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



Centers for Medicare & Medicaid Services (CMS)


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.


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 
    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

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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 
    Regarding Registration Process for Participants, interested persons 
should read the Official Rules and register at the Center of Excellence 
for Collaborative Innovation Challenge portal: http://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 
    Overall, the solution must, at a minimum, meet the following 
    1. Capability to Conduct Identity Verification.
    a. Capability to link individuals to their organizations and vice 
    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 
    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 
     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 
    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 
    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 
    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: http://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: http://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 
    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 

    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]