Sources Sought Notice – Customer Support Front-End Systems (CSFES)

Notice Type: Sources Sought Notice

Posted Date: 05-OCT-15

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: Customer Support Front-End Systems (CSFES)

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

Solicitation Number: CMS-HLH-2016-160777

Contact: Herman Louis Harris, Contract Specialist, Phone 4107869104, Email [email protected] - Evelyn Dixon, Contracting Officer, Phone 410-786-1561, Fax 410-786-9088, Email [email protected]

Setaside: Total Small BusinessTotal Small Business

Place of Performance Country: US

Description: Department of Health and Human Services

Centers for Medicare & Medicaid Services

Office of Acquisition and Grants Management

This is a SOURCES SOUGHT NOTICE posted for INFORMATIONAL PURPOSES ONLY. This is NOT a solicitation for proposals, proposal abstracts, or quotations. The purpose of this notice is to obtain information regarding the availability and capability of all qualified small business sources, including 8(a), service-disabled veteran owned small business (SDVOSB), HUBZone small business, and women-owned small business (WOSB), to perform a potential requirement. Teaming arrangements and Joint Ventures are encouraged. The CMS Center for Medicare (CM) is conducting market research to identify qualified sources that meet the requirements generally described in this notice. THIS IS STRICTLY MARKET RESEARCH. CMS WILL NOT ENTERTAIN QUESTIONS REGARDING THE RESULTS OF THIS MARKET RESEARCH. Background

The Centers for Medicare & Medicaid Services (CMS) administers the Medicare program, providing health care security and choice for aged and disabled people in this country. Jointly with the State governments, CMS administers the Medicaid program and the State Children's Health Insurance Program (SCHIP). CMS is the largest purchaser of health care in the United States - our programs account for more than one third of the dollars spent on health care in the U.S. economy. The Balanced Budget Act of 1997 (BBA), Public Law 105 33, established a program, Medicare + Choice (currently referred to as Medicare Advantage or MA), which is the authority permitting contracts between the Centers for Medicare and Medicaid Services (CMS) and a variety of different managed care and fee-for-service entities. The entities providing services to beneficiaries under Medicare Advantage (MA) are known as Medicare Advantage organizations (MA organizations). CMS currently has over 600 MA Organizations participating in the Medicare Advantage Prescription Drug (MA/PD), Medicare Prescription Drug program (PDP). Under the MA program, MA organizations are paid on a capitated basis using a methodology that establishes payment rates on a per capita basis. The specific rate for each MA enrollee is determined by demographic variables and health status. The health status data, known as risk adjustment data is collected by CMS under a regulatory provision that requires MA organizations to submit inpatient and ambulatory services provided to MA enrollees. CMS utilizes risk adjustment data to calculate a risk adjustment factor, which is applied to the capitated payment for each MA organization enrollee. Over the past several years, there has been dramatic growth in the MA program. Today, approximately one-third of Medicare beneficiaries are enrolled in MA plans and CMS pays these organizations approximately $160 billion per year for the care provided to these 16.6 million beneficiaries. To date, however, CMS has not had sufficiently detailed information on the health care it purchases. In 2009, CMS changed its regulations to allow for the collection of encounter data records and began requiring MA organizations, starting in 2012, to submit to CMS information that is equivalent to the information provided on a Medicare fee-for-service (FFS) claim record. The Encounter Data System (EDS) was developed to support the collection of MA encounters and is now in its fourth year of operation. To date CMS has collected approximately 1.3 billion encounter data records (EDRs). These data will allow CMS to recalibrate the risk adjustment payment model, so that MA payments more accurately reflect the demographics, patterns of care, and the predicted costs of diseases for MA enrollees. CMS would also be able to evaluate coverage, profile and analyze service utilization, assess quality of care, with the goal of reducing fraud, waste and abuse and improving Medicare programs and healthcare in general. CMS is collecting and processing encounter data records that are submitted under the capitated model of the financial alignment demonstration. CMS is working with participating States to test a new payment and service delivery model to improve the quality of care that individuals dually eligible for Medicare and Medicaid (Medicare-Medicaid enrollees) receive. Similar to EDR submission requirements for MA organizations, Medicare-Medicaid plans (MMPs), participating in the demonstrations, are required to submit encounter data on services delivered to dual eligible enrollees. CMS collects MA Medicare and MMP data on a smaller format for Risk Adjustment Processing Systems (RAPS). This is a limited number of data elements also collected for use in the calculation of the risk adjustment payment. With the inclusion of the MMPs to the EDR collection data, CMS collects RAPS for Medicare, EDRs for Medicare and Medicaid for Institutional, Professional, Durable Medical Equipment (DME), as well as Medicaid Dental. In addition to the Medicare and Medicaid medical data, CMS collects Prescription Drug Event Data for use in administration of the MA Prescription Drug (MAPD) program. For all systems, files and reports are returned to the submitters providing status of the files submitted to CSFES. The Customer Support Front-End System provides all systems development and interfaces for the MAs to connect and submit the data to CMS as well as, functions such as the Help Desk for MAs and Support to CMS in administration of the guidance to the MAs. The Contractor will receive approximately 5 million EDRs submitted by Medicare Advantage Organizations (MAOs) and Medicare-Medicaid Plans (MMPs) daily on the X12 837 Professional, 837 Institutional, 837 Dental and NCPDP file formats. These records will contain information on services and items provided to Medicare and dual eligible enrollees by institutional, professional providers (including home health agencies and hospices), suppliers, other health care providers and atypical providers. The Contractor will receive approximately 7 million PDE records; and 6-10 million RAPS records daily. The contractor will transfer the data in an established time frame and in a specified format to the CMS Contractors responsible for the Encounter Data Processing System, the RAS System, and the Prescription Drug System (PDS). All processing activities supported by the contractor will be based on requirements developed and maintained by the contractor based on direction from CMS.

Purpose and Objectives The purpose of this requirement is to acquire a Customer Support Front-End System and associated Help Desk services to support CMS as follows: * Maintain/Develop Front End System processing for Risk Adjustment (RA), Prescription Drug Event (PDE), Encounter Data (ED), and Medicare Medicaid Plans (MMPs) * Maintain/Develop systems to send data to contractors, and CMS' Integrated Data Repository * Maintain/Develop systems to receive data from processing contractors and return reports/files to submitters * Provide customer support to the MAOs and third party submitters of the data files * Maintain/Develop Monitoring for MAOs/Submitters/CMS Capability statement / information sought: Small business vendors interested in this opportunity should provide a response that includes the following information for CMS internal use and consideration in the acquisition plan. The capability statement response shall clearly identify which company (lead or teaming partner) possesses the capability to address the requirements when answering the questions in this notice. A. In order to respond to this notice, contractors must be able to indicate experience performing or completing all of the following, (please provide specific examples). For instances where experience is similar or equivalent to the CMS requirement, please reference where and when the work was completed, and provide the applicable contract number and value: 1. Providing full system life cycle from requirements, design, development, integration, acceptance testing, deployment, and production support in compliance with the CMS Expedited Life Cycle (XLC) at CMMI Level 3 or higher (company level) 2. Implementing IT standards, including but not limited to the Technical Reference Architecture (TRA), CMS Information Security (IS) Acceptable Risk Safeguards (ARS), and the CMS Expedited Life Cycle (XLC) (http://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/XLC/Artifacts.html), or equivalent IT Standards; 3. Working in a Virtual Data Center (VDC) environment that hosts the processing systems; 4. Working with Medicare Fee-For-Service claims systems and business rules, or their equivalent; 5. Supporting set up of, maintaining, and updating schedules for many routine batch file transfers from interfacing systems; 6. Maintaining relationships in a multi-contractor/government environment, working with data center contractors, and other systems contractors that support multi-contractual systems; 7. Having the necessary infrastructure support to effectively interface with all stakeholders (Government, Data Center, multiple contactors, MAOs, States, etc.); 8. Using open source software and commercial software such as, but not limited to: Informatica Power Center, Oracle Enterprise Database, Oracle Golden Gate, Framework Model for Cognos, Cognos Content Store (Reports & Cognos Ad Hoc Packages), DDL & DML Scripts for DB, Informatica Mappings & Workflows (XML Files), Struts EL with JSTL, Servlets, Java Beans, EJB (Stateless Session Beans), struts plug-ins (struts- menu, struts-flow), JSP 1.4 with JSTL, Jakarta commons, JDOM, IBM WebSphere MQ, IBM WebSphere Business Integration Message Broker, CICS/COBOL to achieve system goals; 9. Access to developer maintained mainframe environments that are FISMA compliant and conform to CMS' TRA, or similar TRA. 10. Maintaining Customer Support services, including a system to capture inquiries and responses that allow reporting from the system, e.g. INFO; 11. Collecting and processing Risk Adjustment Processing System (RAPS) files and/or Prescription Drug Event ( PDE) files, or their equivalent; 12. Using the ASC X12 837, ASC X12 276/277, ASC X12 999 and ASC X12 277, version 5010 and subsequent HIPAA named or CMS adopted versions of transactions, or equivalent; 13. Receiving and sending data files to and from multiple entities participating in front end system (FES) programs, or equivalent programs through similar methods; 14. Providing file editing and file transfer services between all plan/submitters, the states, and all back end systems, or similar systems; 15. Processing using an Electronic Data Interchange (EDI) translator and including other edits for syntax, semantics and other business level edits as used in CMS' Common Edits Module (CEM) spreadsheet, or equivalent edits modules, or changing CMS' implemented translator to be Risk Adjustment compatible, or another translator (e.g. TIBCO) to be Risk Adjustment Compatible; 16. Providing support on contracts similar to scope for administrative type contract as it transitions responsibility to another contractor; 17. Performing analysis, back end process and mainframe extracts that are updated to ensure that the downstream systems are sent the correct data; 18. Maintaining/Developing status to submitters and balancing reports returned/received from contractors; 19. Maintaining and Developing Monitoring reports that monitor, certification, submission and compliance criteria established for the MAs and the Submitters and ; 20. Developing, maintaining and managing ad-hoc reports.

B. Vendor's DUNS number, organization name, address, size and type of business (e.g., 8(a), HUBZone, etc.) pursuant to the applicable NAICS code and validated via System Award Management (SAM); respondents' technical and administrative points of contact, including names, titles, addresses, telephone and fax numbers, and e-mail addresses. Please also identify all contract vehicles in which your organization is on ie., NITACC, GSA, STARS II. Responses shall be provided electronically, by 10:00 a.m. local time on October 20, 2015. The subject line of the e-mail message shall read: "Customer Support Front-End Systems" and shall be addressed to the attention of: [email protected] CMS will not accept telephone, facsimile, courier, mail, or hand delivery methods of response. The page limitation is 20 pages. The file size limitation for e-mail attachments is 3 megabytes. Further, access by CMS to information in any files attached to a response is the responsibility of the submitting party. CMS is not responsible for any failure to access information. Therefore, please ensure that files are easily accessible by CMS. Respondents will not be notified of the results of this market research. Capability statements will not be returned, and will not be accepted after the due date for responses.

Disclaimer and Important Notes: This notice does not obligate the Government to award a contract or otherwise pay for the information provided in response. The Government reserves the right to use information provided by respondents for any purpose deemed necessary and legally appropriate. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed. Information provided will be used to assess alternatives available for the potential requirement and may lead to the development of a solicitation. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted.

Confidentiality: No proprietary, classified, confidential, or sensitive information should be included in your response. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s).

THIS IS NOT A REQUEST FOR PROPOSAL. THIS NOTICE CONSTITUTES THE ENTIRE SOURCES SOUGHT ANNOUNCEMENT AND IS THE ONLY INFORMATION PROVIDED BY CMS. REQUESTS FOR ADDITIONAL INFORMATION WILL NOT BE HONORED.

Link/URL: https://www.fbo.gov/spg/HHS/HCFA/AGG/CMS-HLH-2016-160777/listing.html