Durable Medical Equipment Medicare Administrative Contractor (MAC) Jurisdiction C

The Centers for Medicare & Medicaid Services (CMS) intends to issue a Request for Proposal to obtain a Durable Medical Equipment (DME) 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 C. Jurisdiction C includes the following states: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, Puerto Rico, and U.S. Virgin Islands. The Contractor shall perform numerous functions on behalf of Medicare beneficiaries and shall establish relationships with providers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), for Jurisdiction C. The Contractor shall receive and control Medicare claims from DMEPOS suppliers and beneficiaries within its jurisdiction, as well as perform edits on these claims to determine whether the claims are complete and should be paid. In addition, the Contractor calculates Medicare payment amounts and remits these payments to the appropriate party. The Contractor also conducts a variety of different supplier services, such as answering written inquiries, and educating them on Medicare’s rules and regulations and billing procedures. The Contractor also operates Medicare’s provider toll-free lines across the country to answer a wide-range of provider questions. Additionally, the Contractor conducts redeterminations on appeals of claims and responds to complex beneficiary inquiries referred from the Contact Center Operations. 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 approximately in December 2019 with proposals due approximately February 2020. Award is anticipated to be approximately November 2020. 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.