World Trade Center Health Program

In Process

At the time of our review, CDC/NIOSH officials were pursuing a CCE contract awards schedule that was driven by the Zadroga Act's program implementation date of July 1, 2011. CDC/NIOSH officials anticipated awarding multiple cost-plus, fixed-fee contracts for the CCEs on June 30, 2011--the day before WTCHP implementation. The CCE request for proposals issued by NIOSH included requirements that were based on the health claims data requirements included in the Zadroga Act. According to NIOSH officials, as of June 21, 2011, all acquisition milestone dates had been met. Subsequent to our briefing, CDC awarded seven CCE contracts on July 1, 2011. If CDC/NIOSH had not met the planned CCE contract award date, CDC/NIOSH officials' contingency plan was to extend the cooperative agreements with the clinical centers under the current World Trade Center health programs administered by NIOSH to provide medical services to responders and survivors. The WTCHP Administrator plans to develop programwide procedures to be used by the CCEs for collecting and reporting of health care claims data after the program is implemented and CCEs begin submitting health care claims for payment. According to the request for proposals, the CCEs will be expected to use the Centers for Medicare and Medicaid Services (CMS) 1500 form or a similar form to collect the needed health claims data. CCEs will be expected to electronically submit, within specified time frames, all valid health care claims for payment. The request for proposals also required that each CCE implement a quality assurance program that includes a review of all health claims forms for completeness and accuracy before the claims are submitted. The Administrator planned to evaluate potential CCEs' capabilities for collecting and reporting health care claims data as part of the contract awards process. According to the request for proposals, members of a technical panel were to evaluate offerors' approach for accomplishing the contract requirements, including the collecting and reporting of health care claims data. The panel members also were to review offerors' narrative descriptions of their accounting systems' capabilities to assess whether each system is adequate for determining costs applicable to the CCE contract as required by the Federal Acquisition Regulation. NIOSH officials stated that the compressed CCE contract awards schedule could not accommodate site visits by its personnel or personnel from an outside entity, such as the Defense Contract Audit Agency (DCAA), to assess the offerors' financial systems' health care claims data capabilities. The officials also stated that they may consider having DCAA assess the CCEs' financial systems after the contracts are awarded. Further, the WTCHP Administrator plans to establish procedures to randomly monitor and/or periodically inspect a CCE's compliance with the timely submission of health care claims data as part of assessing a CCE's contract performance.