Medicaid Program; Announcement of Requirements and Registration for CMS Provider Screening Innovator Challenge, 31618-31620 [2012-12633]

Download as PDF srobinson on DSK4SPTVN1PROD with NOTICES 31618 Federal Register / Vol. 77, No. 103 / Tuesday, May 29, 2012 / Notices Agency and its customers and stakeholders. It will also allow feedback to contribute directly to the improvement of program management. Collecting voluntary customer feedback is the least burdensome, most effective way for the Agency to determine whether or not its public Web sites are useful to and used by its customers. Generic clearance is needed to ensure that the Agency can continuously improve its Web sites though regular surveys developed from these pre-defined questions. Surveying the Agency Web sites on a regular, ongoing basis will help ensure that users have an effective, efficient, and satisfying experience on any of the Web sites, maximizing the impact of the information and resulting in optimum benefit for the public. The surveys will ensure that this communication channel meets customer and partner priorities, builds the Agency’s brands, and contributes to the Agency’s health and human services impact goals. Form Number: CMS–10415 (OCN 0938— New); Frequency: Occasionally; Affected Public: Individuals and Households, Business or other forprofits and Not-for-profit institutions, State, Local or Tribal Governments; Number of Respondents: 1,000,000; Total Annual Responses: 1,000,000; Total Annual Hours: 67,000. (For policy questions regarding this collection contact John Booth at 410–786–6577. For all other issues call 410–786–1326.) To obtain copies of the supporting statement and any related forms for the proposed paperwork collections referenced above, access CMS Web Site address at https://www.cms.hhs.gov/ PaperworkReductionActof1995, or Email your request, including your address, phone number, OMB number, and CMS document identifier, to Paperwork@cms.hhs.gov, or call the Reports Clearance Office on (410) 786– 1326. To be assured consideration, comments and recommendations for the proposed information collections must be received by the OMB desk officer at the address below, no later than 5 p.m. on June 28, 2012. OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk Officer, Fax Number: (202) 395–6974, Email: OIRA_submission@omb.eop.gov. Dated: May 22, 2012. Martique Jones, Director, Regulations Development Group, Division B, Office of Strategic Operations and Regulatory Affairs. [FR Doc. 2012–12811 Filed 5–25–12; 8:45 am] BILLING CODE 4120–01–P VerDate Mar<15>2010 16:12 May 25, 2012 Jkt 226001 DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services (CMS) [CMS–2382–N] Medicaid Program; Announcement of Requirements and Registration for CMS Provider Screening Innovator Challenge Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. AGENCY: The Centers for Medicare & Medicaid Services (CMS), is announcing the launch of the ‘‘CMS Provider Screening Innovator Challenge.’’ This Challenge is sponsored by CMS and is presented as part of the Partnership for Program Integrity Innovation program, and will be administered by the National Aeronautic and Space Administration’s (NASA) Federal Center of Excellence for Collaborative Innovation. This Challenge addresses our goals of improving our abilities to streamline operations, screen providers, and reduce fraud and abuse. Specifically, the challenge is an innovation competition to develop a multi-State, multi-program provider screening software application which would be capable of risk scoring, credentialing validation, identity authentication, and sanction checks, while lowering burden on providers and reducing administrative and infrastructure expenses for States and Federal programs. More information pertaining to the Medicaid and CHIP programs can be found at www.medicaid.gov. DATES: Important dates concerning the Challenge include the following: Challenge Competition Begin: 6:00 p.m., e.d.t., May 30, 2012. Challenge Competition End: To be determined, but expected to be completed by October/November 2012 timeframe. FOR FURTHER INFORMATION CONTACT: John ‘‘Chip’’ Garner, 410–786–3012. SUPPLEMENTARY INFORMATION: SUMMARY: Subject of Challenge Competition Entrants are asked to develop artifacts and components of software applications that can be integrated into an open source solution that can deliver a reliable, scalable, and cost-effective provider-screening capability for multiple States (or for the nation). We expect the winning entry to exhibit the following characteristics: 1. Reduced processing and transaction time for submitting and receiving PO 00000 Frm 00055 Fmt 4703 Sfmt 4703 queries to authoritative data sources regarding provider credentials and sanctions. 2. Reductions in time needed by providers to submit information and resolve discrepancies. 3. Administrative/infrastructure savings from a multi-tenant provider screening solution. 4. Improved availability of key provider data relevant for program participation and oversight. 5. Improved timeliness and accuracy in provider participation, oversight, and enrollment decisions. 6. Improved ability to implement sections 1902(a)(39) and 1902(a)(77) of the Social Security Act, as amended by the Patient Protection and Affordable Care Act (Pub. L. 111–148 and 111–152) subsections 6401(b) and (c) (Provider Screening and Other Enrollment Requirements Under Medicare, Medicaid, and CHIP), and section 6501 (Termination of Provider Participation Under Medicaid if Terminated by Medicare or Other State Plan). 7. Assist in better driving alignment of the Medicaid Information Technology Architecture (MITA) 3.0 framework to the Information and Technology Architecture levels. More information pertaining to MITA can be found at the following Web site: www.medicaid.gov/ Medicaid-CHIP–Program-Information/ By-Topics/Data-and-Systems/MedicaidInformation-Technology-ArchitectureMITA.html. General Eligibility Rules for Participating in the Competition To be eligible to win a prize under this Challenge, an individual or entity must comply with all the requirements under this section. An individual or entity shall not be deemed ineligible solely because the individual or entity used Federal facilities or consulted with Federal employees during a competition if such facilities and employees are made available to all individuals and entities participating in the competition on an equitable basis. A Federal entity or Federal employee acting within the scope of his or her employment is not eligible to participate. A Federal employee seeking to participate in this competition outside the scope of his/her employment should consult his/her ethics official prior to developing the submission. Employees of CMS, the Challenge judges, and employees of any other company or individual involved with the design, production, execution, or distribution of the Challenge, along with such employees’ or judges’ immediate families (spouse, parents and E:\FR\FM\29MYN1.SGM 29MYN1 Federal Register / Vol. 77, No. 103 / Tuesday, May 29, 2012 / Notices step-parents, siblings and step-siblings, and children and step-children) and household members (people who share the same residence at least three (3) months out of the year) are not eligible to participate. Regarding Registration Process for Participants, interested persons should read the Official Rules and register at the Center of Excellence for Collaborative Innovation Challenge portal: https://community.topcoder.com/ coeci/. Registration is free and can be completed at any time before an entry is submitted in response to a particular competition. Amount of the Prize Based on our current assumptions, we estimate that the total prize amount for the competitions conducted as part of this Challenge will fall between $500,000 and $600,000. srobinson on DSK4SPTVN1PROD with NOTICES Basis Upon Which Winner Will Be Selected Challenge competition entries will be judged by an expert panel composed of CMS program staff. Judges shall be named after commencement of the Challenge. Competitions will be judged based upon both subjective and objective criteria. Should the highestscoring submitted solution be missing requirements or otherwise need modification, it will enter a remediation/fix phase. Projects are posted and administered through a personalized, web-based administration tool. All projects progress, with some variance, through a sequence of phases from Registration to Submission to Screening to Review to Final Fixes. Submissions will be screened to ensure they meet minimum requirements for the project and do not include forbidden material. Competition submissions with subjectively evaluated components (for example, graphical design, workflow, GUI layout, etc.) are anonymized and evaluated by the Judges. Submissions with objectively scored components, such as projects (for example, architecture, development, etc.) are scored by the Judges by their fidelity to exact, enumerated requirements. Overall, the solution must, at a minimum, meet the following criteria: 1. Capability to Conduct Identity Verification. a. Capability to link individuals to their organizations and vice versa. b. Capability to match on multiple variations of an individual’s or organization’s name to ensure that the correct entity is verified. c. Ability to apply a range of screening rules to cross check data VerDate Mar<15>2010 16:12 May 25, 2012 Jkt 226001 elements within the enrollment application. d. Ability to apply a range of screening rules to cross check data elements against authoritative external sources for consistency. e. Capability to establish and employ a graded screening methodology that escalates the intensity of screening for providers that are flagged as higher risk (that is, Report Card Methodology). 2. Capability to Build Provider Profiles. a. Capability to retain screening and enrollment information and results, and compare against past and future screening results. b. Capability to create a watch list to ensure that providers that are suspected or known to be fraudulent are flagged at the time of screening. c. Capability to track re-enrollment attempts to ensure that slight changes to provider information are not considered a new enrollment. d. Capability to revalidate periodically to ensure that changes in provider profiles are updated on a regular basis. e. Capability to leverage public Web sites to conduct link analysis through which provider associations could be explored, and alerts posted on similar Web sites could be considered. f. Capability to capture critical attributes • Collection of application fees status. • Exception waiver approved status. • Incorporating enhanced screening data, including the results of site visits, criminal background checks, and finger printing. • Capturing licensing information, financial data, and any other data attributes which could impact a risk lever. • Other critical attributes. g. Capability to achieve real time screening, scoring, and system outputs (queries/reports). 3. Capability to Evaluate and Maintain the Integrity of the Results. a. Capability to persist data sources scores to determine the most reliable source for each data element. b. Capability to evaluate data sources for reliability and accuracy. c. Capability to create a learning system to ensure that observed negative trends factor back into screening rules so as to flag suspicious enrollments early in the screening process, ensuring the ability to detect and reduce/ eliminate the incidence of false positives. d. Capability to create system outputs to assign reasons/explanations to each code or score used. PO 00000 Frm 00056 Fmt 4703 Sfmt 4703 31619 e. Capability to build processes to allow for appropriate interpretation and action on screening and scoring results. f. Capability to ensure that each rule is tested and its impact is evaluated prior to implementing. 4. Improves Efficiency. a. Capability to allow searches to find specific provider information with minimal search attempts. b. Capability to identify applicants, including individual providers and owners of institutional providers. c. Capability to verify identity and prior history of problems with Medicaid/CHIP or Medicare programs. d. Capability to identify and schedule revalidation process. 5. Meets Architectural Guidelines. a. Adheres to the Architectural Guidance and meets the seven conditions and standards detailed in the Guidance for Exchange and Medicaid IT Systems, Version 2.0, located at: https://www.medicaid.gov/MedicaidCHIP–Program-Information/By-Topics/ Data-and-Systems/Downloads/ exchangemedicaiditguidance.pdf. b. Integrates into the MITA Framework—Is MITA Compliant. Information regarding MITA can be found at: https://www.cms.gov/ MedicaidInfoTechArch/. 6. Accurate, Cost Effective, and Timely. a. Turnaround time for performing automated checks typical for a webbased system. b. Comprehensive verification of all data fields for all providers enrolled. c. Efficiency of the Screening Solution in terms of cost and schedule to actually implement: Potential extra costs (for example, licenses, etc.) are documented. d. Effectiveness of the risk-screening model in detecting fraud based issues. e. Technical soundness of risk-scoring in flagging potential fraudulent patterns and tendencies. Additional Information CMS is one of the principal agencies dedicated to protecting the health of citizens by making our world healthier, safer, and better for all Americans. For more information, see www.cms.gov. General Conditions CMS reserves the right to cancel, suspend, and/or modify the Competition, or any part of it, for any reason, at CMS’ sole discretion. Authority: This competition is administrated by the Federal Center of Excellence for Collaborative Innovation through a partnership between CMS and NASA. The partnership is in accordance with the National Aeronautics and Space Act (51 U.S.C. 20113(e)) and The Economy Act (31 U.S.C. 1535). E:\FR\FM\29MYN1.SGM 29MYN1 31620 Federal Register / Vol. 77, No. 103 / Tuesday, May 29, 2012 / Notices Dated: May 4, 2012. Marilyn Tavenner, Acting Administrator, Centers for Medicare & Medicaid Services. SUPPLEMENTARY INFORMATION: [FR Doc. 2012–12633 Filed 5–25–12; 8:45 am] BILLING CODE 4120–01–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS–1441–N] Medicare Program; Public Meeting in Calendar Year 2012 for New Clinical Laboratory Tests Payment Determinations Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. AGENCY: This notice announces a public meeting to receive comments and recommendations from the public on the appropriate basis for establishing payment amounts for new or substantially revised Healthcare Common Procedure Coding System (HCPCS) codes being considered for Medicare payment under the clinical laboratory fee schedule (CLFS) for calendar year (CY) 2013. DATES: Meeting Dates: The public meeting is scheduled for Monday, July 16, 2012, from 9:00 a.m. to 5:00 p.m., and Tuesday, July 17, 2012, from 9:00 a.m. to 12:00 p.m. All times are Eastern Daylight Savings Time. Deadline for Registration of Presenters: All presenters for the public meeting must register by July 6, 2012. Deadline for Written/Electronic Presentations: Written presentations must also be electronically submitted to on or before July 6, 2012. Deadline for Submitting Requests for Special Accommodations: Requests for special accommodations must be received no later than 5:00 p.m., on July 6, 2012. Deadline for Submission of Written Comments: Interested parties may submit written comments on the proposed payment determinations by September 28, 2012, to the address specified in the ADDRESSES section of this notice. ADDRESSES: The public meeting will be held in the main auditorium of the central building of the Centers for Medicare & Medicaid Services (CMS), 7500 Security Boulevard, Baltimore, Maryland 21244–1850. FOR FURTHER INFORMATION CONTACT: Glenn McGuirk, (410) 786–5723. srobinson on DSK4SPTVN1PROD with NOTICES SUMMARY: VerDate Mar<15>2010 16:12 May 25, 2012 Jkt 226001 I. Background Section 531(b) of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) (Pub. L. 106–554) requires the Secretary to establish procedures for coding and payment determinations for new clinical diagnostic laboratory tests under Part B of title XVIII of the Social Security Act (the Act) that permit public consultation in a manner consistent with the procedures established for implementing coding modifications for International Classification of Diseases (ICD–9–CM). The procedures and public meeting announced in this notice for new tests are in accordance with the procedures published in the Federal Register on November 23, 2001 (66 FR 58743), to implement section 531(b) of BIPA. Section 942(b) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108–173) added section 1833(h)(8) of the Act. Section 1833(h)(8)(A) of the Act requires the Secretary to ‘‘establish by regulation procedures for determining the basis for, and amount of, payment for any clinical diagnostic laboratory test with respect to which a new or substantially revised HCPCS code is assigned on or after January 1, 2005’’ (hereinafter referred to as, ‘‘new test’’). A code is considered to be ‘‘substantially revised’’ if ‘‘there is a substantive change to the definition of the test or procedure to which the code applies (such as a new analyte or a new methodology for measuring an existing analyte-specific test).’’ (See section 1833(h)(8)(E)(ii) of the Act.) Section 1833(h)(8)(B) of the Act sets forth the process for determining the basis for, and the amount of, payment for new tests. Section 1833(h)(8)(B)(i) and (ii) of the Act requires the Secretary to—(1) ‘‘make available to the public (through an Internet Web site and other appropriate mechanisms)a list that includes any such test for which establishment of a payment amount is being considered for a year’’; and (2) ‘‘on the same day such list is made available, causes to have published in the Federal Register notice of a meeting to receive comments and recommendations (and data on which recommendations are based) from the public on the appropriate basis * * * for establishing payment amounts for the tests on such list.’’ The list of codes for which the establishment of a payment amount under the CLFS is being considered for CY 2013 is posted on our Web site at https:// www.cms.hhs.gov/ClinicalLabFeeSched. PO 00000 Frm 00057 Fmt 4703 Sfmt 4703 Section 1833(h)(8)(B)(iii) of the Act requires that we convene a public meeting not less than 30 days after publication of the notice in the Federal Register. These requirements are codified at 42 CFR part 414, subpart G. Two methods are used to establish payment amounts for new tests. The first method called ‘‘crosswalking’’ is used when a new test is determined to be comparable to an existing test, multiple existing test codes, or a portion of an existing test code. The new test code is assigned to the local fee schedule amounts and the national limitation amount of the existing test. Payment for the new test is made at the lesser of the local fee schedule amount or the national limitation amount. (See § 414.508(a).) The second method called ‘‘gapfilling’’ is used when no comparable existing test is available. When using this method, instructions are provided to each Medicare carrier or Part A and Part B Medicare Administrative Contractor (MAC) to determine a payment amount for its carrier geographic area(s) for use in the first year. The carrier-specific amounts are established for the new test code using the following sources of information, if available: charges for the test and routine discounts to charges; resources required to perform the test; payment amounts determined by other payers; and charges, payment amounts, and resources required for other tests that may be comparable or otherwise relevant. In the second year, the test code is paid at the national limitation amount, which is the median of the carrier-specific amounts. (See § 414.508(b).) II. Proposals in the CY 2013 Physician Fee Schedule Proposed Rule We are following our process to determine the appropriate basis and payment amount for new test codes under the CLFS for CY 2013. Some of these tests are molecular pathology tests. Stakeholders in the molecular pathology community continue to debate whether Medicare should pay for molecular pathology tests under the CLFS or the physician fee schedule (PFS). Medicare pays for clinical diagnostic laboratory tests through the CLFS and for services that ordinarily require physician work through the PFS. We believe that we would benefit from additional public comments on whether these tests are clinical diagnostic laboratory tests or whether they are services that should be paid under the PFS. Therefore, we intend to solicit public comments on this issue in the CY 2013 PFS proposed rule as well as E:\FR\FM\29MYN1.SGM 29MYN1

Agencies

[Federal Register Volume 77, Number 103 (Tuesday, May 29, 2012)]
[Notices]
[Pages 31618-31620]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-12633]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services (CMS)

[CMS-2382-N]


Medicaid Program; Announcement of Requirements and Registration 
for CMS Provider Screening Innovator Challenge

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: The Centers for Medicare & Medicaid Services (CMS), is 
announcing the launch of the ``CMS Provider Screening Innovator 
Challenge.'' This Challenge is sponsored by CMS and is presented as 
part of the Partnership for Program Integrity Innovation program, and 
will be administered by the National Aeronautic and Space 
Administration's (NASA) Federal Center of Excellence for Collaborative 
Innovation. This Challenge addresses our goals of improving our 
abilities to streamline operations, screen providers, and reduce fraud 
and abuse. Specifically, the challenge is an innovation competition to 
develop a multi-State, multi-program provider screening software 
application which would be capable of risk scoring, credentialing 
validation, identity authentication, and sanction checks, while 
lowering burden on providers and reducing administrative and 
infrastructure expenses for States and Federal programs. More 
information pertaining to the Medicaid and CHIP programs can be found 
at www.medicaid.gov.

DATES: Important dates concerning the Challenge include the following:
    Challenge Competition Begin: 6:00 p.m., e.d.t., May 30, 2012.
    Challenge Competition End: To be determined, but expected to be 
completed by October/November 2012 timeframe.

FOR FURTHER INFORMATION CONTACT: John ``Chip'' Garner, 410-786-3012.

SUPPLEMENTARY INFORMATION: 

Subject of Challenge Competition

    Entrants are asked to develop artifacts and components of software 
applications that can be integrated into an open source solution that 
can deliver a reliable, scalable, and cost-effective provider-screening 
capability for multiple States (or for the nation).
    We expect the winning entry to exhibit the following 
characteristics:
    1. Reduced processing and transaction time for submitting and 
receiving queries to authoritative data sources regarding provider 
credentials and sanctions.
    2. Reductions in time needed by providers to submit information and 
resolve discrepancies.
    3. Administrative/infrastructure savings from a multi-tenant 
provider screening solution.
    4. Improved availability of key provider data relevant for program 
participation and oversight.
    5. Improved timeliness and accuracy in provider participation, 
oversight, and enrollment decisions.
    6. Improved ability to implement sections 1902(a)(39) and 
1902(a)(77) of the Social Security Act, as amended by the Patient 
Protection and Affordable Care Act (Pub. L. 111-148 and 111-152) 
subsections 6401(b) and (c) (Provider Screening and Other Enrollment 
Requirements Under Medicare, Medicaid, and CHIP), and section 6501 
(Termination of Provider Participation Under Medicaid if Terminated by 
Medicare or Other State Plan).
    7. Assist in better driving alignment of the Medicaid Information 
Technology Architecture (MITA) 3.0 framework to the Information and 
Technology Architecture levels. More information pertaining to MITA can 
be found at the following Web site: www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/Medicaid-Information-Technology-Architecture-MITA.html.

General Eligibility Rules for Participating in the Competition

    To be eligible to win a prize under this Challenge, an individual 
or entity must comply with all the requirements under this section.
    An individual or entity shall not be deemed ineligible solely 
because the individual or entity used Federal facilities or consulted 
with Federal employees during a competition if such facilities and 
employees are made available to all individuals and entities 
participating in the competition on an equitable basis.
    A Federal entity or Federal employee acting within the scope of his 
or her employment is not eligible to participate. A Federal employee 
seeking to participate in this competition outside the scope of his/her 
employment should consult his/her ethics official prior to developing 
the submission. Employees of CMS, the Challenge judges, and employees 
of any other company or individual involved with the design, 
production, execution, or distribution of the Challenge, along with 
such employees' or judges' immediate families (spouse, parents and

[[Page 31619]]

step-parents, siblings and step-siblings, and children and step-
children) and household members (people who share the same residence at 
least three (3) months out of the year) are not eligible to 
participate.
    Regarding Registration Process for Participants, interested persons 
should read the Official Rules and register at the Center of Excellence 
for Collaborative Innovation Challenge portal: https://community.topcoder.com/coeci/. Registration is free and can be 
completed at any time before an entry is submitted in response to a 
particular competition.

Amount of the Prize

    Based on our current assumptions, we estimate that the total prize 
amount for the competitions conducted as part of this Challenge will 
fall between $500,000 and $600,000.

Basis Upon Which Winner Will Be Selected

    Challenge competition entries will be judged by an expert panel 
composed of CMS program staff. Judges shall be named after commencement 
of the Challenge. Competitions will be judged based upon both 
subjective and objective criteria. Should the highest-scoring submitted 
solution be missing requirements or otherwise need modification, it 
will enter a remediation/fix phase. Projects are posted and 
administered through a personalized, web-based administration tool. All 
projects progress, with some variance, through a sequence of phases 
from Registration to Submission to Screening to Review to Final Fixes. 
Submissions will be screened to ensure they meet minimum requirements 
for the project and do not include forbidden material. Competition 
submissions with subjectively evaluated components (for example, 
graphical design, workflow, GUI layout, etc.) are anonymized and 
evaluated by the Judges. Submissions with objectively scored 
components, such as projects (for example, architecture, development, 
etc.) are scored by the Judges by their fidelity to exact, enumerated 
requirements.
    Overall, the solution must, at a minimum, meet the following 
criteria:
    1. Capability to Conduct Identity Verification.
    a. Capability to link individuals to their organizations and vice 
versa.
    b. Capability to match on multiple variations of an individual's or 
organization's name to ensure that the correct entity is verified.
    c. Ability to apply a range of screening rules to cross check data 
elements within the enrollment application.
    d. Ability to apply a range of screening rules to cross check data 
elements against authoritative external sources for consistency.
    e. Capability to establish and employ a graded screening 
methodology that escalates the intensity of screening for providers 
that are flagged as higher risk (that is, Report Card Methodology).
    2. Capability to Build Provider Profiles.
    a. Capability to retain screening and enrollment information and 
results, and compare against past and future screening results.
    b. Capability to create a watch list to ensure that providers that 
are suspected or known to be fraudulent are flagged at the time of 
screening.
    c. Capability to track re-enrollment attempts to ensure that slight 
changes to provider information are not considered a new enrollment.
    d. Capability to revalidate periodically to ensure that changes in 
provider profiles are updated on a regular basis.
    e. Capability to leverage public Web sites to conduct link analysis 
through which provider associations could be explored, and alerts 
posted on similar Web sites could be considered.
    f. Capability to capture critical attributes
     Collection of application fees status.
     Exception waiver approved status.
     Incorporating enhanced screening data, including the 
results of site visits, criminal background checks, and finger 
printing.
     Capturing licensing information, financial data, and any 
other data attributes which could impact a risk lever.
     Other critical attributes.
    g. Capability to achieve real time screening, scoring, and system 
outputs (queries/reports).
    3. Capability to Evaluate and Maintain the Integrity of the 
Results.
    a. Capability to persist data sources scores to determine the most 
reliable source for each data element.
    b. Capability to evaluate data sources for reliability and 
accuracy.
    c. Capability to create a learning system to ensure that observed 
negative trends factor back into screening rules so as to flag 
suspicious enrollments early in the screening process, ensuring the 
ability to detect and reduce/eliminate the incidence of false 
positives.
    d. Capability to create system outputs to assign reasons/
explanations to each code or score used.
    e. Capability to build processes to allow for appropriate 
interpretation and action on screening and scoring results.
    f. Capability to ensure that each rule is tested and its impact is 
evaluated prior to implementing.
    4. Improves Efficiency.
    a. Capability to allow searches to find specific provider 
information with minimal search attempts.
    b. Capability to identify applicants, including individual 
providers and owners of institutional providers.
    c. Capability to verify identity and prior history of problems with 
Medicaid/CHIP or Medicare programs.
    d. Capability to identify and schedule revalidation process.
    5. Meets Architectural Guidelines.
    a. Adheres to the Architectural Guidance and meets the seven 
conditions and standards detailed in the Guidance for Exchange and 
Medicaid IT Systems, Version 2.0, located at: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/Downloads/exchangemedicaiditguidance.pdf.
    b. Integrates into the MITA Framework--Is MITA Compliant. 
Information regarding MITA can be found at: https://www.cms.gov/MedicaidInfoTechArch/.
    6. Accurate, Cost Effective, and Timely.
    a. Turnaround time for performing automated checks typical for a 
web-based system.
    b. Comprehensive verification of all data fields for all providers 
enrolled.
    c. Efficiency of the Screening Solution in terms of cost and 
schedule to actually implement: Potential extra costs (for example, 
licenses, etc.) are documented.
    d. Effectiveness of the risk-screening model in detecting fraud 
based issues.
    e. Technical soundness of risk-scoring in flagging potential 
fraudulent patterns and tendencies.

Additional Information

    CMS is one of the principal agencies dedicated to protecting the 
health of citizens by making our world healthier, safer, and better for 
all Americans. For more information, see www.cms.gov.

General Conditions

    CMS reserves the right to cancel, suspend, and/or modify the 
Competition, or any part of it, for any reason, at CMS' sole 
discretion.

    Authority:  This competition is administrated by the Federal 
Center of Excellence for Collaborative Innovation through a 
partnership between CMS and NASA. The partnership is in accordance 
with the National Aeronautics and Space Act (51 U.S.C. 20113(e)) and 
The Economy Act (31 U.S.C. 1535).


[[Page 31620]]


    Dated: May 4, 2012.
Marilyn Tavenner,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2012-12633 Filed 5-25-12; 8:45 am]
BILLING CODE 4120-01-P
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