Clerical individuals to conduct data-entry, filing, and other clerical and sub-professional activities; and 3. Business process consulting to examine present CMS work processes and implement tactical work process improvement strategies. Task Descriptions: The Contractor shall provide the following services based upon the following approximate calendar with the month of April as the starting point (the projections offered below are subject to change): 1. Application Review Support (April-May): Provide intermittent, expert technical assistance to CMS in reviewing contract applications, particularly with respect to assisting CMS Regional Office staff in: a. Examining Health Service Delivery table submissions by investigating provider network adequacy and conducting outbound calling to samplings of listed providers to confirm their participation; b. Reviewing selected provider contracts to assure compliance with CMS standards; and c. Going on-site to new applicant office for related review work. 2. Reconsideration/Appeals Support (May-July): Provide intermittent expert technical assistance to CMS in documenting disapproved applications, assembling documentation for reconsideration/appeals processes, and maintaining a database (under direction of CMS) of denied applications with germane related information. 3. Bid Support (April-September): Bid and financial reviews occur between the months of March-August and are conducted by a limited number of analysts in need of additional help to complete the timely review of bids and financial applications for CY 2009. Contractor shall assist CMS staff in filing, collating, and mailing materials. Under CMS guidance, maintain existing database related to bids. 4. Contract Issuance (September-November): Provide support assembling contractor approval packages for executive signature, including documents related to new contracts, service area expansions, and various addendums. Assist CMS staff in packaging and mailing materials. Under CMS guidance, maintain existing database related to contract issuance. 5. Notices of Intent (December-January): Provide data-entry support for logging in Notices of Intent from prospective Medicare Advantage applicants for CY 2010. Provide ad hoc assistance to CMS in establishing new contract numbers and related functions. 6. Data Extraction and Reporting (ad hoc): Over the course of the year, provide intermittent and ad hoc support to CMS staff related to extracting data from various application, bid, and contracting materials. 7. Business Process Improvement (intermittent): Over the course of the year,provide intermittent and ad hoc business process improvement consulting designed to improve CMS work processes, particularly as CMS transitions from a paper-bound contract application to a paperless one. Consulting services shall be tactical, not strategic, in nature and designed to address task-specific work challenges. Contractor Requirements: In order to respond to this notice, contractors must be able to indicate experience and/or the ability to provide all of the numbered points below. Please provide enough detail so your response clearly indicates that you can provide the following: 1. Knowledge of Medicare Program: The Contractor shall demonstrate an understanding of the Medicare program related to: Medicare Advantage, Federal and DHHS contracting processes and regulations, and CMS organization and organizational culture. 2. Knowledge of Managed Care Operations: The Contractor shall possess an understanding of managed care contracting, provider network development, different managed care models, and provider contracting. 3. Access to Requisite Skills: The Contractor shall demonstrate that it has on staff or via reliable business partners the full skill-sets and flexible human resources described above. 4. Demonstrated Success on Similar Projects: The Contractor shall demonstrate that it has provided intermittent support of a similar nature to other government agencies. 5. Business Process Improvement: The Contractor shall demonstrate that is has successfully assisted other government agencies in improving their work processes based upon advances created by Information Technology. 6. No Conflicts of Interest: The Contractor shall demonstrate that it does not have any current relationships with organizations that participate in the Medicare Advantage program or have other relationships which would compromise the integrity of the program. Examples to help contractors determine Conflict of Interest: The following shows situations that highlight potential or actual conflict of interest. For example, CMS anticipates that a contractor may have actual, apparent or perceived conflicts of interest with the work performed under a hypothetical contract: the operation or sale of managed care plans, Medigap policies, durable medical equipment, dialysis services, or any other related provider groups, products or services; sale of products or services targeted at populations covered by Medicare, e.g., retirement time-share vacations. The following paragraphs illustrate situations in which questions concerning conflicts of interest may arise. These situations are not inclusive, but are intended to help contractors identify their own organizational conflicts of interest. 1. Contractor A operates and sells managed care plans in the state of Delaware. Under this contract, Contractor A is required to provide names, telephone numbers and other plan information about managed care in the state of Delaware. 2. Contractor B sells a variety of Medigap policies nationwide. Under this contract, Contractor B is required to assist Medicare beneficiaries in determining gaps in their Medicare coverage. Contractor B is also required to provide the names and telephone numbers of Medigap policy providers. 3. Contractor C - A Durable Medical Equipment Supplier markets wheel chairs. Under this contract, Contractor C may assist beneficiaries in answering questions concerning the equipment and where they may obtain such items. 4. Contractor D performs telemarketing to sell vacation properties. Under this contract, Contractor D will have access to data on beneficiaries that could be used for mailing lists and phone listings that would enable Contractor D?s telemarketing division to target that population. Capability Submissions: Capability statements shall also include the following business information: a. DUNS b. Company Name c. Company Address d. Company Point of Contact, phone number and email address e. Type of company under NACIS: 541611-Administrative Management and General Management Consulting Services (Size Standard: $6.5 million), as validated via the Central Contractor Registration (CCR). All offerors must register on the CCR located at http://www.ccr.gov/index.asp. f. Current GSA Schedules appropriate to this Sources Sought g. Point of Contact, phone number and email address of individuals who can verify the demonstrated capabilities identified in the responses. Teaming Arrangements: All teaming arrangements should also include the above-cited information and certifications for each entity on the proposed team. Teaming arrangements are encouraged. The synopsis is for information and planning purposes 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 announcement. No reimbursement will be made for any costs associated with providing information in response to this announcement and any follow-up information requests. Respondents will not be notified of the results of the evaluation. All information submitted in response to this announcement must arrive on or before the closing date. All capability statements can be submitted via e-mail, facsimile, or regular mail to the point of contact listed below. Responses must be submitted not later than April 1, 2008. Responses shall be limited to 10 pages. Resumes of key people are limited to 2 pages and may be submitted as an attachment, which will not count towards the page limit. Documentation should be sent to: Centers for Medicare & Medicaid Services Attn: Heather Robertson, Contract Specialist Office of Acquisitions and Grants Management Acquisitions and Grants Group Division of Beneficiary Support Contracts Mailstop: C2-21-15 7500 Security Boulevard Baltimore, MD 21244 Point of Contact Name: Heather Robertson, Contract Specialist Phone: 410-786-6888 Fax: 410-786-9088 Email: heather.robertson@cms.hhs.gov