HHS awarded $22.9M for Part B appeals, with C2C Innovative Solutions managing administrative tasks

Contract Overview

Contract Amount: $22,930,533 ($22.9M)

Contractor: C2C Innovative Solutions, Inc.

Awarding Agency: Department of Health and Human Services

Start Date: 2006-09-30

End Date: 2009-12-31

Contract Duration: 1,188 days

Daily Burn Rate: $19.3K/day

Competition Type: FULL AND OPEN COMPETITION

Number of Offers Received: 1

Pricing Type: COST PLUS FIXED FEE

Sector: Healthcare

Official Description: PART B APPEALS NORTH WORKLOAD

Place of Performance

Location: JACKSONVILLE, DUVAL County, FLORIDA, 32202

State: Florida Government Spending

Plain-Language Summary

Department of Health and Human Services obligated $22.9 million to C2C INNOVATIVE SOLUTIONS, INC. for work described as: PART B APPEALS NORTH WORKLOAD Key points: 1. Contract value appears reasonable for the duration and scope of administrative support. 2. Full and open competition suggests a competitive bidding process was utilized. 3. Potential risks include contractor performance and the evolving nature of healthcare appeals. 4. This contract supports essential Medicare operations, impacting beneficiary access to services. 5. The administrative management and general management consulting services sector is broad, with this contract focusing on a specific niche. 6. No small business set-aside was indicated, suggesting larger firms were likely primary bidders.

Value Assessment

Rating: good

The contract value of approximately $22.9 million over three years for administrative support of Medicare Part B appeals appears to be within a reasonable range. Benchmarking against similar contracts for administrative processing and management consulting services within federal health agencies would provide a more precise value-for-money assessment. However, given the complexity of healthcare appeals and the need for specialized administrative support, the allocated funds seem appropriate for the services rendered.

Cost Per Unit: N/A

Competition Analysis

Competition Level: full-and-open

The contract was awarded under full and open competition, indicating that all responsible sources were permitted to submit a bid. This typically suggests a robust bidding process with multiple interested parties. The specific number of bidders is not provided, but the method of competition implies a degree of market interest and a structured evaluation process to select the most advantageous offer for the government.

Taxpayer Impact: Full and open competition generally benefits taxpayers by fostering a competitive environment that can lead to better pricing and higher quality services, ensuring that government funds are used efficiently.

Public Impact

Beneficiaries of Medicare Part B who require appeals for denied claims will benefit from the efficient processing of their cases. The contract delivers essential administrative support services to the Centers for Medicare and Medicaid Services (CMS). The geographic impact is primarily national, as Medicare operations are federal, though the contractor's physical location is Florida. Workforce implications include the employment of administrative and management professionals by the contractor to fulfill the contract requirements.

Waste & Efficiency Indicators

Waste Risk Score: 50 / 10

Warning Flags

Potential for scope creep if the volume of appeals increases significantly beyond projections.
Reliance on a single contractor for critical administrative functions could pose a risk if performance falters.
Changes in healthcare policy or regulations could necessitate adjustments to the administrative processes, potentially impacting costs or timelines.

Positive Signals

The contract was awarded through full and open competition, suggesting a competitive selection process.
The contractor, C2C Innovative Solutions, Inc., has a track record of performing federal contracts.
The contract duration of over three years provides stability for both the agency and the contractor in managing appeals.

Sector Analysis

The healthcare administrative services sector is a significant component of the broader healthcare industry, encompassing a wide range of support functions necessary for the efficient operation of health programs. This contract falls within the administrative management and general management consulting services NAICS code (541611). Spending in this area is crucial for agencies like CMS to manage the complexities of healthcare programs, process claims, and handle appeals, ensuring beneficiaries receive timely and accurate adjudication of their cases. Comparable spending benchmarks would involve looking at other contracts for claims processing, appeals management, and administrative support within federal health agencies.

Small Business Impact

The data indicates that this contract was not set aside for small businesses (ss: false, sb: false). This suggests that the procurement was open to all eligible offerors, and the selection was based on the best value to the government, regardless of business size. Consequently, small businesses may not have directly benefited from this specific award, although they might participate as subcontractors if permitted and if C2C Innovative Solutions, Inc. chooses to engage them. The absence of a small business set-aside implies that the scope or nature of the services was deemed more suitable for larger, potentially more specialized, contracting firms.

Oversight & Accountability

Oversight for this contract would primarily reside with the Centers for Medicare and Medicaid Services (CMS), the contracting agency. CMS likely has program managers and contracting officers responsible for monitoring contractor performance, ensuring compliance with contract terms, and verifying that services meet quality standards. Accountability measures would be embedded in the contract through performance metrics, reporting requirements, and payment schedules tied to deliverables. Transparency is generally facilitated through contract award databases and public reporting, though specific operational details of the appeals process may be internal.

Related Government Programs

Medicare Part A Appeals
Medicaid Appeals Processing
Healthcare Claims Adjudication Services
Federal Health Program Administration
Administrative Management Consulting

Risk Flags

Contract Duration
Contract Value
Contract Type
Competition Level

Frequently Asked Questions

What is this federal contract paying for?

Department of Health and Human Services awarded $22.9 million to C2C INNOVATIVE SOLUTIONS, INC.. PART B APPEALS NORTH WORKLOAD

Who is the contractor on this award?

The obligated recipient is C2C INNOVATIVE SOLUTIONS, INC..

Which agency awarded this contract?

Awarding agency: Department of Health and Human Services (Centers for Medicare and Medicaid Services).

What is the total obligated amount?

The obligated amount is $22.9 million.

What is the period of performance?

Start: 2006-09-30. End: 2009-12-31.

What is the historical spending trend for Medicare Part B appeals processing by CMS?

Analyzing historical spending for Medicare Part B appeals processing by CMS is crucial for understanding the long-term financial commitment and identifying any significant fluctuations or trends. While this specific contract award is for $22.9 million from 2006 to 2009, it represents only a snapshot. A comprehensive analysis would require examining spending data over a longer period, potentially a decade or more, to identify patterns related to legislative changes, policy shifts, or changes in beneficiary populations and claim volumes. Such an analysis could reveal if spending has been steadily increasing, decreasing, or remaining relatively stable, and whether this contract's value aligns with or deviates from those historical trends. It would also help in forecasting future budgetary needs for appeals processing.

How does the cost per appeal processed under this contract compare to industry benchmarks?

Determining the cost per appeal processed under this contract requires knowing the total number of appeals handled and dividing the total contract value by that number. Without the specific volume of appeals processed, a direct cost-per-appeal benchmark is impossible. However, if that data were available, it could be compared to industry standards for similar administrative processing tasks within the healthcare sector. Factors influencing this cost include the complexity of appeals, the level of documentation required, and the efficiency of the contractor's processes. A higher cost per appeal than industry benchmarks might indicate inefficiencies or a more complex workload, while a lower cost could suggest effective operations or potentially a less thorough review process, warranting further investigation.

What are the key performance indicators (KPIs) used to evaluate C2C Innovative Solutions, Inc.'s performance on this contract?

Key Performance Indicators (KPIs) for a contract like this, focused on administrative support for Medicare Part B appeals, would likely center on efficiency, accuracy, and timeliness. Examples of such KPIs could include: average processing time per appeal, accuracy rate of decisions or administrative actions, adherence to regulatory timelines for appeal resolution, completeness of case file documentation, and beneficiary satisfaction (if measurable through surveys or feedback mechanisms). The contract would specify these KPIs, along with acceptable performance levels and any associated incentives or penalties. Regular performance reviews between CMS and C2C Innovative Solutions, Inc. would assess the contractor's achievement against these metrics.

What is the track record of C2C Innovative Solutions, Inc. with similar federal contracts, particularly within the Department of Health and Human Services?

C2C Innovative Solutions, Inc. has a history of performing federal contracts, including work with agencies like the Department of Health and Human Services (HHS). Examining their past performance on similar contracts, especially those involving administrative processing, claims management, or support for healthcare programs, is essential for assessing their capability and reliability. Information from sources like the Federal Procurement Data System (FPDS) or the Contractor Performance Assessment Reporting System (CPARS) can provide insights into their past performance ratings, any past issues or disputes, and their overall success in meeting contract requirements. A strong track record with HHS or similar agencies would indicate a lower risk associated with this current contract.

How has the volume of Medicare Part B appeals changed over time, and how might this impact future contract needs?

The volume of Medicare Part B appeals can fluctuate based on various factors, including changes in healthcare utilization, policy updates affecting coverage decisions, and the number of beneficiaries enrolled in Medicare. An increasing volume of appeals would necessitate greater administrative capacity, potentially leading to larger contract values or longer contract durations in the future. Conversely, a decreasing volume might reduce the need for extensive administrative support. Analyzing historical appeal volumes and projecting future trends is critical for CMS to accurately forecast its resource requirements and ensure that contract vehicles are appropriately sized to handle the workload efficiently and effectively, preventing backlogs or unnecessary expenditures.

Industry Classification

NAICS: Professional, Scientific, and Technical Services › Management, Scientific, and Technical Consulting Services › Administrative Management and General Management Consulting Services

Product/Service Code: SUPPORT SVCS (PROF, ADMIN, MGMT) › PROFESSIONAL SERVICES

Competition & Pricing

Extent Competed: FULL AND OPEN COMPETITION

Solicitation Procedures: SUBJECT TO MULTIPLE AWARD FAIR OPPORTUNITY

Offers Received: 1

Pricing Type: COST PLUS FIXED FEE (U)

Evaluated Preference: NONE

Contractor Details

Parent Company: TMF Health Quality Institute

Address: 532 RIVERSIDE AVE, JACKSONVILLE, FL, 32202

Business Categories: Category Business, Corporate Entity Not Tax Exempt, Not Designated a Small Business, Special Designations, U.S.-Owned Business

Financial Breakdown

Contract Ceiling: $22,930,533

Exercised Options: $22,930,533

Current Obligation: $22,930,533

Contract Characteristics

Commercial Item: COMMERCIAL PRODUCTS/SERVICES PROCEDURES NOT USED

Cost or Pricing Data: YES

Parent Contract

Parent Award PIID: HHSM500200400005I

IDV Type: IDC

Timeline