CMS to extend contract to evaluate the impact of the Medicare Appeals Demonstration to Conduct Formal Discussions with Suppliers/Providers

Notice ID: 210337

Contract: HHSM-500-2011-00013I

Task: HHSM-500-T0014

The estimated value of the proposed action is $4,836,795.57.

The proposed extension is necessary for IMPAQ to continue to evaluate the impact of the Medicare Appeals Demonstration to Conduct Formal Discussions with Suppliers/Providers, specifically on how suppliers/providers submit claims, the rate of claims denials, and the number of claims that go through Level 2 and Level 3 reconsiderations. This work is necessary to determine whether further engagement between suppliers/providers and the QIC improves the understanding of the reasons for claim denials.

The Demonstration was originally a 5-year effort that initially began in the Durable Medical Equipment Qualified Independent Contractor (DME QIC) Jurisdiction on January 1, 2016. Upon approval from the Office of Management and Budget (OMB), the Demonstration expanded into the Part A East QIC Jurisdiction effective May 1, 2019. All Demonstration activities were to conclude on December 31, 2020; however, recently CMS received approval from OMB for a 1-year extension to the existing Demonstration activities. The Demonstration is now scheduled to end on December 31, 2021. As such, the evaluation of those Demonstration activities must continue as well. The evaluation of all Demonstration activities will extend beyond the December 31, 2021 timeframe, as there is an inherent timeframe lag as it relates to data collection efforts, deliverables, and completion of final reporting…

The activities under the proposed period of performance extension are essentially the same as the above listed QDEC task order scope of work. As described in Section 2 above, the proposed period of performance extension of the QDEC task order is necessary to continue all evaluation activities (data collection, analysis, and reporting) as it relates to the Demonstration activities currently conducted by the Part A East QIC under HHSM-500-2004-00005I/HHSM-500-T0008 and DME QIC under HHSM-500-2004-00007I/ 75FCMC18F0001. As mentioned above, the Demonstration was set to end on December 31, 2020. However, OMB approved a 1-year extension of all Demonstration activities through December 31, 2021. As the result of this extension, it is in the best interest of the government to continue, through completion of this effort, the Demonstration evaluation activities, which are performed under this task order…

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