The Office of the Federal Detention Trustee (OFDT) is seeking industry’s comments to a draft Statement of Work (SOW) for a National Managed Care Contract for the United States Marshals Service (USMS) Prisoner Medical Program. The USMS is a law enforcement agency within the Department of Justice and is responsible for providing medical care to prisoners in USMS custody. USMS prisoners are routinely housed in federal, state, local, and private detention facilities located throughout the 50 states, and protectorates such as Puerto Rico, the Virgin Islands, and Guam. The USMS requires the services of a Contractor to provide a nationwide integrated health care system to augment the services provided through federal, state, local, and private detention facilities. USMS statutory authority for the provision of medical care services to USMS prisoners is contained in Title 18 U.S.C. 4006, 4007, and 4013. The USMS Office of Interagency Medical Services (OIMS) works to assure that the health care provided to the USMS prisoners housed within 95 USMS District Offices (DOs), and approximately 200 District Sub-offices (DOSUBs) is consistent with established Prisoner Health Care Standards (PHCS) guidelines described in USMS Publication Number 100 http://www.usmarshals.gov/prisoner/standards.htm . USMS expends approximately $22.5 million per year for all medical services delivered to prisoners by community medical care providers outside the walls of detention facilities. In addition to the funds for the medical claims, the USMS also expends approximately $9 million a year for prescription drugs. The purpose of this contract is to: (1) establish a nationwide integrated health care delivery system; and (2) process and pay medical claims consistent with the Medicare payment standards required by 18 U.S.C. 4006, as amended. The manner in which the Contractor elects to provide these services shall be determined by the Contractor in consultation with OIMS: OIMS shall grant final approval. The USMS requires the services in this document in order to meet its basic mission of providing health care to USMS prisoners. A managed health care system, which includes negotiated contracts with medical facilities and providers, claims processing and payment, interactive website, utilization review, and quality management enables the USMS to arrange for appropriate prisoner health care at substantial savings to the taxpayer. The OFDT is requesting industry to review the draft SOW and offer feedback on industry standards, specific technologies and/or capabilities to meet the SOW requirements, and approaches for how OFDT/USMS can more effectively and efficiently prepare this RFP. Industry comments are limited to (thirty) 30 pages using no less than 12-point font and one-inch margins. Responses must be prepared in the following format: • Provide a two-page executive summary; • Answer the following questions: 1. In private industry, what is considered to be a contractor generated claims error that would reflect adversely on contractor performance? What types of claims errors should be considered as an indicator of substandard performance by a contractor? 2. OIMS is requesting the Contractor to maintain original copies of the claims submitted to OIMS for payment to the contractor. For each claim, submitted the Contractor will be responsible for submitting a copy of the claim to OIMS with the Monthly Transaction Report (MTR) and Explanation of Benefits (EOB). OIMS wants to have this information available on the USMS interactive Intranet/Internet website. • How do you propose submitting the requested information and can technology be utilized to limit paper copies? • What is your experience implementing a paperless process for other government or commercial customers? How would you estimate the cost and, explain the process and its effectiveness? • In an effort to reduce paperwork maintenance for the contractor and the government, provide the current process and any downside for achieving this goal and the feasibility of implementation. 3. OIMS plan to conduct a monthly statistically valid random audit of the Contractor’s re-pricing and payment of claims. To facilitate this audit, OIMS requires access to the Contractor’s re-pricing system. Will USMS access to the system be limited by software licensing or any other issues? Will training for my OIMS staff to use the system be an issue? 4. OIMS requires the Contractor to train the USMS staff and other entities at the 95 USMS District Offices or location determined by OIMS in support of the implementation of the USMS Health Care Delivery System. What training solutions do you offer and recommend? What are the associated costs for each training solution recommended? 5. The USMS is seeking assistance in reducing overall prescription costs. Currently, prescription costs are approximately $9 million per year. Prescriptions are filled through local and mail-order pharmacy agreements. The USMS is seeking advice and guidance as part of this RFI on possible solutions to reduce prescription costs. Prescription services are currently part of the RFI, but may not be part of the RFP – or may be enacted as a later service within the contract. 6. What would be the optimal term for this contract? 7. The USMS is soliciting comments on the C.10. Performance-Based Requirements Summary Matrix - Do the Performance-Based Requirements meet industry standards? 8. With regard C.8.4. Task IV: Database Management/Information/Reporting the USMS would like to clarifications, suggestions for enhancements, and questions on database development. 9. With regard to contract time frames the USMS is soliciting comments and suggestions on timeframes, for example database development and processing/ payment of claims. Please provide additional comments to the draft Statement of Work in two pages max. All responses will be considered proprietary in nature. Industry comments must be emailed to Deborah M. Johnson; email address:
[email protected] or Scott Stermer; email address:
[email protected]. No phone calls will be accepted.