UNIFIED PROGRAM INTEGRITY CONTRACTOR (UPIC)

SOURCES SOUGHT NOTICE (SSN) THIS IS NOT A REQUEST FOR PROPOSAL (RFP) AND DOES NOT COMMIT THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) TO AWARD A CONTRACT NOW OR IN THE FUTURE Department of Health and Human Services, CMS, Centers for Program Integrity Contracting Office Location 7111 Security Boulevard Baltimore, MD 21244 Contract Performance Location: TBD The Product Service Code (PSC) for this requirement is R499. The NAICS for this requirement is 541990 with a size standard of $14 million. All capable small businesses are encouraged to respond. General Information This is a market research tool being used to determine potential and eligible small business firms that are capable of providing same or similar services to the requirements described herein prior to determining the method of acquisition and issuance of a Request for Proposal. While the intent of this sources sought is to determine capabilities, vendors submitting a capabilities statement, may submit a single page of questions and comments on the provided draft Statement of Work (SOW). This one page will not be counted as part of the 25 page limit for capabilities statements. The results of this Sources Sought will be used to determine the availability of capable small businesses that can perform the program integrity (fraud, waste, and abuse) functions for audits and investigations across Medicare and Medicaid as delineated in the draft SOW. CMS is interested in responses to this notice from all small businesses (small business, 8(a), veteran- owned small business, service-disabled veteran owned small business, HUB Zone small business, , and/or women owned small business). The Government retains the right to procure these services through any means which is in the best interest of the Government. It is the responsibility of the potential offerors to monitor appropriate internet sites, to include; FBO, GSA, etc., for additional information pertaining to this requirement. The Government is not obligated to and will not pay for any information received from potential sources as a result of this synopsis. 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 THIS NOTICE AND THE ATTACHED DRAFT SOW. THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) MAY OR MAY NOT ISSUE A REQUEST FOR PROPOSAL OR REQUEST FOR QUOTATION. RESPONSES TO THIS SOURCES SOUGHT NOTICE (SSN) SHALL BE THE SUBMISSION OF A CAPABILITY STATEMENT; SUBMISSIONS IN RESPONSE TO THIS SOURCES SOUGHT ARE VOLUNTARY. THE CMS WILL NOT COMPENSATE, ANY OFFEROR, FOR ANY COSTS, ASSOCIATED WITH A VENDORS RESPONSE TO THIS REQUEST FOR CAPABILITIES STATEMENTS. Project Background: CMS currently relies on a network of Contractors to carryout program integrity work in Medicare and Medicaid. The Zone Program Integrity Contractors (ZPICs) and Program Safeguard Contractors (PSCs) are under contract to perform Medicare program integrity functions. The Medicare-Medicaid Data Match (Medi-Medi) program is incorporated under the ZPIC scope of work to conduct Medi-Medi activities including matching Medicare and Medicaid data and investigating potential instances of fraud, waste, and abuse. The Medicaid Integrity Contractors (MICs) are under contract to perform Medicaid program integrity functions. The UPIC seeks to combine these functions into a single requirement which will be performed under contracts based on, defined geographic areas performing Medicare and Medicaid program integrity work, on behalf of CMS. The entities awarded contract(s) will be referred to as UPICs. Instructions/Requirements for Submitting SSN Responses to CMS: Interested parties having the capability and expertise necessary to perform the stated requirements outlined below are requested to submit capability statements via email to Nathaniel.Dean@CMS.hhs.gov, and Debra.Stidham@cms.hhs.gov . Please email responses on or before 12:00 Noon (Eastern Standard Time) June 9th, 2014. Please limit responses to no more than 25 pages. CMS software standard is MS Word. Therefore, responses should be submitted in a Word or Word comparable document. Page size should be 8.5 by 11 inches, using 12 pt. font and standard margins. CMS requests that respondents specifically address each question identified below. In general, while this SSN is not a request for a technical proposal, respondents should provide enough information for CMS to make a determination as to the capability to perform the same or similar work. Although it is not necessary to address within capability statements, interested vendors and teaming partners, should be aware of any potential, actual, or perceived organizational conflicts of interests. Any real or potential conflicts must be sufficiently mitigated prior to contract award. For further guidance, refer to the Federal Acquisition Regulation, Part 9.5. Contractors must respond to all the following questions (please provide examples, where applicable), by indicating your capabilities as well as the scope and extent of your experience performing these requirements. Responses will be reviewed for content that demonstrates both capability and experience. 1. Business Information (Not included in the 25 page limit.) a. Company Name b. Company Address c. DUNS Number d. Does your organization have a Government approved accounting system or the ability to attain one by the projected contract award date of 3rd quarter of fiscal year 2015. e. Type of company (e.g., small business, 8(a), veteran-owned small business, service- disabled veteran owned small business, HUB Zone small business, , and/or women owned small business) as validated via the System of Acquisition Management (SAMs) f. Company Point of Contact - Name, Phone and Email address g. Point of contact, phone and email address of individuals who can corroborate the demonstrated capabilities identified in the responses. 2. Confirm if your organization is ISO registered and/or compliant. If not, please explain your ability to attain ISO certification within one year of contract award. (Limited to 1 page - not included in the 25 page limit.) 3. The UPIC jurisdictions are provided as an attachment to the draft SOW. In order to determine a vendor capable, it must demonstrate ability to perform all of the requirements in more than one jurisdiction. Restated, to meet the minimum capability requirements, responses must demonstrate the ability to act as a prime contractor in at least two jurisdictions. As stated in FAR 52-219-14 interested vendors must demonstrate that "at least 50 percent of the cost of personnel for contract performance will be spent for employees of the concern or employees". Note: Responses that leverage teaming or subcontracting need to delineate between the work that would be accomplished by the prime and the work accomplished by the teaming partners and what role the responding vendor intends to fulfill. 4. Demonstrate your experience conducting program integrity activities in support of the following healthcare programs: - Medicare Part A; - Medicare Part B; - Medicare Part C (including Medicare Advantage (MA), Cost Contract, PACE, Private fee-for-service (PFFS), Medical Savings Accounts (MSA), HCCP and Medicare Advantage-Prescription Drug (MA-PD); - Medicare Part D; - Medicare DMEPOS; - Medicare Home Health; - Medicaid Fee for Service; and - Medicaid Managed Care. 5. Demonstrate capability and experience analyzing data from each of the programs outlined in Question 4 in support of program integrity to detect fraud, waste, and abuse aberrancies and trends. 6. Demonstrate capability and experience matching Medicare and Medicaid data in support of program integrity and conducting data analysis on the matched data to identify fraud, waste, and abuse aberrancies and trends. 7. Demonstrate capability and experience developing and implementing healthcare claims processing edits for program integrity purposes. 8. Demonstrate your capability and experience developing and implementing a workload prioritization and management protocol that governs the disposition of leads based on the likelihood of fraud, waste, and abuse identification. Additionally, demonstrate capability and experience linking the prioritization of leads to return on investment. 9. Demonstrate capability and experience performing investigations and audits that encompass potential fraud, waste, and abuse in the Medicare and Medicaid programs, as well as issues that cross these programs. Please demonstrate in this response capability and experience conducting investigations and audits that require coordination across States or on a national scale. 10. Demonstrate capability and experience recommending appropriate and timely administrative actions provided under authority to CMS and State Medicaid Agencies. 11. Demonstrate capability to recognize patient harm/safety/quality issues for referral or administrative action. 12. Demonstrate capability and experience supporting investigation and audit outcomes throughout the Medicare, Medicaid, and Law Enforcement appeals processes. 13. Demonstrate capability and experience performing medical review in support of program integrity fraud, waste, or abuse investigations and audits. 14. Demonstrate capability and experience supporting and coordinating with other government agencies, such as the State Medicaid Agencies, Office of Inspector General, Federal Bureau of Investigation, Department of Justice, and other public and private entities. 15. Demonstrate capability and experience providing information technology security and physical security of Protected Health Information (PHI) and Personally Identifiable Information (PII) in accordance with HIPAA and FISMA requirements. Please demonstrate in the response to this question the capability of obtaining an Authority to Operate (ATO) in accordance with the Business Partner System Security Manual (BPSSM). http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/117_systems_security.pdf 16. Demonstrate capability and experience working with the Electronic Submission of Medical Documentation (eSMD) system including conducting investigations involving Electronic Health Records (EHR). 17. Demonstrate capability and experience developing and providing education material in support of program integrity activities. 18. Demonstrate capability and experience conducting audit, settlement, and reimbursement of Medicaid cost reports. 19. Demonstrate capability and experience developing and operating an internal quality assurance program that results in program integrity work (e.g. data analysis, investigations, audits) that is supported through a legal appeals process. 20. Demonstrate capability and experience operating a similar healthcare-related program integrity operation and successfully integrating and managing all of the components outlined in this sources sought. In other words, please describe capabilities and experience bringing together each of the individual elements requested in this sources sought into a single program. Vendors are requested to provide when available specific examples of most recent experience as it relates to the UPIC scope demonstrating capability and expertise to perform the services outlined in this announcement, specifically demonstrating competency in all areas above and how have you operationalized the task. Vendors are also requested to provide when available contract numbers, contract value and type, where your firm acted as the prime vendor or a subcontractor with government points of contact. Other Information: - Proprietary Information and Disclaimers: Respondents should identify any proprietary information in its SSN response. Information submitted in response to this SSN will be used at the discretion of the Government. Further, the information submitted will remain confidential insofar as permitted by law, including the Freedom of Information and Privacy Acts. CMS reserves the right to utilize any non-proprietary technical information in the anticipated SOW or solicitation. - Responses to the SSN are not offers and cannot be accepted by CMS to form a binding contract. CMS does not intend to award a contract on the basis of this SSN, or to otherwise pay for the information solicited. No reimbursement for costs will be made associated with providing information in response to this SSN or follow-up information request. - Respondents should be aware that this SSN is for market research purposes only and any responses submitted do not constitute a commitment by CMS to treat any offeror more or less favorably in any anticipated forthcoming solicitation and/or ultimate award. - Responses to the SSN will not be returned. All communications shall be by email. - Respondents will not be notified of the results of the review of the responses. On behalf of the Centers for Medicare & Medicaid Services, thank you for your interest.