State Medicaid Program Integrity Reviews

The contract involves providing support to the Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity in overseeing Medicaid program integrity across states. The contractor is tasked with developing and revising protocols and questionnaires used for conducting onsite State Medicaid focused program integrity reviews. In addition to assisting with these onsite reviews and any necessary follow-up, the contractor will help CMS review the findings, analyze the data to benefit both CMS and the States, and generate comprehensive reports based on the reviews. The scope also includes developing protocols and questionnaires for desk reviews of State Medicaid program integrity. Furthermore, the contractor is required to provide technical assistance during onsite reviews when CMS identifies problematic or non-compliant areas within States’ Medicaid program integrity operations. This work supports CMS in ensuring states adhere to Medicaid program integrity regulations and strengthens overall oversight. The contract is listed under solicitation number 190518, was posted in April 2019, and is designated as an 8(a) competed sources sought opportunity. Key contacts for the contract are specified as a Contract Specialist and a Contracting Officer at CMS.