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Recovery - Comparative Effectiveness Research (CER) Data Infrastructure Medicaid Analytic eXtract (MAX) Long-Term Care- Assessment (LTC-A) File

This opportunity is a Recovery and Reinvestment Act action
Solicitation Number: RTOP-CMS-2010-001VAC
Agency: Department of Health and Human Services
Office: Centers for Medicare & Medicaid Services
Location: Office of Acquisition and Grants Management
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Award Notice
March 31, 2010
Actuarial Research Corporation
6928 Little River Turnpike
Suite E
Annandale, Virginia 22003
United States
Added: Mar 31, 2010 3:55 pm

Recovery Act-Funded Contract Action

Identification of OPDIV/Contracting Activity: OAGM/AGG/DRCG
Project Officer: Negussie Tilahun, ORDI
Title: Long-Term Care - Assessment File
Contract Type: Cost-Plus-Fixed-Fee
Contractors: Expedited Research and Demonstration (XRAD) Task Order Contractors (SB)

I. Authority

This task order is funded by the American Recovery and Reinvestment Act of 2009, (Recovery Act, P.L. 111-5) which specifies, "To the maximum extent practicable, contracts funded under this Act shall be awarded as fixed-price contracts through the use of competitive procedures."
II. This contract action is competitive.
__X__ Yes
_____ Not Available for Competition. This action is statutorily exempt from competition, e.g., noncompetitive 8(a) set-aside, Tribal agreements (for IHS only), mandatory source.
_____ No As appropriate, please attach a copy of (1) the Justification for Other than Full and Open Competition (JOFOC); (2) the Limited Source Justification (LSJ); (3) documentation of Exception to the Fair Opportunity Process (under FAR 16.505(b)(5)); or (4) for simplified acquisitions, a brief description of the circumstances which justify not competing, signed by the contracting officer.
III. This contract action is fixed price.
_____ Yes
___X_ No
This Medicaid Analytic eXtract file (MAX) comparative effectiveness research (CER) task order funded per the American Recovery and Reinvestment Act of 2009 will develop a research file that incorporates key administrative assessment data from the Minimum Data Set (MDS) for nursing facilities, data from the Outcome and Assessment Information Set (OASIS) for home health agencies, and selected On-line Survey and Certification Assessment Reporting (OSCAR) data and link it to Medicare and Medicaid administrative data. This file will be known as the Long-Term Care Assessment file (LTC-A). A wide range of beneficiary and provider information will be linked with the MAX system of files and the Medicare Base Summary Files (BASF) from the CMS Chronic Condition Warehouse. CMS believes that this effort will greatly enhance CER studies pertaining to long-term care and post-acute services. The LTC-A file will enable researchers to access more readily the wide range of information across programs that constitute data that may be of interest for conducting comparativeness research in the area of long term care.
MDS and OASIS assessment data provide basic information on beneficiary functional and health status as well as enabling CMS to monitor provider compliance and oversight regarding the case-mix and quality of long-term care services offered by nursing homes and home health agencies. OSCAR is used for reporting facility information and provides key provider-level information. The combined potential for use of this individual level information as linked to Medicaid and Medicare administrative data is anticipated to be useful to regulators, comparative effectiveness and other health care services researchers and providers in order to monitor the effectiveness of current delivery systems and improve quality of care and outcomes.
The LTC-A will allow the creation of valid and reliable information about the care givers, facilities, care provided and profile of beneficiaries over a long period of time- information that is fundamental for obtaining a more complete understanding of the relationship between Medicaid, Medicare and the provision of post-acute and institutional long-term care with implications for monitoring and improving the quality of care.
The project will include data for the years 1999-2011. Tasks include the development of a file design report and work plan, a pilot test of the LTC-A file using data for calendar year 2006, finalizing the LTC-A file, production of the file for all other years, conducting a sample research study task, and the submission of a final report.

Key Deliverables (subject to change):
• Design Report and Work plan 90 Days after award
• LTC-A Pilot 20 months after award
• LTC-A Production Through 54 Months after award
• LTC-A Feasibility Study 9/2013
• Final Report 9/2013

Specificity/nature of requirement (risk and profit):
The MAX CER initiative will enhance and expand the experience that CMS has in building research data from States on Medicaid eligibility and claims information. This foundation must be continually enhanced in significant ways to make it more adaptive to the needs of researchers examining comparative effectiveness of health care procedures and services. The below described MAX/CER contract requirements illustrate the problem in developing accurate and comprehensive price information. In addition, problems with data accuracy and production efforts affect a determination of the realistic cost of capturing Medicaid data.

Long-Term Care - Assessment File

• A very wide range of information will need to be considered for inclusion in this analytic file in combination with Medicare and Medicaid LTC assessment data from MDS and OASIS. The innovative and developmental aspects of the design requirements make this work incompatible with fixed price contracting goals with respect to achieving price efficiency.

• A major challenge in this task will be to determine to what extent and with what frequency the data from the two assessment systems should be incorporated into a research file as is proposed. The design task in the contract is intended to determine the answer to this question. There are trade-offs for researchers both per inclusion and exclusion decisions. It will be important to involve technical experts as part of the design development;

• Linkage of assessment data to Medicaid claims and eligibility data should be anticipated to be predictable to a certain extent with fully operationalized sets of processes to complete the linkage task. Nevertheless variation in data accuracy and quality across States and years will lead directly to variation in resources required by contractors to optimize the data for research use.

• The development of an analytic file to enhance the capability of the file to serve CER requires a set of activities starting with concept development to prototype implementation. CMS will not be able to provide precise performance requirements for this task until a prototype system is developed, designed, revised as may be necessary, and then implemented for all States.

Monitoring and Cost Control
CMS has always utilized a significant degree of cost control over contracts that are not conducive to fixed pricing arrangements. This has been possible because of the vast knowledge and experience within the Office of Research Demonstrations and Information regarding Medicare, Medicaid and CHIP research programs. In addition, OAGM proposes to compete the acquisitions utilizing the XRAD (6 small business contractors) Task Order Contracts. This acquisition approach combines the knowledge and experience of CMS' technical program acumen and the vast experience of our contractor community with CMS programs and goals. This partnering relationship permits the most efficient use of CMS funds, promotes efficiencies and costs savings, and quickly facilitates the identification and resolution of problems. Although the above considerations are positive the very nature of research projects has demonstrated that projected results at the start of a project are subject to varying circumstances, most notably the enactment of new legislation and/or regulations that may govern the nature of the final requirement. In addition to the above concerns with determining a sound basis for developing a scope of work that would be conducive to fixed price contracting environment, the following price and technical issues also adversely affect that process:
Although a fixed price contract is desirable in that the contractor assumes the risk for performance, the CMS must consider the potential financial and performance risk to the contractor under these highly visible ARRA programs.
A firm-fixed price contract is suitable when reasonable definitive functional or detailed specifications exist, and the contracting officer can establish fair and reasonable prices based on the following considerations:
• there is adequate price competition
• there are reasonable price comparisons under prior purchases of the same or similar services on a competitive basis supported by valid pricing data
• available pricing information permits realistic estimates of probable cost, and
• performance uncertainties can be identified and reasonable estimates of their cost impact can be made.

Technical Generic Issues Regarding State MSIS Reporting
• Lack of timely MSIS submissions
• Multiple failures of submitted MSIS data meeting minimum standards for quality
• Missing service records
• Miscoding of critical data elements
• Changing "unique" MSIS personal identifiers
• Unexpected and inconsistent changes in enrollment records eligibility groups
• Unexpected and inconsistent changes in utilization by type of service, and
• Incomplete reporting of encounter records for person in prepaid managed care plans

IV. If this contract action is not both fixed price and competitive, describe any additional steps taken to pursue a fixed priced competitive award (e.g., prepared more precise requirements documents; established more stringent review thresholds; expanded market research). If no additional steps were taken, please so state.
No additional steps were taken to pursue a fixed price award. 
V. Determination:
Based upon the findings, it is the determination of the government that Cost-Plus-Fixed-Fee contract type enhances the degree of potential successful performance and promotes the potential of competition from the XRAD contractors that could not absorb the risk of a fixed-price contract type.

The HCA (or a GS-1102-15 or higher designee) certifies that a fixed price award is not appropriate (considering contract risk, profit, and specificity/nature of requirement).


7500 Security Blvd.
Baltimore, Maryland 21244-1850
Evelyn R Dixon,
Contracting Officer
Phone: 410-786-1561
Fax: 410-786-9088