Sources Sought for Medicare DME Administrative Contractor(s)

FEE-FOR-SERVICE MEDICARE ADMINISTRATIVE CONTRACTOR DURABLE MEDICAL EQUIPMENT, JURISDICTION B, D OR A SOURCES SOUGHT NOTICE 4.3.14 Introduction This SOURCES SOUGHT NOTICE is to determine the availability of potential small businesses (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 specific fee-for-service (FFS) health insurance benefit administration services, including Medicare claims processing and payment services, in support of the "traditional" Medicare program (also known as the Medicare fee-for service, or FFS program). The information from this market research will help the Centers for Medicare & Medicaid Services (CMS) plan their acquisition strategy. Please be sure to indicate if you have a GSA schedule contract, a contract on GSA 8(a) STARS, or a contract on GSA VETS GWAC. THIS IS STRICTLY MARKET RESEARCH. CMS WILL NOT ENTERTAIN QUESTIONS REGARDING THIS MARKET RESEARCH. Background As required by 911of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), CMS must re-compete its Durable Medical Equipment Medicare Administrative Contractors (DME MAC) contracts every five (5) years. The purpose of these contracts is to obtain DME MAC's (hereinafter, referred to as "the Contractor") to provide specified health insurance benefit administrative services, including Medicare claims processing and payment services, in support of the Medicare FFS program. The Contractor shall perform its responsibilities under the direction of CMS. The Contractor shall perform numerous functions on behalf of Medicare beneficiaries and shall establish relationships with suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), for a defined geographic area or "jurisdiction." The Contractor shall perform the requirements of this contract in accordance with applicable laws, regulations, Medicare manuals and CMS requirements to ensure the financial integrity of the Medicare FFS program. The Medicare FFS program's legal, policy and operating environment is complex, and the Contractor shall be familiar with and utilize or interact with certain CMS-required payment schedules, systems, equipment and/or operational capabilities in the performance of its functions. Further, the Contractor shall coordinate its activities not only with CMS, but also with a broad range of agencies at the federal, state and local levels of government, other CMS partners and Contractors, and a diverse range of stakeholders within the health care system of the United States. In accordance with CMS' technical specifications, the Contractor shall receive and control Medicare claims from DMEPOS suppliers and beneficiaries within its jurisdiction, as well as perform edits on these claims to determine whether the claims are complete and should be paid. An edit is defined as "logic within the Standard Claims Processing System (or PSC/ZPIC Supplemental Edit Software) that selects certain claims, evaluates or compares information on the selected claims or other accessible source, and, depending on the evaluation, takes action on the claims, such as pay in full, pay in part, or suspend for manual review." In addition, the Contractor calculates Medicare payment amounts and remits these payments to the appropriate party. The Contractor also conducts a variety of different supplier services, such as answering written inquiries, and educating them on Medicare's rules and regulations and billing procedures. The Contractor also operates Medicare's suppliers toll-free lines across the country to answer a wide-range of supplier questions. Additionally, the Contractor conducts redeterminations on appeals of claims and responds to complex beneficiary inquiries referred from Beneficiary Contract centers. This Sources Sought Notice is targeted for: Jurisdiction B Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin, and Kentucky Jurisdiction D Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming Jurisdiction A Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, new Jersey, New York, Pennsylvania, Rhode Island, and Vermont Response Information In order to respond to this notice, potential small businesses must be able to indicate experience and/or the ability: 1. To perform all MAC functions specified in the CMS Internet-Only-Manuals (IOMs) at the following web address: http://www.cms.hhs.gov/Manuals/IOM/list.asp ; and 2. To provide specified health insurance benefit administrative services, including Medicare claims processing and payment services, in support of the Medicare FFS program. Potential small businesses shall also include the business information outlined in the section below as part of their response. Business Information 1. DUNS: 2. Company Name 3. Company Address 4. Current GSA Schedules appropriate to this Sources Sought 5. Do you have a Government approved accounting system? If so, please identify the agency that approved the system. 6. Type of Company (i.e., small business, 8(a), woman owned, veteran owned, etc.) as validated via the Central Contractor Registration (CCR). All offerors must register on the CCR located at http://www.ccr.gov/index.asp. 7. Company Point of Contact, Phone, and Email address 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. Response Due Date Responses must be submitted electronically not later than 4:30 PM Eastern Standard Time, April 18, 2014. Submissions should be sent to the Contracting Officer and Contract Specialist, contact information below. 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. 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 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 CMS' review of any submission. Contact information Contracting Officer: John Webster, e-mail John.Webster@cms.hhs.gov; phone 410-786-7229 Contract Specialist: Michele Lanasa, e-mail Michele.Lanasa@cms.hhs.gov; phone 410-786-7537