Description
The purpose of this notice is to notify any interested parties that CMS intends to release an RFP in the next 15 days, with the intent to competitively award a QIO Contract (within the 8a program) entittled: "Beneficiary and Family Centered Care Oversight & Review Center (BFCC ORC)" which supports the QIO 11th SOW. The Centers for Medicare & Medicaid Services (CMS) is the federal agency tasked with overseeing a variety of healthcare programs, including Medicare and Medicaid. It strives to ensure that beneficiaries receive the highest quality of care, consisting of personalized, prevention-oriented, and beneficiary-centered care, based on evidence about the benefits and costs applicable to each individual beneficiary. The Quality Improvement Organization (QIO) Program serves an important role in the administration of the Medicare Program by conducting reviews to ensure that items and services provided under the Medicare Program adhere to statutory and regulatory requirements. These kinds of reviews will be covered under the Beneficiary and Family-Centered Care (BFCC) SOW. The QIO statute, as amended by Section 261 of the Trade Adjustment Assistance Extension Act of 2011, also requires QIOs to perform, subject to the terms of their contracts, activities that the Secretary of the Department of Health and Human Services (HHS) determines may be necessary for the purposes of improving the quality of care furnished to Medicare beneficiaries. The Government seeks to align the QIO Program with broader quality goals, initiatives, and activities developed and implemented by the HHS, such as the National Quality Strategy (NQS) and the CMS Quality Strategy. The Government anticipates that this alignment will help maximize the benefits of the QIO Program for Medicare beneficiaries, while potentially producing secondary benefits for the national healthcare system. The Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) is one of the CMS QIO Program components that serve to improve the quality of care for Medicare beneficiaries. One of the primary statutory missions of the Program, as set forth in the Social Security Act (the "Act") is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. One method used to ensure the BFCC-QIOs are effectively meeting its mission is through the Beneficiary and Family Centered Care Oversight and Review Center (BFCC ORC). The objective for the Beneficiary and Family Centered Care Oversight & Review Center (BFCC-ORC) is to improve Medicare beneficiary health care, health, and reduce cost. The BFCC-ORC shall focus on continuous improvement across the BFCC-QIO Program by providing actionable findings regarding operations, performance, outcomes, and impact of the overall BFCC-QIO services. The findings will be used by the BFCC-QIO and by CMS to identify quality improvement opportunities in program functions, including policy development, business architecture, outreach, and education. The BFCC-ORC will involve ongoing data collection and analysis to identify events that require further investigation, and include studies to determine the root cause of the observation. The overall objectives of this contract are as follows: a. Inter-rater reliability - 1) Implement an inter-rater reliability (IRR) method to monitor BFCC-QIO case review effectiveness and quality; and identify areas for improvement. 2) Assess the degree to which BFCC-QIOs' case reviews determinations are consistent. b. Contract impact monitoring and evaluation - 1) BFCC-QIO Program Impact Monitoring - Compile and produce tables and reports, and make recommendations to CMS for contract monitoring and for actionable program improvement. The Contractor will assist CMS's analysis of BFCC-QIO activities relative to contract requirements, targets, and milestones for each of the respective states and territories. 2) BFCC-QIO ProgramEvaluation - BFCC-QIOs will produce reports at each of the 12, 24, 36, 48 and 54th month intervals, for contract evaluation. The BFCC-ORC shall develop evaluation design(s), which shall measure relevant aspects of program performance and develop instruments, a data collection plan, and a data analysis plan to facilitate CMS evaluation of BFCC-QIO performance based on achievement associated with the requirements and measures as described in the BFCC-QIO contracts. c. Survey - Provide consultation and survey program support services to assist in the development, administration, analysis and reporting on surveys of Medicare beneficiaries experience with services provided by BFCC-QIOs.