TRICARE Overseas Program (TOP)
Added: Aug 12, 2014 1:17 pm
This is the PRESOLICITATION NOTICE for the TRICARE Overseas Program (TOP). THIS IS NOT A REQUEST FOR PROPOSAL. The DRAFT RFP was posted on February 21, 2014 under a SPECIAL NOTICE for information purposes only. DHA anticipates posting the formal Request for Proposal on or about 15 days from this notice.The Information contained herein does not necessarily reflect all requirements to be found in any future solicitation. Neither unsolicited proposals nor any other kinds of offers will be considered in response to this PRESOLICITATION Notice. Responses to this notice are not offers and will not be accepted by the Government to form a binding contract. Responders are solely responsible for all expenses associated with responding to this PRESOLICITATION Notice. Responses to the PRESOLICITATION Notice will not be returned.Potential offerors may submit requests for confidential and protected information (Detail Level Claims Data) at this time. The ordering instructions for confidential and protected information are located in Attachment J-5a as an attachment to the notice. Upon release of the RFP, Detail Level Claims Data (in CD-ROM format) will be sent via overnight mail (to U.S. addresses only) free of charge to parties who fulfill the requirements outlined in the ordering instructions.TRICARE OVERSEAS PROGRAM (TOP) OVERVIEWThe TOP contract encompasses a wide range of health care support services for TRICARE-eligible beneficiaries who reside outside the 50 United States and the District of Columbia. These services include the development of host nation provider networks, referral management activities, TRICARE eligibility verification and enrollment, medical evacuations, dental care for Active Duty Service Members (ADSMs) in remote overseas locations, medical record translation services, medical management activities, customer service/call center activities, beneficiary and provider education and marketing, and claims processing. These health care support services are necessary to supplement the health care services provided by overseas MTFs to ensure that eligible beneficiaries have access to the full range of TRICARE benefits, since the overseas MTFs do not have sufficient capability or capacity to meet the demand for services.The TOP has two primary components: (1) health care support services for ADSMs and their command-sponsored Active Duty Family Members (ADFMs) who are enrolled in the TOP Prime option and are referred by MTFs for civilian health care, and (2) health care support services for ADSMs and command-sponsored ADFMs in remote locations who are enrolled in the TOP Prime Remote option. Enrollment in TOP Prime or TOP Prime Remote may also be available to other TRICARE-eligible beneficiaries (e.g., transitional survivors) based on the specific eligibility and enrollment criteria established in the TRICARE Operations Manual (TOM), Chapter 24, Section 6. The TOP contractor is responsible for developing host nation provider networks and providing all related health care support services for TOP Prime and TOP Prime Remote enrollees. Additionally, certain TRICARE beneficiaries ("transient" beneficiaries) are eligible for TOP Prime-like benefits when they require urgent or emergent care while traveling overseas. Finally, the TOP contractor provides customer service/call center support, preauthorization services, and claims processing for TRICARE Standard beneficiaries who reside overseas. Extensive information can be found in the system of TRICARE Manuals (Policy, Reimbursement, Systems, and Operations Manuals) located at http://manuals.tricare.osd.mil. Unique TOP requirements are included in Chapter 12 of the TRICARE Policy Manual and Chapter 24 of the TRICARE Operations Manual.
HT9402-14-R-0001 Defense Health Agency
8/12/14, 1:17 PM TRICARE Overseas Program (TOP)
Added: Feb 21, 2014 11:37 am
INTRODUCTIONThe Defense Health Agency (DHA) wishes to further develop its current TRICARE Overseas Program (TOP) requirements for health care support services, including (but not limited to) customer service/call center support activities, referral/authorization processing, claims adjudication, provider network development and management, beneficiary and provider education, medical evacuations, translation services, and other activities related to the delivery of health care in locations outside the 50 United States and the District of Columbia. DHA seeks feedback from the commercial health care industry regarding the structure of a contemplated formal TOP contract solicitation and the adequacy of its description (as identified in the draft Request for Proposals (RFP) and data attachments attached to this special notice). DHA also seeks information from industry to enable inclusion of commercial best practices into the Government's objectives and requirements in a way that will encourage competition. Suggestions from industry will be considered; however, the Government reserves the right to solicit for the required services in a manner of its choosing in accordance with applicable procurement regulations.DHA is currently in the requirements definition and acquisition planning state for the follow-on to the current TOP contract, which is scheduled to conclude in August 2015 if all options are exercised. Before proposals are formally solicited, DHA is releasing the DRAFT RFP included in this Special Notice for industry comment. Responses to this request for comment on the RFP are due by 4:00 PM Mountain Daylight Time (MDT) on March 25, 2014DISCLAIMERThis Special Notice is issued for informational purposes only and does not constitute a solicitation. Information contained herein does not necessarily reflect all requirements to be found in any future solicitation. Neither unsolicited proposals nor any other kinds of offers will be considered in response to this Special Notice. Responses to this notice are not offers and will not be accepted by the Government to form a binding contract. Responders are solely responsible for all expenses associated with responding to this Special Notice. All information received in response to this Special Notice that is marked Proprietary will be handled accordingly. Responses to the Special Notice will not be returned.This posting constitutes the only DRAFT RFP that will be posted in advance of the formal RFP.TRICARE OVERVIEWThe TOP falls under the Department of Defense (DoD) Military Health System (MHS) and the TRICARE Program.TRICARE is the health care program for approximately 9.6 million active duty and retired members of the Uniformed Services (the U.S. Army, the U.S. Navy, the U.S. Air Force, the U.S. Marine Corps, the U. S. Coast Guard, the Commissioned Corps of the Public Health Service, and the Commissioned Corps of the National Oceanic and Atmospheric Administration), their spouses and children, including TRICARE for Life beneficiaries entitled to Medicare Part A and Part B based on their age, disability and/or end-stage renal disease. Also eligible are Medal of Honor recipients. Military reservists (and their families) are also TRICARE beneficiaries, for the period during which they are on active duty, or if they choose to enroll to TRICARE Reserve Select or the TRICARE Retired Reserve program(s). More information about TRICARE may be found at http://www.tricare.mil.The MHS must be prepared not only to provide a high quality, cost-effective health care benefit to its eligible members during peacetime, but also must be prepared to support the armed forces during exercises, contingencies, operations other than war, and in wartime. The MHS provides quality medical care through: (1) a network of health care providers and pharmacies in the United States and its territories and (2) direct care Military Treatment Facilities (MTFs) (hospitals, health and dental clinics) in the Continental United States and overseas. While the number and size of direct care facilities has declined in recent years, it remains important that MTFs are optimized in order to maintain the clinical skills of military clinical staff to support medical readiness. The direct care system cannot fully support the total demand for health care services; therefore, TRICARE uses the direct care system as the main delivery system and, through contracts, augments the direct care system through a civilian network of providers and facilities serving its eligible members.TRICARE OVERSEAS PROGRAM (TOP) OVERVIEWThe TOP contract encompasses a wide range of health care support services for TRICARE-eligible beneficiaries who reside outside the 50 United States and the District of Columbia. These services include the development of host nation provider networks, referral management activities, TRICARE eligibility verification and enrollment, medical evacuations, dental care for Active Duty Service Members (ADSMs) in remote overseas locations, medical record translation services, medical management activities, customer service/call center activities, beneficiary and provider education and marketing, and claims processing. These health care support services are necessary to supplement the health care services provided by overseas MTFs to ensure that eligible beneficiaries have access to the full range of TRICARE benefits, since the overseas MTFs do not have sufficient capability or capacity to meet the demand for services.The TOP has two primary components: (1) health care support services for ADSMs and their command-sponsored Active Duty Family Members (ADFMs) who are enrolled in the TOP Prime option and are referred by MTFs for civilian health care, and (2) health care support services for ADSMs and command-sponsored ADFMs in remote locations who are enrolled in the TOP Prime Remote option. Enrollment in TOP Prime or TOP Prime Remote may also be available to other TRICARE-eligible beneficiaries (e.g., transitional survivors) based on the specific eligibility and enrollment criteria established in the TRICARE Operations Manual (TOM), Chapter 24, Section 6. The TOP contractor is responsible for developing host nation provider networks and providing all related health care support services for TOP Prime and TOP Prime Remote enrollees. Additionally, certain TRICARE beneficiaries ("transient" beneficiaries) are eligible for TOP Prime-like benefits when they require urgent or emergent care while traveling overseas. Finally, the TOP contractor provides customer service/call center support, preauthorization services, and claims processing for TRICARE Standard beneficiaries who reside overseas. Extensive information can be found in the system of TRICARE Manuals (Policy, Reimbursement, Systems, and Operations Manuals) located at http://manuals.tricare.osd.mil. Unique TOP requirements are included in Chapter 12 of the TRICARE Policy Manual and Chapter 24 of the TRICARE Operations Manual.REQUEST FOR COMMENT - RFP ELEMENTSThis request for comment follows on to an earlier Request for Information (RFI) postings and provides the DRAFT RFP and data attachments for a contemplated formal solicitation. DHA is seeking information and recommendations from industry that will improve its approach to a future TOP health care support services contract that will support the MHS. Your feedback is sought on the structure of this prospective program and the adequacy of its description (as identified in the draft RFP sections and data attachments attached to this special notice). DHA also wishes to take advantage of the expertise of the industry and incorporate best practices and appropriate incentives to ensure the delivery of high quality health care support services to TRICARE beneficiaries overseas. Please remember there are statutory and regulatory limitations, so DHA may not be able to implement recommendations conflicting with these limitations. However, administrative practices which support a more efficient program may be acceptable within these limitations and your presentation of information concerning such practices is welcomed. DHA is providing descriptive data (identified below) in an effort to enhance understanding of the proposed requirements and remove barriers to competition.Comments are being sought at this time on the following elements of the contemplated formal solicitation. Responders are asked to key their comments to specific paragraphs/sections in the documents where appropriate. The elements are included as file attachments to this Special Notice:DRAFT RFP (Sections A through K) Technical Exhibit A: Contract Data Requirements List (CDRLs)The initial set of historical data and other information is being provided with this Special Notice in order for potential respondents to gain a better appreciation of the scope of the contemplated contract activity and to allow for more meaningful responses. It is expected that additional data will be made available as it is developed during the course of this acquisition.CONCLUSIONPlease submit responses via e-mail in Microsoft Office 2010 format or hard copy by 4:00 PM Mountain Daylight Time (MDT) on March 25, 2014 to the Point of Contact (POC). Earlier responses are encouraged.This Special Notice seeks feedback of the DRAFT RFP (to include the data attachments) and the adequacy of its description. To the extent that simplifying assumptions are needed, respondents are encouraged to make and document such assumptions in their responses. Additionally, the Government seeks industry's feedback on alternative concepts or new technologies or approaches that could meet the functional requirements of the contemplated solicitation. Capability statements, promotional material, or sales pitches are not desired. Responses by consultants or attorneys shall disclose themselves as such and describe or identify the client or clientele served. Comments regarding any TOP postings prior to this Special Notice will not be entertained at this time.
HT9402-14-R-0001 Defense Health Agency
2/21/14, 11:37 AM