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Part C Program Integrity Contractor (CPIC)

ID: 250475J • Type: Sources Sought

Description

This Sources Sought Notice is being issued to determine the availability and capability of potential small businesses (e.g., 8(a), service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business and woman-owned small business) to support the following:

The purpose of the CPIC is to provide oversight of the Medicare Part C program. The CPIC shall perform FWA detection and prevention activities to proactively deter FWA in Medicare Part C. The CPIC shall perform their responsibilities under the direction of CMS. The CPIC shall develop and conduct data analysis and audits thoroughly and in a timely manner and take immediate action to ensure that the Medicare Trust Fund is protected. The CPIC shall use or interact with CMS-required systems as needed in the performance of its functions. Further, the CPIC shall coordinate its activities not only with CMS, but also with agencies at the federal, state, and local levels of government as well as other CMS partners and contractors.

CMS has traditionally used the Plan Program Integrity Medicare Drug Integrity Contractor (PPI-MEDIC) for Medicare Part C and D plan oversight, including audits, outreach and education, and data analysis. The CPIC will perform the Part C audits, outreach and education, and data analysis work previously performed by the PPI-MEDIC. Another contract, the Medicare Drug Integrity Contractor (MEDIC), will perform the Part D audits, outreach and education, and data analysis work.

This announcement is a Sources Sought Notice (SSN) for planning purposes only and is only reviewing responses to this notice from eligible) SBs under the NAICS code below. This is not an invitation for bid, request for quote, or other solicitation and in no way obligates the Government to award a contract. CMS will not entertain questions regarding this market research.

PLEASE SEE ATTACHMENT FOR FULL DETAILS

Background
The Centers for Medicare & Medicaid Services (CMS) is seeking to determine the availability and capability of potential small businesses to support the Center for Program Integrity (CPI) in its Part C Program Integrity Contractor (CPIC) work.

The CPIC's primary focus is on conducting fraud, waste, and abuse (FWA) detection, deterrence, and prevention activities for Medicare Part C. This includes oversight of Medicare Advantage Organizations (MAOs) and ensuring the protection of the Medicare Trust Fund. Traditionally, CMS has utilized the Plan Program Integrity Medicare Drug Integrity Contractor (PPI-MEDIC) for oversight activities related to Medicare Part C and D, which the CPIC will now assume responsibility for.

Work Details
The CPIC will perform a variety of tasks including:
1. Conducting FWA detection and prevention activities under CMS direction.
2. Performing data analysis and audits of MAOs, including outreach and education efforts.
3. Developing audit plans that include methodology and timelines.
4. Producing data analytics reports to assist plan sponsors in their FWA efforts.
5. Creating Peer Activity Reports (PARs) to compare utilization trends among plan sponsors/providers/suppliers.
6. Issuing Plan Sponsor Alerts (PSAs) when trends associated with FWA are identified.
7. Sending Targeted Compliance Notifications (TCNs) to plan sponsors whose audit results indicate noncompliance.
8. Monitoring communications through the CMS Part C Plan Correspondence Mailbox.
9. Overseeing Risk Adjustment Payment compliance with OIG audit recommendations.
10. Conducting self-audits as directed by CMS, including identifying topics for these audits.
11. Ensuring compliance with federal privacy requirements in data handling.

Place of Performance
The geographic location(s) for performance are not explicitly stated but will likely involve coordination with various federal, state, and local agencies.

Overview

Response Deadline
Jan. 28, 2025, 11:00 a.m. EST (original: Jan. 21, 2025, 11:00 a.m. EST) Past Due
Posted
Jan. 7, 2025, 1:07 p.m. EST (updated: Jan. 15, 2025, 7:50 a.m. EST)
Set Aside
Small Business (SBA)
Place of Performance
Baltimore, MD United States
Source
SAM

Current SBA Size Standard
$19.5 Million
Pricing
Multiple Types Common
Est. Level of Competition
Low
Odds of Award
10%
Signs of Shaping
94% of obligations for similar contracts within the Centers for Medicare and Medicaid Services were awarded full & open.
On 1/7/25 CMS Office of Acquisition and Grants Management issued Sources Sought 250475J for Part C Program Integrity Contractor (CPIC) due 1/28/25. The opportunity was issued with a Small Business (SBA) set aside with NAICS 541990 (SBA Size Standard $19.5 Million) and PSC R499.
Primary Contact
Name
Charlene Barnes   Profile
Phone
(410) 786-8827

Secondary Contact

Name
Jennifer Kuhn   Profile
Phone
(410) 786-2299

Documents

Posted documents for Sources Sought 250475J

Question & Answer

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Additional Details

Source Agency Hierarchy
HEALTH AND HUMAN SERVICES, DEPARTMENT OF > CENTERS FOR MEDICARE AND MEDICAID SERVICES > OFC OF ACQUISITION AND GRANTS MGMT
FPDS Organization Code
7530-75FCMC
Source Organization Code
500019128
Last Updated
Jan. 15, 2025
Last Updated By
jennifer.kuhn@cms.hhs.gov
Archive Date
Feb. 12, 2025