Modification to a Previous Presolicitation Notice – Workers Compensation Review Contractor

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Notice Type: Modification to a Previous Presolicitation Notice

Posted Date: 13-FEB-17

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: Workers Compensation Review Contractor

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

Solicitation Number: RFP-CMS-2016-8A-0008

Contact: Debbie R Stidham, Contracting Officer, Phone 410-786-5129, Email [email protected] - Stephen D. Stoyer, Contract Specialist, Phone 410-786-9803, Email [email protected]

Description: Department of Health and Human Services

Centers for Medicare & Medicaid Services

Office of Acquisition and Grants Management

******UPDATE, FEBRUARY 13, 2017 AMENDMENT 000005 ISSUED****** Amendment 000005 for the Workers Compensation Review Contractor is hereby posted. Please see the updated attachments for further details. Attachments marked as Amendment 000005 have been updated with this posting. Please note that the proposal due date remains 10:00 AM LPT on February 15, 2017. ******UPDATES, FEBRUARY 7, 2017 AMENDMENT 000004 ISSUED****** Amendment 000004 for the Workers Compensation Review Contractor is hereby posted. Please see the updated attachments for further details. Attachments marked as Amendment 000004 have been updated with this posting. CMS has included all other attachments as well to clear up any confusion about which versions of the attachments should be used for proposal development. As a result please only use attachments included with this Amendment 000004 posting. Please note that the proposal due date remains 10:00 AM LPT on February 15, 2017. ******UPDATE, FEBRUARY 2, 2017 AMENDMENT 000003 ISSUED****** Amendment 000003 for the Workers Compensation Review Contractor is hereby posted. Please see the updated attachments for further details. Attachments marked as Amendment 000003 have been updated with this posting. CMS has included all other attachments as well to clear up any confusion about which versions of the attachments should be used for proposal development. As a result please only use attachments included with this Amendment 000003 posting. Please note that the proposal due date is updated from 10:00 AM LPT on February 8, 2017 to 10:00 AM LPT on February 15, 2017.

*****UPDATE, JANUARY 26, 2017 AMENDMENT 000002 ISSUED****** Amendment 000002 for the Workers Compensation Review Contractor is hereby posted. Please see the updated attachments for further details. Attachments marked as Amendment 000002 have been updated with this posting. CMS has included all other attachments as well to clear up any confusion about which versions of the attachments should be used for proposal development. As a result please only use attachments included with this Amendment 000002 posting.

Please note that the proposal due date remains 10:00 AM LPT on February 8, 2017.

*****UPDATE, JANUARY 19, 2017 AMENDMENT #1 ISSUED*

This post is to notify industry that Amendment #1 for the Workers Compensation Review Contractor has been posted. Please see the updated attachments for further details.

Please note that the proposal due date has been pushed back to 10:00 AM LPT on February 8, 2017.

**********UPDATE, DECEMBER 22, 2016 SOLICITATION ISSUED********** The Centers for Medicare and Medicaid Services has released a Request for Proposal for the Workers Compensation Review Contractor.

Questions on the solicitation shall be submitted electronically in writing by no later than 4:00 PM LPT on January 3, 2017. All questions for which answers can be provided will be conveyed in the form of a solicitation amendment. Questions shall be submitted via e-mail in attachment J.6 to mailto:[email protected] with courtesy copies being provided to mailto:[email protected], mailto:[email protected], and mailto:[email protected].

This solicitation is for 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 four (4) one (1) year options. The proposal due date is 10:00 AM LPT on January 30, 2017. Proposals shall be submitted electronically to mailto:[email protected] with courtesy copies being provided to mailto:[email protected] and mailto:[email protected]. The anticipated award date is June 30, 2017. This solicitation is issued pending the availability funds.

Please make sure that the attachments provided with this update are used for any submissions. CMS thanks you for your participation in this important initiative and looks forward to receiving your proposals.

********************UPDATE, APRIL 15, 2016********************* The following is being provided as an update to the previously posted (Feb, 22, 2016, RFP-CMS-2016-8A-0008) PRE-SOLICITATION NOTICE contained herein: ATTENTION: RFP-CMS-2016-8A-0008 PRE-SOLICITATION notice has been updated as follows. 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.

CMS anticipates releasing a solicitation for the WCRC on or about June 27, 2016 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 four (4) one (1) year options. The anticipated proposal due date is July 27, 2016 with an anticipated award date of November 7, 2016. This solicitation is expected to be issued pending the availability funds. ********************************************************************* 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 March 8, 2016 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 proposl due date is April 8, 2016 with an anticipated award date of June 20, 2016. This solicitation is expected to be issued pending the availability of funds. 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. [Section] 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).