Sources Sought Notice – Medicare Casework Support Contract – 0601

Notice Type: Sources Sought Notice

Posted Date: 19-MAR-13

Office Address: Department of Health and Human Services; Centers for Medicare & Medicaid Services; Office of Acquisition and Grants Management; 7500 Security Blvd.C2-21-15 Baltimore MD 21244-1850

Subject: Medicare Casework Support Contract - 0601

Classification Code: R - Professional, administrative, and management support services

Solicitation Number: 131283

Contact: Brian J Humes, Contract Specialist, Phone 410-787-8898, Email [email protected] - Debra A. Hoffman, Contracting Officer, Phone 410-787-0517, Email [email protected]

Description: Department of Health and Human Services

Centers for Medicare & Medicaid Services

Office of Acquisition and Grants Management

SOURCES SOUGHT - Medicare Casework Support Contract - 0601 THIS IS NOT A FORMAL REQUEST FOR PROPOSAL (RFP) AND DOES NOT COMMIT THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) TO AWARD A CONTRACT NOW OR IN THE FUTURE.

This is a SOURCES SOUGHT NOTICE to determine the availability of potential businesses (e.g., 8 (a), services-disabled veteran owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business, and women-owned small business) that are qualified to support CMS exceptions processing services over a five year period to support the Centers for Medicare and Medicaid Services (CMS). The exceptions processing work, known as the Medicare Casework Support Contract 0601, includes processing system exceptions and corrections from various CMS systems and data bases. These include the Medicare Enrollment and Premium Billing Systems, which include the Enrollment Database (EDB) and its operational processes, the Direct Billing System (DB), and the Third Party System (TPS).

The systems noted are accessed daily by numerous users in various federal and state agencies, and other medical and financial corporations. Data is also received from Third­ party payers, Group health plans (GHPs) such as HMOs, End Stage Renal Disease (ESRD) networks, and SSA's Program Service Centers (PSCs) direct input actions.

The beneficiary records must be complete and correct, and must be in agreement with the Beneficiary records of other data systems, both internal and external to CMS.

Disagreements in the information create "exceptions" that must be analyzed, researched, and resolved. Enrollment/entitlement exceptions also occur when enrollment information is collected during an annual general enrollment period, and during the distribution, correction, and replacement of Medicare cards for enrolled beneficiaries.

Customer services must be provided that include, but will not be limited to, control and correction of exceptions provided by the Government, that occur when automated systems either cannot process or fail to process Medicare enrollment, direct billing or third party transactions. These exceptions include, but will not be limited to, payment of direct billed premiums through the automated clearinghouse; processing exceptions that occur when CMS solicits enrollment in Medicare Part B during annual general enrollment period for beneficiaries who have lost or been refused Part B; investigate, resolve and respond to inquiries on data discrepancies related to Medicare enrollment, direct billing and third party data; provide support for the collection of Medicare premiums from the direct-paying beneficiary population; provide information on premium liability, premium billing and collection and beneficiary premium status to authorized users; provide support to process accretions, changes and deletions for third party beneficiaries; and process debits, credits and foreign checks to ensure Medicare premium data are correct. The following is more detail on the individual systems:

The EDB is the authoritative source of information for anyone who has ever been entitled to receive Medicare. The system contains personally identifiable information in the form of names, entitlement, health insurance number, etc. The EDB is CMS's single resource for managing Medicare entitlement data, including premium billing (both direct beneficiary and third-party billing). CMS's major operations and goals are directly supported by the EDB.

Enrollment Database

The EDB includes the following information for each Medicare enrollee: Beneficiary identification (e.g. name, birth date, address, date of death), Part A and Part B enrollment (current and historical), Medicare card issuance, Medicare Secondary Payer (MSP), Third-Party Buy-in, Medicare Choice enrollment, Common Working File (CWF) host site, Hospice information, Cross-reference numbers, Direct Billing, Disability data, ESRD data

The EDB is accessed daily by numerous users in various federal and state agencies, and other medical and financial corporations. The following systems interface with EDB: Beneficiary Enrollment Retrieval System (BERT), Enrollment Retrieval New Interactive Edit (ERNIE), Lock -Box Remittance System (LBRS), Distributed Index of Rejected Transaction (DIRT), Medicare Update Process for Enrollment Transaction System (MUPPETS), Social Security Administration (SSA), Medicare Customer Service Center (MCSC), Next Generation Desktop (NGD), End Stage Renal Disease (ESRD), Railroad Board (RRB), Common Working Files (CWF) and Medicare Easy Pay System (MEPS). EDB also receives data from Third-party payers, Group health plans (GHPs) such as HMOs, End Stage Renal Disease (ESRD) networks, and SSA's Program Service Centers (PSCs) direct input actions.

Enrollment/Entitlement Exceptions

The beneficiary records contained on the Enrollment Database (EDB) must be complete and correct and must be in agreement with the beneficiary records of other data systems, both internal and external to CMS. Disagreements in the information create "exceptions" that must be analyzed, researched and resolved. Enrollment/entitlement exceptions also occur when enrollment information is collected during an annual general enrollment period, and during the distribution, correction and replacement of Medicare cards for enrolled beneficiaries. Data systems that exchange enrollment/entitlement information with the EDB include: Social Security Administration's master beneficiary record, Railroad Retirement Board's beneficiary record, U. S. Office of Personnel Management's civil service retirement system beneficiary record, State Buy-in systems of 50 states and 4 territories, Local governments and Private retirement agencies

Direct Billing System (DB)

<p>This system maintains the billing and collection actions on beneficiaries in direct billing status because they are either uninsured for SSA benefits or they are insured and in suspended or deferred SSA payment status. The system includes a historical record of all direct-billing information and payments. DB is involved in the following actions: Billing for Part A and Part B premiums. Recording payments made to the Medicare Premium Collection Center, Recording SSA PSC adjustments, Notifying Master Beneficiary Record (MBR) and EDB when it has terminated enrollees due to nonpayment of premiums, Refunding excess premium payments.

DB processes actions daily, monthly, and quarterly. The daily DB processes include the following: applies payments and adjustments, reverses terminations and notifies the EDB, provides premium status upon request, maintains a history of actions against the individual DB records, refers rejected or questionable actions to the PSC. The monthly DB processes include the following: maintains premium liability, generates bills, identifies records for potential termination at the end of the month and alerts the EDB, identifies records for final termination, performs terminations, gives termination date to the MBR, and writes off debt. The monthly DB processes also include creation of two (2) Direct Billing special reports: the Monthly Direct Billing Collection Report and the Monthly Direct Billing Receivables Report. The process is run on the first business day of each month and copies of each report are forwarded to CMS. The quarterly DB processes include the following: automatically refunds excess premiums to individuals who have gone back into current pay when the amount is equal to or less than three times the premium rate and sends to the PSC when the amount of refund exceeds three times the premium rate. Additionally, DB supports another application: Direct Billing Query (DB Query), an ad-hoc retrieval system designed to allow users to interrogate the DB Data mart directly using multiple selection criterions.

Direct Billing System Exceptions

Some Medicare beneficiaries pay their premiums for Medicare rather than have them withheld from Social Security or Civil Service retirement checks. These premiums are collected with the aid of the CMS direct billing system. When automated systems fail to account for the payment of directly billed premiums, "exceptions" occurs and must be processed.

DB Exception Types: Payment processing errors by the Medicare premium collection center, automated clearinghouse, Credit cards, foreign checks, Debit/credit adjustments from the collection center. Payment processing errors by the Medicare Premium Collection Center are often located by Treasury's Financial Management System (FMS). CMS will correct this by processing Bank Debits and or Bank Credits to the Enrollment Data Base (EDB).

Third Party System (TPS)

TPS is responsible for all the processes related to payment of a beneficiary's Medicare premiums or premium surcharge by a third party. TPS contains information for Medicare beneficiaries whose premiums or premium surcharges are currently (or have been) paid by third parties. These third parties include state Medicaid agencies, civil service (Office of Personnel Management [OPM]) Formal Group Payers (who pay the entire Medicare premium including any premium surcharge) and state or local government retirement offices (who pay only the premium surcharge portion of the Medicare premium).

Third Party System Exceptions

In some cases Medicare premiums are collected from third parties on behalf of beneficiaries. When automated systems do not agree or edits are failed, "exceptions" result. The exceptions resulting from automated processes and data exchanges between CMS and third parties must be researched.

Agencies and organizations that exchange third party data with CMS: States and territories, Social Security Administration, Railroad Retirement Board, Office of Personnel Management, Local governments, Private organizations.

In addition to the systems that access the EDB, the EDB provides data to the Medicare Beneficiary Database (MBD) another repository of beneficiary information. The EDB and the MBD have been merged into a single data repository and are the main source of information for Medicare entitlement and demographic information, including managed care. Currently, MBD is the authoritative source of information required to support managed care enrollments and payments to Managed Care Organizations (MCOs). The integrated MBD (Common Medicare Environment or CME) will become the authoritative source of Medicare and Managed Care beneficiary data.

Data systems that exchange enrollment /entitlement information with the EDB include:

* The Social Security administration's master beneficiary record

* The Railroad Retirement Board's beneficiary record

* The U. S. Office of Personnel Management's civil service retirement system beneficiary record

* The State Buy-in systems of 50 states and 4 territories

* Local governments

* Private retirement agencies

Scope of Services:

The services required by the contractor include processing exceptions for the systems noted above as well as making manual corrections as needed and approved by CMS. The contract will include the following scope of services:

* Processing exceptions that occur when CMS solicits enrollment in Medicare Part B during the annual general enrollment period for beneficiaries who have lost or been refused Part B;

* Investigate, resolve and respond to inquiries on data discrepancies related to Medicare enrollment, direct billing and third party data;

* Provide support for the collection of Medicare premiums from the direct-paying beneficiary population;

* Provide information on premium liability, premium billing and collection, and beneficiary premium status to authorized users;

* Provide support to process accretions, changes and deletions for third party beneficiaries;

* Process debits, credits and foreign checks to ensure Medicare premium data are correct;

* Maintain a record of all exceptions processed by type, date received, and date answered/provided and provide to the Contracting Officer or designated representative upon request;

* Prepare other documents designated by CMS Government Task Leaders (GTLs).

The North American Industrial Classification System (NAICS) code is 518210. This is not an invitation for bid, request for proposal or other solicitation and in no way obligates the Government to award a contract.

The minimum contractor requirements are:

(1) Process exceptions at a Contractor facility (it is not anticipated that Contractor staff need to be on site at CMS for this work assignment) capable of obtaining and maintaining adequate computer systems to interface with the necessary systems while maintaining appropriate CMS system security requirements;

(2) Work as a team member, interfacing with CMS personnel, personnel of external agencies and organizations, beneficiaries, and other Contractor staff to meet specified time frames via telephone conference. Provide only personnel who are fully qualified and competent to perform their assigned work and who possess the necessary background/experience for each labor category proposed.

(3) Demonstrate proficiency/experience in/with:

* Medicare Beneficiary data

* Medicare enrollment and benefits

* The use of Microsoft Office and its suite of products

* The use of Microsoft Project

* Basic accounting principles

* The ability to communicate proficiently, both orally and in writing

Information Security Requirements

This clause applies to all organizations which possess or use Federal information, or which operate, use or have access to Federal information systems (whether automated or manual), on behalf of CMS. The central tenet of the CMS Information Security (IS) Program is that all CMS information and information systems shall be protected from unauthorized access, disclosure, duplication, modification, diversion, destruction, loss, misuse, or theft-whether accidental or intentional. The security safeguards to provide this protection shall be risk-based and business-driven with implementation achieved through a multi-layered security structure. All information access shall be limited based on a least-privilege approach and a need-to-know basis, i.e., authorized user access is only to information necessary in the performance of required tasks. Most of CMS' information relates to the health care provided to the nation's Medicare and Medicaid beneficiaries, and as such, has access restrictions as required under legislative and regulatory mandates. The CMS IS Program has a two-fold purpose: (1) To enable CMS' business processes to function in an environment with commensurate security protections, and (2) To meet the security requirements of federal laws, regulations, and directives. The principal legislation for the CMS IS Program is Public Law (P.L.) 107-347, Title III, Federal Information Security Management Act of 2002 (FISMA), http://csrc.nist.gov/drivers/documents/FISMA-final.pdf. FISMA places responsibility and accountability for IS at all levels within federal agencies as well as those entities acting on their behalf. FISMA directs Office of Management and Budget (OMB) through the Department of Commerce, National Institute of Standards and Technology (NIST), to establish the standards and guidelines for federal agencies in implementing FISMA and managing cost-effective programs to protect their information and information systems. As a contractor acting on behalf of CMS, this legislation requires that the Contractor shall:

* Establish senior management level responsibility for IS,

* Define key IS roles and responsibilities within their organization,

* Comply with a minimum set of controls established for protecting all Federal information, and

* Act in accordance with CMS reporting rules and procedures for IS. Additionally, the following laws, regulations and directives and any revisions or replacements of same have IS implications and are applicable to all CMS contractors.

* P.L. 93-579, The Privacy Act of 1974, http://www.usdoj.gov/oip/privstat.htm , (as amended);

* P.L. 99-474, Computer Fraud & Abuse Act of 1986, www.usdoj.gov/criminal/cybercrime/ccmanual/01ccma.pdf P.L. 104-13, Paperwork Reduction Act of 1978, as amended in 1995, U.S. Code 44 Chapter 35, www.archives.gov/federal-register/laws/paperwork-reduction;

* P.L. 104-208, Clinger-Cohen Act of 1996 (formerly known as the Information Technology Management Reform Act), http://www.cio.gov/Documents/it_management_reform_act_Feb_1996.html;

* P.L. 104-191, Health Insurance Portability and Accountability Act of 1996 (formerly known as the Kennedy-Kassenbaum Act) http://aspe.hhs.gov/admnsimp/pl104191.htm;

* OMB Circular No. A-123, Management's Responsibility for Internal Control, December 21, 2004, http://www.whitehouse.gov/omb/circulars/a123/a123_rev.html;

* OMB Circular A-130, Management of Federal Information Resources, Transmittal 4, November 30, 2000, http://www.whitehouse.gov/omb/circulars/a130/a130trans4.html;

* NIST standards and guidance, http://csrc.nist.gov/; and,

* Department of Health and Human Services (DHHS) regulations, policies, standards and guidance http://www.hhs.gov/policies/index.html These laws and regulations provide the structure for CMS to implement and manage a cost-effective IS program to protect its information and information systems. Therefore, the Contractor shall monitor and adhere to all IT policies, standards, procedures, directives, templates, and guidelines that govern the CMS IS Program, http://www.cms.hhs.gov/informationsecurity and the CMS System Lifecycle Framework, http://www.cms.hhs.gov/SystemLifecycleFramework. The Contractor shall comply with the CMS IS Program requirements by performing, but not limited to, the following:

* Implement their own IS program that adheres to CMS IS policies, standards, procedures, and guidelines, as well as industry best practices;

* Participate and fully cooperate with CMS IS audits, reviews, evaluations, tests, and assessments of contractor systems, processes, and facilities;

* Provide upon request results from any other audits, reviews, evaluations, tests and/or assessments that involve CMS information or information systems;

* Report and process corrective actions for all findings, regardless of the source, in accordance with CMS procedures;

* Document its compliance with CMS security requirements and maintain such documentation in the systems security profile;

* Prepare and submit in accordance with CMS procedures, an incident report to CMS of any suspected or confirmed incidents that may impact CMS information or information systems; and

* Participate in CMS IT information conferences as directed by CMS.

Interested parties (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) having the capabilities necessary to perform the stated requirements may submit capability statements to point of contact (Brian Humes) listed at the end of this document. CAPABILITY STATEMENTS MUST DEMONSTRATE THE REQUIREMENTS OUTLINED ABOVE. Please address each in order listed above.

Along with the above, the following information is requested: (a) company descriptive literature; (b) specific related corporate experience; (c) experience with the type of performance expectations mentioned above; (d) the ten points of business information described below: and references (to include a point of contact and phone number) with first-hand knowledge of the experience cited in (b), and (c) above.

Business information to be submitted in the response:

1. DUNS Number 2. Company Name 3. Company Address. 4. Company Point of contact, phone number and email address 5. Type of company under NAICS: 518210 (Size Standard: $30 million), as validated via the Central Contractor Registration (CCR). Additional information on NAICS codes can be found at www.sba.gov. 6. Corporate structure (corporation, LLC, sole proprietorship, partnership, limited liability partnership, professional corporation, etc.); 7. Any potential government contract must be registered on the CCR located at http://www.ccr.gov/index.asp. 8. Current GSA Schedules appropriate to this Sources Sought 9. Point of contact, phone number and email address of individuals who can verify the demonstrated capabilities identified in the responses. 10. Responders should also include a statement about whether or not they have an approved accounting system. If the responder has an approved accounting system, please provide the certification in which the accounting system was deemed adequate (e.g. the name of the audit agency and audit number). You may submit as an attachment, which will not count towards the overall page limit.

Teaming Arrangements: All teaming arrangements shall also include the above-cited information and certifications for each entity on the proposed team. Teaming arrangements are encouraged.

All capability statements can be submitted via e-mail, facsimile, or regular mail to the point of contact listed below. Responses must be submitted no later than TBD. Responses shall be limited to 25 pages. Resumes of key people are limited to 2 pages and may be submitted as an attachment, which will not count towards the page limit.

Documentation should be sent to: Centers for Medicare & Medicaid Services Attn: Brian Humes, Contract Specialist Office of Acquisitions and Grants Management Acquisitions and Grants Group Division of Beneficiary Support Contracts Mailstop: B3-30-03 7511 Security Boulevard Baltimore, MD 21244 Point of contact Name: Brian Humes, Contract Specialist Phone: 410-786-8898 Email: [email protected]

NO REIMBURSEMENT WILL BE MADE FOR ANY COSTS ASSOCIATED WITH PROVIDING INFORMATION IN RESPONSE TO THIS ANNOUNCEMENT AND ANY FOLLOW-UP INFORMATION REQUESTS. RESPONDENTS WILL NOT BE NOTIFIED OF THE RESULTS OF THE EVALUATION.

Link/URL: https://www.fbo.gov/spg/HHS/HCFA/AGG/131283/listing.html