CMS RFI: Medicare Secondary Payer Systems Contractor (MSPSC)

AGENCY: Centers for Medicare & Medicaid Services
OFFICE: Office of Financial Management (OFM)
TITLE: Medicare Secondary Payer Systems Contractor (MSPSC) 260061J

THIS IS A REQUEST FOR INFORMATION (RFI) ONLY. This RFI is issued solely for CMS’ information and planning purposes. The Medicare Secondary Payer Systems Contractor (MSPSC) supports all Medicare Secondary Payer Systems (MSPS) and initiatives for the Coordination of Benefits (COB) and Medicare Secondary Payer Recovery (MSPR).

Read The Full RFI Here.

Scope
The contractor shall provide support for the operations, maintenance, enhancements and special projects for the following components of the Coordination of Benefits & Recovery (COB&R) Program systems. Maintenance and enhancement activities shall include, but not be limited to, systems analysis, design, database maintenance support, programming, unit, system/string, and limited regression testing, data analysis, system documentation, special projects, integration between the COB&R subsystems, quality assurance, and general support of CMS Medicare Secondary Payer (MSP) systems activities.

Medicare Secondary Payer Integration Contractor (MSPIC)
The role of the MSPIC is to make certain that all components supporting the MSP COB&R contract function in concert. The MSPIC would ensure all new and ongoing activities are properly communicated, handled, and managed by all COB&R supporting matrix contractors. The MSPIC would not be held responsible for the program deliverables, but would be expected to make sure all impacted components were aware and working toward the same goals.
The following is a synopsis of the activities that would be performed by the MSPIC:

• Program Release Management
  • Change Control Board (CCB) oversight
  • Problem/Change request database support
  • Program-wide implementation plans
  • Project Help Desk
• Business Analysis
  • Business Requirement Development
  • Testing and Testing support
  • Documentation development.
• Program-wide Document Management
  • Document management system.
  • Document management administration.
• Security Oversight.
  • Quality Assurance Oversight.
  • Outreach and Education.

Commercial Recovery Contractor (CRC)
The MSP CRC functions would include the identification and development of Group Health Plan (GHP) MSP Recovery and Non-GHP recovery cases where Ongoing Responsibility for Medical care (ORM) exists, and all associated recovery activities, which include, but are not limited to:

• Identifying and developing debts;
• Responding to incoming inquiries;
• Reviewing and responding to demand defenses and rebuttals;
• Providing litigation and negotiation support;
• Performing all related Debt Collection Improvement Act of 1996 (DCIA) activities;
• Complying with all required financial activities.

Workers’ Compensation Recovery Contractor (WCRC)
The WCRC functions include reviewing submitted Workers’ Compensation Medicare Set-aside Arrangement (WCMSA) proposals to determine adequacy of proposed settlement funds in anticipating a beneficiary’s future ongoing course of medical treatment in association with his/her work-acquired illness, injury, or disease. The WCRC counters WCMSA proposals that have not anticipated future costs appropriately in light of standard medical care guidelines. As necessary, the WCRC also reconsiders additional information not previously provided in association with a previously submitted WCMSA proposal.
Outcome
The outcome of this effort is the operations and maintenance of the Medicare Secondary Program and Coordination of Benefits applications which identify proper order and payer for claims and facilitate the recovery of Medicare primary payments from responsible entities. The Medicare Secondary Payer Systems Contractor (MSPSC) supports all Medicare Secondary Payer Systems (MSPS) and initiatives for the Coordination of Benefits (COB) and Medicare Secondary Payer Recovery (MSPR).
Performance Requirements
Tasks/Services
The contractor shall work cooperatively with other external support staff as designated by CMS. This staff shall consist of CMS, contractor personnel and other CMS Partners. The contractor shall work closely with, but not limited to, the following:

1. CMS staff
2. Benefits Coordination and Recovery Contractor (BCRC)
3. Medicare Secondary Payer Integration Contractor (MSPIC)
4. Commercial Recovery Contractor (CRC)
5. Workers Compensation Recovery Contractor (WCRC)
6. Any other staff or partners as required

System Development Management Plan (SDMP)
Develop and deliver a SDMP. Provide, implement and maintain an integrated project management approach that combines the technical plans, schedule plans and the plans to meet cost objectives
AWS Cloud Operations Support
The contractor will provide all necessary materials and supplies not otherwise provided by the government, to host existing MSP COB&R systems and data supporting the performance of tasks.
AWS Cloud Operations Support tasks shall include, but are not limited to, the following:

• Daily Operations
• Production Support
• Telecommunications & Networking
• Database Administration
• Storage Administration
• Systems Backup and Disaster Recovery
• Capacity Planning
• Production Software Releases
• Systems Transition

MSP systems are processed within AWS with CMS Authority to Operate (ATO) certifications. Disaster recovery availability zones must be available for immediate rollover and assumption of processing as a result of disaster per the MSPS Contingency Plan. The MSPSC MA, in compliance with the most comprehensive option noted within CMS ARS 5.1 control CP-4 (Contingency Plan Testing), performs actual Disaster Recovery failover tests from one Availability Zone to another once every 365 days.
The minimum mid-tier requirements for the production environment are:
MSPS utilize MySQL, Postgres, SQLServer and Oracle databases. Additionally, in depth experience with , RHEL, Windows, REST/ web services, data services, and 3-tier Architecture are necessary to manage these systems properly. The Medicare Secondary Payer Systems Contractor is also required to support production (Pro) and non-production development environments (Dev & Impl) as well as ensuring availability zones are provisioned and maintained to support redundancy and disaster recovery.
The MSPSC is responsible for application integration and interconnections internally and with external partners. User and batch transactions are also a significant part of system processes.
COB&R Maintenance
Perform maintenance, enhancement, and special project activities.
Enhancements improve the performance or effectiveness of the COB&R program. Examples of enhancements include ICD-10 enhancements, Recovery Audit Contractor (RAC) implementation changes, as well as, implementing a consolidated imaging system.
Special projects shall include, but not be limited to: performing analysis, answering questions, and providing data to support lawsuits, audits, GAO requests, etc.

COB&R System Implementation
Implementation shall include development of source code and creation of implementation products necessary for test and installation of the modification.
Code
Develop the required software to meet the validated requirements.
The contractor shall develop and record software corresponding to each software unit. This activity shall include, as applicable, computer instructions, and data definitions, building databases, if necessary, populating databases and other data files with data values, and other activities needed to implement the design. For deliverable software, the contractor shall obtain CMS approval to use any programming language not specified in the contract.
Code Review
Conduct a code review for each software unit prior to submitting it to the MSPIC. This code review may include CMS staff as well as contractor and MSPIC personnel. The contractor shall include a softcopy of all developed software, to include source code, executables, and any operational software, test software, scripts and data that have been developed.
Software Support
Provide software support which shall include, but is not limited to, the following:

1. Analysis, programming, and unit testing, system/string testing, and preliminary regression testing to fix any software problems identified.
2. Data synchronization of databases and files,
3. Design and develop new code to meet CMS’ changing environment,
4. Perform adhoc processing such as:
   1. Creating reports,
   2. Creating extracts,
5. Document all changes Run Books,
6. Build code migration packages in GIT as appropriate,
7. Follow CMS code migration authorization process,
8. Keep the system software operational and responsive after installation,
9. Update technical and user documentation,
10. Report all software problems by opening a RT/CR,
11. Follow CMS standards.

This does not limit or define the set of activities that can be performed during the development of software code and/or making changes to the baseline system.
Software Development Files (SDF)
Establish and maintain Software Development Files (SDF) that include, but are not limited to…

Read The Full RFI Here.

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