Description
The Centers for Medicare & Medicaid Services (CMS) has entered into individual agreements with the state Medicaid agencies of Connecticut, Massachusetts, and New York (collectively, “the parties”) to operate a demonstration program to determine the Medicare payment of certain home health services provided to certain individuals. This project is being conducted under CMS’ statutory authority to conduct Medicare demonstration projects, 42 U.S.C. 1395 b-1. The Centers for Medicare and Medicaid Services (CMS) (formerly known as the Health Care Financing Administration) intends to negotiate a sole source contract with Blue Cross and Blue Shield Association (BCBSA) for legal representation services. CMS estimates approximately 298 cases over a three (3) year period; forty-five (45) of these cases need legal representation over the first year. BCBSA has provided similar services under the Provider Reimbursement Review Board (PRRB) appeals for the past 20 years. BCBSA shall perform the following services, but not limited to, in accordance with the provisions stated in the American Arbitration Association (AAA) Medicare Demonstration Project Rules (the Rules): • Participate in the initial administrative conference if such a conference is scheduled. • Participate in pre–hearing conferences. At these conferences the contractor will represent CMS in discussing the future conduct of the case, including clarification of the issues and claims, establish the hearing date, and any other preliminary matters, including exchange of exhibits and identification of witnesses. • Review the initiating party’s (i.e, the state and/or its agents) legal memorandum and prepare a legal memorandum in support of CMS’ position with AAA within 30 days of the filing of the initiating party's memorandum. The memoranda must conform with the specifications in the Rules. • Prepare CMS’ case for presentation at the arbitration hearing, including identification of and arrangement for witnesses, interpreters (if needed), etc. • Attend and represent CMS at the hearing, presenting evidence and argument to support the Government’s position; including conducting direct examination of witnesses for each party. • If necessary, submit additional documents, other evidence or additional memoranda of law following the hearing: (1) upon the arbitrator's request; (2) upon the agreement of the parties; or (3) upon the request of one of the parties with the arbitrator's consent. These memoranda of law, documents or other evidence shall be filed with the AAA for transmission to the arbitrator within time limits specified by the arbitrator. • Represent CMS at any rehearing if reopening of a hearing is necessary. • Arrange for service of any papers, notices, or other documents necessary or proper to be served on the opposing party and its representatives. • Represent CMS in any discussions to settle a case dispute during the course of the arbitration. • Review the arbitrator’s award and provide CMS with a summary of the arbitrator’s decision, reasoning (findings of fact and conclusions of law), actions required, and errors that require correction. • Represent CMS in requesting correction of any clerical, typographical, or computational errors in the award within 20 days after the transmittal of the award; and responding (within 10 days) to any request by the opposing party (state) for a correction. The government anticipates a period of performance for twelve (12) months from date of award with options for two (2) additional years. This announcement is for informational purposes only. See number Note 22.