Part A/Part B Medicare Administrative Contractor (MAC) Jurisdiction L (JL) Synopsis

The Centers for Medicare & Medicaid Services (CMS) intends to issue a Request for Proposal to obtain a Medicare Administrative Contractor (hereinafter referred to as “the contractor”) to provide specified health insurance benefit administration services, including Medicare claims processing and payment services, in support of the Medicare Program (also known as the Medicare Fee-For-Service or FFS) for Jurisdiction L. Jurisdiction L includes the following states: Delaware, Maryland, New Jersey, Pennsylvania, the District of Columbia, Part B services in Arlington and Fairfax counties in Virginia and the city of Alexandria, Virginia. The contractor shall perform numerous functions to support healthcare services for Medicare beneficiaries, which include performing claims-related activities and establishing relationships with providers of Medicare services, both institutional and professional, both in-patient (Part A) and out-patient (Part B). The contractor will perform the requirements of this contract in accordance with applicable laws, regulations, Medicare manuals, as well as CMS requirements to ensure the financial integrity of the Medicare FFS Program. Pursuant to the authority of FAR Part 15, Contracting by Negotiation, CMS intends to conduct a full and open procurement to fulfill this need. Accordingly, the Contracting Officer will seek to award to the vendor whose proposal represents the best solution to CMS’ requirements at a fair and reasonable price. Award will be made to the Offeror whose proposal offers the best overall value to the Government using FAR 15.101-1 trade-off processes, which “…allows the Government to consider award to other than the lowest cost Offeror or other than the highest technically rated Offeror…”; affording the Government the most advantageous balance of cost and technical factors as defined in the upcoming solicitation. The resulting contract is anticipated to include a base year plus six (6) one-year options. The NAICS code applicable to this procurement is 524114, Direct Health and Medical Insurance Carriers, with a small business size standard of $41.5 million. CMS anticipates releasing a solicitation for Jurisdiction L on or about August 2020 with proposals due approximately October 2020. Award is anticipated to be approximately August 2021. It will be the offeror's responsibility to frequently check the same site where the solicitation is posted for any amendments and/or changes to the RFP issue and closing date. This solicitation is expected to be issued pending availability of funds.