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Recovery - Development of a Medicaid/CHIP Environmental Scanning and Program Characteristics (ESPC) Database

This opportunity is a Recovery and Reinvestment Act action
Solicitation Number: RTOP-CMS-2010-002DB
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
10420 Little Patuxent Parkway
Suite 300
Columbia, Maryland 21044
United States
Added: Mar 31, 2010 4:01 pm

Recovery Act-Funded Contract Action

Identification of OPDIV/Contracting Activity: OAGM/AGG/DRCG
Project Officer: David Baugh, ORDI
Title: Environmental Scanning Activity
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

The purpose of this project is to define basic requirements for a Medicaid/CHIP Environmental Scanning and Program Characteristics (ESPC) database that will include an array of Medicaid program characteristics for each of the 50 States and the District of Columbia. The competitive task order will support comparative effectiveness research (CER) for Medicaid and Child Health Insurance Program (CHIP) enrollees.

Title XIX and subsequent Federal legislation has permitted States many options in the design and the State administration of the Medicaid program. As a result, there are nearly infinite dimensions on which State Medicaid programs may differ, including the following Medicaid program characteristics:

• Extending eligibility to a number of optional eligibility groups;
• Providing full or restricted coverage for dual Medicare/Medicaid enrollees;
• Providing coverage of an array of optional services;
• Identifying service coverage limits;
• Establishing prior authorization requirements;
• Determining payment methods and levels;
• Establishing mandatory managed care initiatives;
• Implementing a wide variety of waivers to standard program requirements; and
• Defining the covered prescription drug formulary.

There are a plethora of other "environmental scanning" factors that affect enrollment, utilization, and spending within individual State Medicaid programs. Data on these factors may be used in a number of ways. The ESPC information set of state-specific values will enable the use of contextual (or independent variables) which will enrich multivariate analyses combining Medicaid Analytic eXtract file (MAX) data and ESPC variables, as well as help researchers interpret research findings in the context of ESPC information.

In order to understand specific statistical findings, Medicaid trends within a State, or to compare experience across States it is usually necessary to consider the relative effects of many of these contextual factors on observed data. The ESPC will be a single source that captures data on many of these factors. It will represent a ready data set for CER that includes observations needed to support research and policy analysis in Medicaid and CHIP.

Key Deliverables (subject to change):
• Base: Design Report and Work plan 90 Days after award
• ESPC Pilot 12/2010
• ESPC Production Through 4/2013
• Option: Feasibility Study 9/2013
• Final Report 9/2013

Specificity/nature of requirement (risk and profit):
The Medicaid Analytic eXtract file (MAX) comparative effective research (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.

Environmental Scanning Activity

• The design for the Environmental Scan involves preparing a concept and then building the data file based on the approved concept. This is a completely new task/approach for which there is no precedent. A very wide range of information that might be useful to consider for inclusion in this file would need to be considered and then winnowed down for potential conclusion. Until the contents of this file are designed, collected, and prepared for use, it will be impossible to know sufficient information to fully understand the magnitude of the requirement.

• Technological innovations in the design and implementation of this task cannot be determined in advance. CMS will want offerors to consider innovative IT solutions in their responses to the statement of work which is likely to generate a wide range of options for further CMS consideration.

• Design of file: The parameters are not easily determined and must be flexible. Availability of information is subject to change, and, often, data may come from internal CMS sources and non-CMS sources beyond the control of the contractor.

• Uniqueness of product: The work is a highly specialized set of information to be developed across a wide range of potential content domains pertaining to Medicaid and CHIP program characteristics as well as State economic and health care characteristics. The development of this file requires an unusual focus on the relationship of the information to be included and its relevance to research and policy development needs pertaining to CER.

• Need for revised and updated files: Once an initial product is delivered, it will be necessary to adapt for future program updates and continuous changes in Federal and State laws and regulations. Such changes cannot be anticipated in advance.

• Reliance on external sources for information: The contractor will need to rely on State government personnel as sources for much key information about current or past program information. To the extent that State staff turnover leads to the loss of institutional memory, many details relevant to the environmental scan activity may be increasingly difficult to obtain.

• Again, the open and less certain aspects of the "Environmental Scanning Activity" create an uncertain contracting environment.
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 acquisition 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.

Technical Generic that Adversely Impact 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