Workers' Compensation Review Contractor (WCRC)

ATTENTION: RFP-75FCMC22R0020 PRE-SOLICITATION The Centers for Medicare and Medicaid Services (CMS) has adjusted the referenced solicitation for the Workers' Compensation Review Contractor (WCRC) due to updates that are currently being made to the Statement of Work (SOW) to include the processing of other Non-Group Health Plan (NGHP) Medicare Set-aside Arrangements. PRE-SOLICITATION NOTICE ONLY: The Centers for Medicare and Medicaid Services (CMS) anticipates releasing a solicitation for the Workers' Compensation Review Contractor (WCRC) on or about May 3, 2022 as a full and open competitive 8(a) set aside utilizing FAR part 15 procedures. The contract will be awarded on a Firm Fixed Price (FFP) basis and will include a 12-month base period plus (4) four one (1) year options. The anticipated proposal due date is June 3, 2022 with an anticipated award date of November 14, 2022. SCOPE: The WCRC shall, in accordance with CMS guidelines, evaluate workers' compensation Medicare set-aside arrangement (WCMSA) proposals and project the future medical costs, including prescription drugs, related to the workers' compensation (WC) injury, illness, or disease that would be otherwise reimbursable by Medicare. This future cost projection is known as the WCMSA. The contractor shall, upon reviewing complete WCMSA proposals, recommend the WCMSA amount for each proposal to CMS for final determination. PURPOSE: The purpose of this contract is to procure an impartial entity, not as an agent of the Federal government, to independently price the future Medicare-covered medical services costs related to the WC injury, illness, and/or disease and to price the future Medicare covered prescription drug expenses related to the WC injury, illness and/or disease thereby taking Medicare's payment interests appropriately into account. BACKGROUND: Insurers, agencies, and attorneys have significant responsibilities under the Medicare Secondary Payer (MSP) provisions of the Social Security Act Section 1862(b) [42 U.S.C. 1395y] to protect Medicare's interests. Because Medicare does not pay for an individual's WC-related medical services and/or prescription drugs when the individual receives a WC settlement that includes funds for future medical and/or prescription drug expenses, it is highly critical that the individual consider Medicare's interests at the time of settlement. For this reason, CMS recommends that parties to a WC settlement set aside funds, known as a Workers' Compensation Medicare Set- Aside Arrangement or "WCMSA," for all future medical and/or prescription drug expenses related to the WC injury or illness/disease that would otherwise be reimbursable by Medicare. More information on CMS policies, procedures, and operational guidelines pertaining to the CMS WCMSA review process is available at: http://www.cms.hhs.gov/ WorkersComp Agency Services. Medicare Overview Medicare is a nationwide Federal health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). Congress enacted Medicare in 1965 as Title XVIII of the Social Security Act ("the Act"; 42 U.S.C. - 301 et seq.) for persons 65 years of age or older, certain younger disabled persons, and persons with end-stage renal disease (ESRD). The Medicare program serves well over 43 million beneficiaries and processes over one billion claims per year. Fee-for-service (FFS), or "traditional," Medicare consists of two primary parts: Hospital Insurance (HI) otherwise known as Part A, and Supplemental Medical Insurance (SMI) also known as Part B. A third part of Medicare, known as "Medicare Part C" or the "Medicare Advantage (MA) program," was established by the Balanced Budget Act of 1997 (Public Law 105-33). It allows beneficiaries the option of receiving their Medicare benefits through private managed care plans and related kinds of organizations. Finally, the Medicare prescription drug program, also known as "Medicare Part D," was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).