Technical Support for the Production of Medicare Outpatient Prospective Payment System Payment Rates

INTRODUCTION: The Centers for Medicare & Medicaid Services (CMS)is performing Market Research to determine capabilities in the marketplace for performing Technical Support for the Production of Medicare Outpatient Prospective Payment System Payment Rates PURPOSE: This SOURCES SOUGHT NOTICE is to determine the availability of potential small businesses/small disadvantaged businesses (e.g., 8(a), service-disabled veteran owned small business, HUBZone small business, veteran-owned small business, and women-owned small business) that can provide technical support for the production of Medicare outpatient prospective payment system payment rates for CY 2012. The information/Capability Statements obtained from this market research will be considered in planning the appropriate 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 TO ASSIST IN DETERMINING THE APPROPRIATE ACQUISITION STRATEGY TO OBTAIN CONTRACTOR SUPPORT SERVICES TO PERFORM THE SAME OR SIMILAR REQUIREMENTS TO THOSE DESCRIBED IN THE ATTACHED DRAFT SOW. THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) MAY OR MAY NOT ISSUE A REQUEST FOR PROPOSAL. RESPONSES TO THIS SOURCES SOUGHT NOTICE SHALL BE THE SUBMISSION OF A CAPABILITY STATEMENT; ACCORDINGLY, CMS WILL NOT ENTERTAIN QUESTIONS REGARDING THIS MARKET RESEARCH. BACKGROUND: Under Section 1833(t) of the Social Security Act, CMS is required to update the hospital outpatient prospective payment system (OPPS) on an annual basis. Among the factors that fall within the scope of that annual review are the Ambulatory Payment Classification (APC) payment groups, relative payment weights, the wage and other adjustments made by CMS to take into account changes in medical practice, the addition of new services, and new cost data. The annual update is made on a calendar year basis, through rulemaking and by law must be made public no later than 60 days before implementation at the beginning of the following calendar year. The OPPS is considered by many inside and outside the government to be the most complex of the various Medicare fee-for-service payment systems. It has characteristics of both a prospective payment system and a fee schedule, but is neither in its entirety. The system is idiosyncratic in numerous respects and requires extensive hands-on experience to understand. Yet, CMS must use this complicated and often cumbersome system to establish payments for tens of millions of outpatient services that are furnished each year to beneficiaries at approximately 5,000 hospitals. The CY 2010 update of OPPS rates was based on information extracted from approximately 140 million claim records and the most recent cost report data submitted to Medicare by those hospitals. The OPPS proposed and final rules establishing the payment rates from 2000 to 2010 describe the OPPS rate-setting methodology in detail. (See http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/list.asp#TopOfPage for a list of OPPS proposed and final rules.) Moreover, there is a "claims accounting", an even more detailed description of the data process, provided under the supporting documentation for the proposed and final rules. RESPONSE REQUIREMENTS/INFORMATION: In order for CMS to assess a firm's capability, Capability Statements, submitted in response this SSN, shall include written responses that demonstrate the necessary knowledge, experience and ability to meet the SOW requirements. Specifically, Capability Statements (not exceeding 10 pages) shall include sufficient detail that clearly demonstrates your ability to provide the following services: 1. Policy, clinical, data analysis, and programming experience in developing a comprehensive system of healthcare claims based payment rates for the public or private sector. For example, developing a comprehensive system of claims based healthcare payment rates for outpatient hospital services, inpatient hospital services, physician services, or another significant health care sector. Provide specifics of the policy aspects, clinical aspects, data analysis aspects and programming aspects of the experience and the dates of such experience. (CRITICAL REQUIREMENT). 2. Experience developing policy options for modifications to a comprehensive system of health care claims based payment rates for the public or private sector, including the following: evaluations of the advantages and disadvantages of such modifications from a clinical and policy perspective, modeling such modifications using healthcare claims and accounting data, estimating the impact of such modifications on patients and providers of the clinical services, and integrating the modifications into the existing comprehensive payment system. (CRITICAL REQUIREMENT). 3. Experience with complex programming in mainframe Statistical Analysis System (SAS) and Common Business Oriented Language (COBOL). Experience manipulating Healthcare Cost Reporting Information System (HCRIS) data and Medicare claims data of the type found on the standard uniform bill (UB-04) bill types 12X, 13X, and 14X. Experience with the Integrated Outpatient Code Editor (IOCE) and the OPPS Pricer. 4. Experience producing specialized claims Medicare outpatient hospital data from CMS data systems using nontechnical specifications developed by policy analysts. Provide specifics of experience and dates of such experience. 5. Capability, capacity and willingness to produce data on an "as needed" basis, without a previously known or fixed schedule, including responding to urgent data requests nights, weekends and holidays, except for defined periods of time that are agreed to in advance by the project officer. 6. Experience with the CMS and other governmental rules and regulations concerning privacy and use of confidential data. Note: Please refer to the draft SOW for additional information. Please include the following in your response: Business Information -- a. DUNS: b. Company Name c. Company Address d. Current GSA Schedules appropriate to this Sources Sought (MOBIS) e. Do you have a Government approved accounting system? If so, please identify the agency that approved the system. f. 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 g. Company Point of Contact, Phone and Email address h. Please provide three professional references to include type of work performed and dates. Teaming Arrangements: All teaming arrangements should also include the above-cited information and certifications for each entity on the proposed team. Responses must be submitted not later than 2:00 PM on February 5, 2010 via email to the Contract Specialist at Jessica.sanders@cms.hhs.gov. 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 no to be construed as a commitment by the Government. This is not a solicitation 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 this evaluation. CONTACT INFORMATION: Contract Specialist, Jessica Sanders, e-mail: jessica.sanders@cms.hhs.gov; phone: (410) 786-1076 Contracting Officer, Debra Stidham; e-mail: debra.stidham@cms.hhs.gov