Health Insurance and Medicare Part C and Part D Medical Loss Ratio (MLR) Examinations
ID: 250300Type: Sources Sought
Overview

Buyer

HEALTH AND HUMAN SERVICES, DEPARTMENT OFCENTERS FOR MEDICARE AND MEDICAID SERVICESOFC OF ACQUISITION AND GRANTS MGMTBALTIMORE, MD, 21244, USA

NAICS

Offices of Certified Public Accountants (541211)

Original Source

https://sam.gov/opp/4b75a54f4071475bb41cb1aa8e41b92c/view
Timeline
    Description

    The Department of Health and Human Services, specifically the Centers for Medicare and Medicaid Services (CMS), is seeking qualified small businesses to assist in the evaluation of compliance with Medical Loss Ratio (MLR) requirements under the Affordable Care Act. The procurement aims to conduct examinations of MLR reports, provide training, implement best practices, and ensure that healthcare entities prioritize spending on healthcare services over administrative costs. This initiative is crucial for enhancing compliance oversight and accountability in healthcare spending for beneficiaries, particularly within the Medicare Advantage and Part D programs. Interested parties should contact Kelly Housein at kelly.housein@cms.hhs.gov or call 410-786-2352 for further details regarding submission requirements and deadlines.

    Point(s) of Contact
    Kelly Housein
    (410) 786-2352
    kelly.housein@cms.hhs.gov
    Files
    Title
    Posted
    Sources Sought Notice FY25 - 250300.pdf
    The Centers for Medicare & Medicaid Services (CMS) has issued a Sources Sought Notice to identify small businesses capable of assisting in the evaluation of compliance with Medical Loss Ratio (MLR) requirements under the Affordable Care Act. This includes conducting examinations of MLR reports, providing training and implementing best practices, and ensuring entities prioritize spending on healthcare services over administrative costs. The CMS seeks contractors experienced in auditing, financial analysis, and regulatory review. Respondents are expected to demonstrate expertise in MLR regulations, data analysis, and project management. The document outlines the requirements for potential contractors, details the MLR standards applicable to Medicare Advantage and Part D programs, and specifies the submission format for responses. It highlights the urgency of the mission in ensuring effective healthcare delivery and outlines the anticipated services, emphasizing the need for a well-qualified partner to enhance compliance oversight and accountability in healthcare spending for beneficiaries.
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