17-233-SOL-00263_000001.pdf

(x)

17-233-SOL-00263

x x

1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT

THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

x

DAM

Bethesda MD 20814 8th Floor 7700 Wisconsin Avenue

DHHS/PSC/AMS/DAM

03/30/2017000001

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

7. ADMINISTERED BY (If other than Item 6)CODE 6. ISSUED BY

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

03/20/2017

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

E. IMPORTANT: Contractor is not, is required to sign this document and return __________________ copies to the issuing office.

ORDER NO. IN ITEM 10A.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

The purpose of Amendment 000001 is the following:

1. REMOVE subsection L.9.1 (requirement to submit the SF1449) in its entirety.

2. CORRECT/CHANGE the header on the RFP document FROM "Office of Adolescent Health" TO

"Office of Public health Service"

3. REMOVE Attachment C (reflected under Section J-List of Attachments on page 37 of 68) in its entirety. The requirement to complete and submit this form is no longer applicable.

Continued ...

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

JESSICA TREANOR

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

NSN 7540-01-152-8070

Previous edition unusable

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 2

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

17-233-SOL-00263/000001

4. CORRECT the email address listed for Jessica

Treanor for question submission and proposal submission in Section L.6-INQUIRIES/SUBMISSION on page 59 of 68.

4. Extend the submission date for QUESTIONS ONLY from Wednesday, March 29, 2017 TO Friday, April

7, 2017 at 8:00am, EST (See page 59 of 68). (The date and time indicated for proposal submission remains UNCHANGED).

A revised version of the RFP is enclosed with this Amendment 000001 and should be the ONLY version of the RFP referenced from this point forward. All revisions indicated above, as well as revisions made in response to questions from potential offerors, were completed using track changes for convenient viewing.

All other terms and conditions of the RFP remain unchanged.

Period of Performance: 07/03/2017 to 07/02/2022

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

Office Of Public Health Service Public Health Service Active Duty Dental Program (PHS ADDP)

Solicitation/RFP #: 17-233-SOL-00263 Page 1 of 68

COMBINED SYNOPSIS/SOLICITATION

This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; quotes are being requested and a written solicitation will not be issued. The solicitation number is 17-233-SOL-00263. This solicitation is being issued as a RFP. This solicitation and incorporated provisions and clauses are those in effect through Federal Acquisition Circular 2005-95. The corresponding NAICS code is 524114 and the small business size standard is $38.5M. This requirement is unrestricted (open to Large and Small Businesses) for quote submission. The resultant award shall be a Time and Materials Award.

Solicitation/RFP #: 17-233-SOL-00263 Page 2 of 68

SECTION A - Solicitation/Contract Form

SECTION B - Supplies or Services and Prices/Costs

B.1 BRIEF DESCRIPTION OF SERVICES

B.2 TYPE OF CONTRACT

The contract type awarded is a Time and Materials type contract.

B.3 SEVERABLE SERVICES

The services acquired under this contract are severable services. Funds are only available for use for the contract line item (CLIN) to which they are obligated. Unused funds from one CLIN may not rollover for use in other CLINs.

B.4 CONSIDERATION AND PAYMENT

The Service Provider (SP) shall be paid in accordance with the schedule shown below upon submission of a proper voucher and completion and acceptance by the Government, of all work performed during the monthly or quarterly billing period for the Public Health Service Active Duty Dental Program@(PHS ADDP). The annual claims adjudication numbers given below are estimates only, based on the projected size of the PHS Commissioned Corps (CC) over the next four and one/half years and cannot be guaranteed. The SP will be paid based on the actual number of claims and predeterminations processed.

All claim amounts paid by the SP on behalf of the PHS for dental services rendered to PHS CC Officers will be reimbursed on an actual cost basis. Claim amounts will be paid under a separate agreement to be agreed upon by PHS and the SP.

Only amounts bid for the work contained in Sections C.5.1. (Claims Adjudication and Payment) should be placed on Line Item 0001, Claims Adjudication & Payment, of the Bid Schedule. Amounts bid for work in other sections should be placed on Line Item 0002 Pre-Determination Processing.

CLIN 1 - Base Year: July 3, 2017 through July 2, 2018

Item No.

Supplies/Services Quantity Unit Fixed Unit Price Total

Claims Adjudication & Payment

15000

EA

Pre-Determination Processing

TOTAL ESTIMATED COST FOR BASE YEAR $___________

Solicitation/RFP #: 17-233-SOL-00263 Page 3 of 68

CLIN 2 – Option Year 1: July 3, 2018 through July 2, 2019

TOTAL ESTIMATED COST FOR OPTION YEAR 1 $___________

CLIN 3 – Option Year 2: July 3, 2019 through July 2, 2020

TOTAL ESTIMATED COST FOR OPTION YEAR 2 $___________

CLIN 4 – Option Year 3: July 3, 2020 through July 2, 2021

TOTAL ESTIMATED COST FOR OPTION YEAR 3 $___________

CLIN 5 – Option Year 4: July 3, 2021 through July 2, 2022

TOTAL ESTIMATED COST FOR OPTION YEAR 4 $___________

Solicitation/RFP #: 17-233-SOL-00263 Page 4 of 68

TOTAL ALL YEARS July 3 2017 through July 2, 2022

TOTAL ESTIMATED COST FOR ALL YEARS $ _________

B.5 CEILING PRICE

The quantity states in each of the CLINs above are for budgeting purposes only. The quantity of each item number may exceed or be less than the estimate by item number as long as the ceiling price for the CLIN is not exceeded. The ceiling for each CLIN is identified in Section B. The Government shall not be obligated to pay any amount in excess of this ceiling price nor is the Contractor obligated to continue performance if to do so would exceed this ceiling price. In the event that the Government chooses to exercise optional CLINS, unused funds from a previous CLIN may not be used to fund any services taking place in a subsequent CLIN. The ceiling price may be modified by the Government if it is determined that the quantity is insufficient for the work required.

Solicitation/RFP #: 17-233-SOL-00263 Page 5 of 68

SECTION C - Description/Specifications/Statement of Work

C.1 ACRONYMS AND DEFINITIONS

Acronym Definition

Public Health Service Active Duty Dental Program

PHS ADDP

Beneficiary Medical Program

BMP

Medical Affairs

MA

Dental Service Point of Contact

DSPOC

Commissioned Corps

CC

Public Health Service

PHS

Service Provider

SP

Quality Control Plan

QCP

Quality Assurance Surveillance Plan

QASP

Quality Assurance Evaluator

QAE

Health Insurance Portability and Accountability Act

HIPAA

Dental Explanation of Benefits

DEOB

C.2 BACKGROUND

The PHS Commissioned Corps (CC) consists of approximately 6,500 officers working in the following categories: Medical, Dental, Nurse, Pharmacy, Veterinarian, Scientist, Engineer, Environmental Health, Dietitian, Therapy and Health Services.

Medical Affairs’ (MA) mission is to ensure that all CC officers have access to cost-effective, quality health care services in accordance with established polices and standards set by the Public Health Service, while simultaneously ensuring that all CC officers are fit for duty. The Beneficiary Medical Program (BMP) is the component of MA responsible for facilitating access to health care services for active duty CC officers, family members, retirees, and retiree dependents, with its primary focus being on the active duty PHS Officer. The BMP came into existence at a time when healthcare resources for remotely stationed officers were limited.

Beginning on October 16, 2003 the BMP of MA underwent an A-76 Streamlined Competition Study that reviewed the dental claims processing function provided by BMP for active duty PHS Officers. On December 5, 2003 the A-76 Performance Decision announced that the BMP claims processing function could be performed in the private sector by a dental service provider at a lower cost to the government. The Performance Decision also stated that the contracting officer shall award the dental service provider a contract for processing the dental claims and pre- determinations.

Solicitation/RFP #: 17-233-SOL-00263 Page 6 of 68

C.3 OBJECTIVES

Outsource the PHS CC dental claims processing function and support services, to a commercial dental service provider.

Develop and implement an electronic dental pre-authorization process.

Provide the required dental services in the most efficient and cost effective manner practicable using a combination of best commercial management practices and federal entitlement requirements.

Provide data to support PHS’s financial planning, dental resources planning, contract administration and readiness and deployment planning.

C.4 GOVERNMENT FURNISHED PROPERTY (GFP) AND SERVICES

C.4.1 Government Furnished Data

The Government will furnish electronic personnel files to create an eligibility and benefits profile for each officer. The Government will provide direct contact information for IT issues to the SP to facilitate the transfer of data and IT problem resolution.

C.5. PERFORMANCE WORK STATEMENT

At a minimum the SP shall provide dental care management services that will include the objectives listed below:

Claims adjudication, payment and support services. The selected provider must have the financial capability to pay all dental claims weekly (approximately $75,000-$100,000) and be reimbursed up to 30-35 days later. Up to approximately $380,000 may be paid out each month.

Pre-authorization support services

Access to SP’s Network Dentists

Statutory requirements

Interactive website for beneficiaries and providers

Program and data security

Utilization review system and reports

Fraud and abuse detection system Toll free customer service calls 60 hours per week (Monday-Friday)

C.5.1. Claims Adjudication and Payment Requirements

C.5.1.1 The SP shall process claims to payment or denial in an accurate and timely manner.

C.5.1.2. Conditions of Performance

SP will submit dental claims and all pre-authorizations, over $2,000, to the PHS DSPOC (DSPOC indicated at time of award) for review.

After the review by the PHS DSPOC the claims and pre-authorizations will be forwarded to the SP for processing and payment.

The DSPOC will clearly indicate which claims and/or pre-authorizations are to be paid/approved.

The DSPOC will clearly indicate which claims and/or services are to be denied.

Justification will be provided by the DSPOC to the SP for denied claims and/or services.

Solicitation/RFP #: 17-233-SOL-00263 Page 7 of 68

The SP will accept various types of claim forms for processing payments such as the Universal ADA Dental Claim Forms, Super Bills, etc.

Verification of beneficiary eligibility shall be performed by the DSPOC prior to submitting the claims to the SP for processing.

The original Dental Explanation of Benefits (DEOB) with the check for payment attached or enclosed is to be mailed to the provider with a copy of the EOB sent to the beneficiary.

The SP shall reimburse OCONUS beneficiaries in U.S. dollars using the exchange rate for the date of service.

The SP may pay OCONUS providers directly using the local currency based on the exchange rate for the date of service.

For dental coding purposes the SP shall use the most current version of the American Dental Association’s (ADA) Current Dental Terminology (CDT).

OCONUS providers shall not be expected to submit standard claim forms or to utilize the ADA’s CDT. The DSPOC shall utilize all submitted information on OCONUS claims to cross reference the services with the CDT for claims processing and payment purposes.

Report cases of claims fraud and abuse and the resolution to the DSPOC.

C.5.1.3. Standards of Performance Category Standard

Process Claim to Completion 90% within 14 calendar days* 98% within 30 calendar days* 100% within 60 calendar days*

* This standard is for clean claims only. The standard evaluation times start upon the SP’s receipt of claims from dental providers.

Claim Payment Accuracy 95% Coding Accuracy 95%

C.5.1.4. Workload Requirements (Estimated)

Base Year 16,000 Claims/Pre-authorizations Option Year 1 16,000 Claims/Pre-authorizations Option Year 2 16,000 Claims/Pre-authorizations Option Year 3 16,000 Claims/Pre-authorizations Option Year 4 16,000 Claims/Pre-authorizations

C.5.2. The SP shall provide access to network providers.

C.5.2.1 Conditions of performance

Access to network providers shall be provided to beneficiaries, where available.

Access to network providers shall include specialists, where available.

The SP will not be penalized for failure to provide access to network providers based on the lack of network providers in remote geographical areas of the U.S. or OCONUS.

Beneficiaries will be encouraged but not be required to see a network provider.

Beneficiaries may choose a non-network provider over a network provider without penalty.

The SP is encouraged to enroll non-network providers into the SP’s network.

All Network Providers shall be subjected to a credentialing process that includes, at a minimum, verification of State licensure and malpractice insurance coverage in keeping with State minimums.

The SP may not require a non-network provider to join the SP’s network to participate in the program.

Solicitation/RFP #: 17-233-SOL-00263 Page 8 of 68

C.5.3. The SP shall comply with all statutory requirements.

C.5.3.1 Conditions of Performance

The SP shall document and employ procedures to assure confidentiality of all beneficiary and provider information. This includes the protection of rights of the individual in accordance with the provisions of the Privacy Act [5 U.S.C. 552(a)]; the Freedom of Information Act (FOIA) (5 U.S.C.

552); the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) Reorganization Act (RA) (42 U.S.C. 290dd-2) and the HIPAA Privacy Regulation, 45 CFR Subtitle A, Subchapter C, Part 160 and part 164, Subpart E. The SP shall prevent unauthorized use of files and comply with all applicable requirements of the Health Insurance Portability and Accountability Act (HIPAA).

All non-compliance must be reported no later than the next business day after discovery to the Contracting Officer and the COR.

C.5.3.2. Standard of Performance

Compliance with the Privacy Act, FOIA, HIPAA and ADAMHARA 100%

C.5.4. The SP shall provide access to an interactive website.

C.5.4.1. Conditions of Performance

Beneficiaries and providers shall have 24 hour, 7 days a week access to the SP’s website except during routine website maintenance and for emergency repairs.

The website shall allow beneficiaries and providers to review enrollment and claims status.

The website shall also provide a current list of network providers with the provider’s current contact information including address and telephone number.

The network provider list shall be searchable by zip code and/or city and state.

C.5.5. The SP shall provide security for protection of the program data.

C.5.5.1. Conditions of Performance

The SP shall provide internal and external security measures to guarantee protection for the sensitive and personal information used to administer the program.

All contractor personnel that work on the USPHS Dental Program shall have ADP Level II clearance.

The SP must be National Institute of Standards and Technology (NIST) compliant or have the DoD Information Assurance Certification and Accreditation Process (DIACAP) and Authority to Operate (ATO).

The SP shall report no later than the next business day all security breaches to the COR and the Contracting Officer.

Solicitation/RFP #: 17-233-SOL-00263 Page 9 of 68

1.5.6. The SP shall provide Utilization Review Reports.

C.5.6.1. Conditions of Performance

1.5.6.1.1. Bi-annual Report (electronic copy to be submitted to the COR and the CO) to include the following:

Utilization report listing the number of paid services during the reporting period.

Post-utilization review reports highlighting any identifiable patterns of provider fraud and/or abuse.

Ad-hoc reporting as requested from existing data.

Progress report including a compilation of all monthly reports for the reporting period

1.5.6.1.2. Annual Report-for Each Contract Year (electronic copy to be submitted to the COR and the CO) to include the following:

Utilization report listing the number of paid services during the reporting period.

Post-utilization review reports highlighting any identifiable patterns of provider fraud and/or abuse.

Ad-hoc reporting as requested from existing data.

Progress report including a compilation of all monthly reports for the reporting period

C.5.7. The SP shall participate in a Transition Period

There will be a transition period between Award and the full performance start date, for the purposes of SP staffing, cross training, familiarization, systems testing, etc. The transition period shall be no longer than 90 calendar days in duration, to commence not more than 5 calendar days after Award. Within 10 days after Award, the SP shall submit a transition plan to the COR for approval. The transition plan shall include a schedule for implementation. By the end of the transition period, the SP shall be ready to perform this PWS in full, with all key and non-key personnel in place and performing assigned functions.

C.5.8. Benefits

Active Duty PHS Officers have a statutory entitlement to dental care. Officers have no deductible, no co-payment and no maximum benefit. PHS will determine covered and non-covered benefits based on PHS policy and regulations.

C.5.9 Eligibility

The PHS DSPOC will provide the final determination concerning an individual’s eligibility for benefits.

PHS will provide the SP with an electronic eligibility file on a frequency schedule agreed upon by PHS and the SP.

C.5.10. Customer Support

The COR shall set and maintain cost and schedule estimates for any change orders coming into the MA possession. After the COR and Contracting Officer authorize work, the SP shall maintain direct contact with customers and other support organizations, to meet customers’ needs.

Solicitation/RFP #: 17-233-SOL-00263 Page 10 of 68

C.5.11. Quality Assurance

C.5.11.1. Quality Control Plan (QCP)

1. The SP shall internally develop and implement a new QCP or utilize an existing QCP that will provide top SP management with an effective and efficient means of identifying and correcting problems throughout the entire scope of operations. The initial QCP shall be submitted with the contractor’s proposal and shall be revised, as needed, by the SP during the life of the contract.

2. A file of all QC inspections both performed and scheduled, inspection results, dates and details of corrective actions taken shall be maintained by the SP through the term of this award. The SP shall submit an electronic copy of the report containing the periodic QC inspections, as well as a summary of defects observed and corrected to the COR.

C.5.11.2. Quality Assurance Surveillance Plan (QASP)

The Government intends to utilize a Quality Assurance Surveillance Plan (QASP) to monitor the quality of the Contractor’s performance. The oversight provided for in the contract and in the QASP will help to ensure that service levels reach and maintain the required levels throughout the contract term. Further, the QASP provides the COR with a proactive way to avoid unacceptable or deficient performance, and provides verifiable input for the Contractor Performance Assessment Reporting System (CPARS). The QASP may be updated by modification to the contract. The Government’s QASP is not a substitute for Quality Control by the SP. All costs associated with rework are the responsibility of the SP.

***THIS IS A SAMPLE AND CAN BE REPLACED/UPDATED AS NEEDED. IT IS AT THE

DISCRETION OF THE OFFEROR TO SUBMIT A QASP THAT IS INCLUSIVE OF THE TASKS

PRESENTED IN THE PERFORMANCE WORK STATEMENT. A FINAL AGREED UPON QASP WILL

BE INCLUDED UPON CONTRACT AWARD.***

Required Services/Tasks

Performance Standards

Method of Surveillance (Quality Assurance)

Standard to be Met/ Allowable Deviation

Customer Satisfaction

Contractor complies with SOW specifications. Contractor adheres to guidance provided by COR.

COR feedback

Fewer than 2 written complaints from COR during the period of performance.

Overall Contract Management, Including Timeliness

Contractor maintains high level of quality assurance.

Contractor informs COR timely of issues or problems.

Contractor meets time frames agreed upon.

COR and Contracting Officer monitoring and review of activities and deliverables.

COR makes no more than 2 valid written complaints during the period of performance. No more than a two week delay in agreed upon schedule.

Written Products

Contractor provides high-quality written materials.

COR and other federal staff reviews of draft and final products.

Minimal rewriting or editing required; product utilized (e.g., disseminated) as planned.

Cost Performance Contractor is performing within the budget of the contract.

COR to review monthly invoices and cost reports

Contractor shall perform within the negotiated budget/cost of the contract each month.

Solicitation/RFP #: 17-233-SOL-00263 Page 11 of 68

C.5.12. Disclosure of Activities or Information

Neither the SP nor its employees shall disclose, or cause to be disclosed, any information, the release of which could result in, or increase the likelihood of, a breach of security, or adversely affect the continuity of MA operations. The SP shall brief all its employees on the handling of sensitive information and procurement sensitive and proprietary technical data. The SP shall be responsible and liable for all unauthorized disclosures of, or loss of control over, classified and protected information, regardless of the likelihood of compromise or the degree of harm to national security resulting there from. The SP shall refer outside Requests for Information (RFI) to the Contracting Officer.

The SP shall fully comply with the most recent and current Federal, state, and local laws and regulations, the conditions and requirements of all environmental permits, CC directives and instructions, and other matters set forth in Section C-5. The SP shall document all Standard Operating Procedures (SOP).

C.5.13. Technical Data

The SP shall not use, disclose, transfer, convert, or otherwise appropriate any technical data for non-authorized use during the performance of this PWS, unless written permission from the COR and the Contracting Officer is obtained.

C.5.14. Liability for Violations

The SP shall perform all work in accordance with environmental laws and regulations, and the terms and conditions of permits issued by competent regulatory authority. Non-compliance with environmental requirements is grounds for cancellation of this award.

The SP is liable to PSC for fines, civil penalties, and other assessments levied against the Government by competent regulatory authority, as a result of spills, releases, and other violations of environmental laws or regulations, for which it is legally responsible. Additionally, the SP shall be liable for PSC’s transaction costs incurred in responding to enforcement proceedings initiated as a result of action or inaction by the SP. Likewise, the SP is liable to the PSC for injury to persons (including without limitation, Government employees, MA contractor personnel, and invitees) and damage to Government property (including Government furnished property), resulting from the performance of any work under this PWS, for which it is legally responsible.

C.5.15. Payments (PLEASE ALSO SEE SECTION G.5 FOR ADDITONAL INVOICE INFORMATION)

C.5.15.1. Paid Claims Reimbursement

1. The SP will be reimbursed for paid claims on a weekly basis.

2. The SP shall submit an itemized statement for payment consisting of the provider’s name, date of payment issuance, and paid amount.

3. The SP will identify a bank and account number for the electronic deposit of funds to reimburse the SP for paid claims.

4. Billing details to be provided upon contract award.

C.5.15.2. Administrative Service Bills

1. The SP will be paid for administrative service costs on a monthly basis.

2. The SP shall submit an itemized bill for payment.

3. The SP will identify a bank and account number for the electronic deposit of funds to reimburse the SP for paid claims.

4. Billing details to be provided upon contract award.

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C.5.16 Staffing Requirements

PHS does not require or expect the SP to dedicate staff to the performance of this contract. However, PHS does expect that qualified staff members will be utilized at all times in the performance or support of this contract. All individuals that work on the USPHS Dental Program shall have ADP Level II clearance.

C.5.17. SP Electronic Pre-determination Capability Statement (4 pages or less, included in maximum page count for Technical Proposal)

A complete response to this RFP requires a brief, general, descriptive narrative addressing the capability of the SP to develop, implement and support an electronic dental pre-determination system.

Pre-determination requests would be submitted to the SP for entering into an electronic format and for electronic submission to the PHS DSPOC for review. The DSPOC would return the approval or denial to the SP for forwarding to the provider. The statement may give examples of the SP’s current or planned systems that are similar in nature to the stated future objective. Statements considering the utilization of the SP’s dental consultants for pre-determination with program oversight by the PHS DSPOC are encouraged. Oversight by the PHS DSPOC is required. PHS reserves the right to choose not to implement the proposed electronic pre-determination system if the cost is prohibitive.

C.5.18. Some of the frequently paid ADA codes for PHS claims are:

D0120 Periodic Oral Evaluation D0140 Limited Oral Evaluation

D0150 Comprehensive Oral Evaluation D0180 Comprehensive Periodontal Evaluation D0210 Intraoral - Complete Series D0220 Intraoral - Periapical - 1st Film

D0230 Intraoral - Periapical Each Additional Film D0272 Bitewings - Two Films D0274 Bitewings - Four Films D0330 Panoramic Film D1110 Prophylaxis D2140 Amalgam - One Surface D2150 Amalgam - Two Surface D2330 Resin/Comp - One Surface, Ant D2331 Resin/Comp - Two Surface, Ant D2332 Resin/Comp - Three Surface, Ant D2391 Resin/Comp - One Surface, Post D2392 Resin/Comp - Two Surface, Post D2393 Resin/Comp - Three Surface, Post D2740 Crown - Porcelain/Ceramic substance D2750 Crown - Porcelain - High Noble Metal D2790 Crown - Full Cast High Noble Metal D2950 Core Buildup D3310 Anterior Endo D3320 Bicuspid Endo D3330 Molar Endo

D4341 Periodontal Scaling & Root Planing D4910 Periodontal Maintenance D6010 Surgical Placement of implant body D6057 Custom fabricated abutment D6058 Implant related Abutment supported Porcelain/Ceramic crown D6240 Pontic – Porcelain fused to High Noble Metal D6750 Retainer Crown - Porcelain High Noble Metal D6790 Retainer Crown - Full Cast High Noble Metal

Solicitation/RFP #: 17-233-SOL-00263 Page 13 of 68

D7140 Extraction of Erupted Tooth or exposed root.

D7210 Surgical Removal of Erupted Tooth

D9243 Intravenous moderate (conscious) sedation-15 min increment D9940

Occlusal Guard

C.5.19. Excluded Dental Procedures

Orthodontics and/or Orthognathic Surgery

Developmental Growth Deformities

Cosmetic Dentistry: Bleaching, Veneers

Inlays

C.5.20. Customer Service Requirements:

C.5.20.1 The SP shall provide call center and approved support services.

C.5.20.1.1 Conditions of Performance

1. The call center number shall be a toll free number for CONUS beneficiaries.

2. Telephone calls shall not be dropped or blocked.

3. Call center hours should be 0800-2000 EST Monday through Friday.

4. Call center shall provide, at minimum, general information, assistance in locating providers, and claims status.

5. An Automated Response Unit may be used to answer incoming telephone calls but must offer the option to speak with a customer service representative during normal business hours.

C.5.20.1.2. Standards of Performance

Telephone Answering Initial Answer 90% within 45 seconds

C.5.20.1.3. Workload Requirements (Estimated)

9,100 calls per contract year

C.5.20.2 The SP shall respond to all correspondence, written and electronic.

C.5.20.2.1. Conditions of Performance

1. The SP’s response to correspondence may be in the form of written correspondence, fax, telephone or e-mail as appropriate to the initial contact and nature of the request.

2. The date of receipt and date of response are to be used to determine compliance with the Standards of Performance.

3. High priority correspondence is defined as correspondence from Members of Congress, HHS/PHS Senior Leadership, attorneys representing beneficiaries and other similar correspondence.

4. Copies of high priority correspondence and the response shall be forwarded to the DSPOC.

5. Routine correspondence is all other correspondence.

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C.5.20.2.2. Standards of Performance

Category Standard

High Priority Written 95% within 7 business days Correspondence 100% within 20 business days

Routine Written 85% within 10 business days Correspondence 100% within 30 business days

Saturday and Sunday are not considered business days.

C.5.20.2.3. Workload Requirements (Estimated)

100 Routine written correspondences per contract year.

< 2 High Priority written correspondences per contract year.

C.5.20.3 The SP shall provide a grievance process.

C.5.20.3.1. Conditions of Performance

The grievance process must resolve complaints in a timely, consistent and unbiased manner.

Written complaints shall be documented by the SP to evaluate trends and determine solutions.

The SP’s response to complaints may be in the form of written correspondence, fax, telephone or e-mail as appropriate to the initial contact and nature of the complaint.

Complaints that cannot be resolved by the SP must be forwarded to the DSPOC for resolution in a timely manner.

C.5.20.3.2. Standards of Performance

Complaint Resolution 90% in 30 calendar days 100% in 60 calendar days

C.5.20.3.3. Workload Requirements (Estimated)

Five written complaints per contract year

C.6 PROTECTION OF INDIVIDUAL PRIVACY (PRIVACY ACT)

This contract specifically provides for the design, development, or operation of a system of records on individuals. Therefore, in accordance with the Privacy Act of 1974 (5 U.S.C. 552a) and FAR Subpart 24.103, the system of records on individuals that is applicable to this contract is:.

09-40-0001 Public Health Service (PHS) Commissioned Corps General Personnel Records 09-40-0005 Public Health Service (PHS) Beneficiary-Contract Medical/Health Care Records

The contractor and its employees are subject to criminal penalties for violations of the Act (5 U.S.C. 552a(i)) to the same extent as employees of the Department of Health and Human Services. The contractor does hereby agree and assures that each one of its employees know the prescribed rules of conduct, and each employee is aware that he/she can be subjected to criminal penalties for violations of the Act. A copy of the rules of conduct and other requirements are set forth in 45 CFR Part 5b. NOTE: See H.9 HIPAA BUSINESS ASSOCIATE CLAUSE (2006) and H.10 ADDITIONAL HIPAA PRIVACY TERMS for instructions regarding how to handle the system(s) of records on individuals and other confidential records and information upon completion of performance of the contract.

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C.7 HHS SECTION 508 ACCESSIBILITY STANDARDS

This contract is subject to Section 508 of the Rehabilitation Act (the Act) of 1973 (29 U.S.C. 794d), as amended by the Workforce Investment Act of 1998, and the Architectural and Transportation Barriers Compliance Board (Access Board) Electronic and Information Accessibility Provisions (36 CFR Part 1194). Section 508 of the Act requires that, unless an exception applies, all communications products and services that require a contractor or consultant to produce content in any format that is specifically intended for publication on, or delivery via, a federally owned or federally funded website permit the following:

1. Federal employees with disabilities to have access to and use information and data that is comparable to the access and use of information and data by federal employees who are not individuals with disabilities.

2. Members of the public with disabilities seeking information or services from a federal agency to have access to and use of information and data that is comparable to the access and use of information and data by members of the public who are not individuals with disabilities.

(Note: Information about Section 508 of the Act is available at http://www.section508.gov/. The complete text of Section 508 can be accessed at https://www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-section-508-standards/section-508-standards

Accordingly, regardless of format, all web content or communications materials specifically produced for publication on, or delivery via, HHS websites, including text, audio, or video, under this contract shall conform to applicable Section 508 accessibility standards. Remediation of any materials that do not comply with the applicable accessibility standards of 36 CFR Part 1194 as set forth herein shall be the responsibility of the Contractor.

1194.22 Web based intranet and Internet information and applications

SECTION D - Packaging and Marking - RESERVED http://www.section508.gov/ https://www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-section-508-standards/section-508-standards https://www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-section-508-standards/section-508-standards

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SECTION E - Inspection and Acceptance

E.1 INSPECTION AND ACCEPTANCE

Pursuant to FAR clause 52.212-4, all work described in Section C to be delivered under this contract is subject to final inspection and acceptance by an authorized representative of the Government. The authorized representative of the Government is the Contracting Officer’s Representative (COR), who is responsible for inspection and acceptance of all services, materials, or supplies to be provided by the Contractor.

E.1.1 Inspection and Acceptance Criteria Final inspection and acceptance of all work performed, reports and other deliverables will be performed at the place of delivery by the COR.

E.1.2 General Acceptance Criteria General quality measures, as set forth below, will be applied to each work product received from the Contractor under this Statement of Work.

Accuracy - Work Products shall be accurate in presentation, technical content, and adherence to accepted elements of style.

Clarity - Work Products shall be clear and concise. Any/all diagrams shall be easy to understand and be relevant to the supporting narrative.

Consistency to Requirements - All work products must satisfy the requirements of this Statement of Work.

File Editing - All text and diagrammatic files shall be editable by the Government.

Format - Work Products shall be submitted in hard copy and electronic copy. The electronic copy must be in a format as indicated in the Deliverables Table.

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SECTION F - Deliveries or Performance

F.1 PERIOD OF PERFORMANCE – Severable Services

The period of performance shall be for a base period of 12 months with four, 12-month option periods, as follows:

Base Period: July 3, 2017 through July 2, 2018 Option Period 1: July 3, 2018 through July 2, 2019 Option Period 2: July 3, 2019 through July 2, 2020 Option Period 3: July 3, 2020 through July 2, 2021 Option Period 4: July 3, 2021 through July 2, 2022

Option periods may be exercised in accordance with FAR Clause 52.217-9 entitled "Option to Extend the Term of the Contract."

F.2 PLACE OF PERFORMANCE

Work will be performed at the Contractor’s facility

F.3 DELIVERABLES AND DELIVERY SCHEDULE

The contractor shall submit all required report(s)/deliverables in accordance with the following schedule: All reports shall reference and cite the contract number.

Deliverable Due

Standards Implementation 5 Days After Award

Transition/Phase-In Plan 10 Days After Award Project Implementation Plan 30 Days After Signing Contract QC Inspection Reports TBD as applicable

Beneficiary Satisfaction Report TBD as applicable

Monthly Progress Reports 15 th

Day of Each Month

Bi-annual report 15 th day of the 6 th month after start of each year

Annual Report 15 th day prior to the end of each contract year

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SECTION G - Contract Administration Data

G.1 PROVISIONS APPLICABLE TO MATERIAL COSTS

Unless otherwise expressly provided elsewhere in the contract or in any modification thereto, the cost of the following items or activities shall be unallowable as material costs:

1. Acquisition by purchase or lease, of any interest in real property.

2. Special rearrangement or alteration of facilities;

3. Purchase or lease or rental of any item of general purpose; office furniture or office equipment (including data tapes);

4. Travel to foreign countries; and

5. Food and beverage costs unless part of per diem expenses paid in accordance with the Federal Travel Regulations.

Any equipment having a unit acquisition cost in excess of $1,000.00, of which the Contractor wishes to be reimbursed as a material cost, shall not be acquired by the Contractor without the specific advance written approval of the Contracting Officer.

G.2 AUTHORITIES OF GOVERNMENT PERSONNEL

Notwithstanding the Contractor's responsibility for total management during the performance of this contract, the administration of this contract will require maximum coordination between the Government and the Contractor. The following individuals will be the Government's points of contact during the performance of this contract:

Contracting Officer Name: Jessica Treanor Address: 7700 Wisconsin Avenue, Bethesda, MD 20814 Phone: 301-492-4527 Email: Jessica.Treanor@psc.hhs.gov

All communications pertaining to contractual and/or administrative matters under this contract shall be sent to:

Contract Specialist Name: Jessica Treanor Address: 7700 Wisconsin Avenue, Bethesda, MD 20814 Phone: 301-492-4527 Email: Jessica.Treanor@psc.hhs.gov

Contracting Officer's Representative Name: TBD Address: TBD Phone: TBD Email: TBD

Note: The Contracting Officer is the only individual authorized to modify the contract.

mailto:Jessica.Treanor@psc.hhs.gov mailto:Jessica.Treanor@psc.hhs.gov

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G.3 CONTRACTING OFFICER'S REPRESENTATIVE (COR) AUTHORITY

(a) Performance of work under this contract must be subject to the technical direction of the Contracting Officer's Representative identified above, or a representative designated in writing. The term "technical direction" includes, without limitation, direction to the contractor that directs or redirects the labor effort, shifts the work between work areas or locations, fills in details and otherwise serves to ensure that tasks outlined in the work statement are accomplished satisfactorily.

(b) Technical direction must be within the scope of the specification(s)/work statement.

The Contracting Officer's Representative does not have authority to issue technical direction that:

(1) Constitutes a change of assignment or additional work outside the specification(s)/statement of work;

(2) Constitutes a change as defined in the clause entitled "Changes";

(3) In any manner causes an increase or decrease in the contract price, or the time required for contract performance;

(4) Changes any of the terms, conditions, or specification(s)/work statement of the contract;

(5) Interferes with the contractor's right to perform under the terms and conditions of the contract; or

(6) Directs, supervises or otherwise controls the actions of the contractor's employees.

(c) Technical direction may be oral or in writing. The Contracting Officer's Representative shall confirm oral direction in writing within five work days, with a copy to the Contracting Officer.

(d) The contractor shall proceed promptly with performance resulting from the technical direction issued by the Contracting Officers, Representative. If, in the opinion of the contractor, any direction of the Contracting Officers, Representative, or his/her designee, falls within the limitations in (b), above, the contractor shall immediately notify the Contracting Officer no later than the beginning of the next Government work day.

(e) Failure of the contractor and the Contracting Officer to agree that technical direction is within the scope of the contract shall be subject to the terms of the clause entitled "Disputes."

G.4 GOVERNMENT-FURNISHED PROPERTY

The Government will provide the following items(s) of Government property to the Contractor for use in the performance of this contract. The property shall be used and maintained by the Contractor in accordance with the HHS Contractors' Guide for Control of Government Property (Appendix Q of the HHS Logistics Management Manual) found at https://web.archive.org/web/20111015044731/http:/www.hhs.gov/hhsmanuals/.

The Contractor shall be responsible and accountable for all government property; either furnished or acquired, and also is required to keep the Government's official records of Government property in their possession and control. The following item(s) of Government property are hereby furnished to the Contractor:

The Government will furnish electronic personnel files to create an eligibility and benefits profile for each officer. The Government will provide direct contact information for IT issues to the SP to facilitate the transfer of data and IT problem resolution.

https://web.archive.org/web/20111015044731/http:/www.hhs.gov/hhsmanuals/

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G.5 INVOICE SUBMISSION - COMMERCIAL

The Contractor shall submit invoices once per month. A complete invoice with all required back-up documentation shall be sent electronically, via email, to:

1. Contract Specialist: Jessica.Treanor@psc.hhs.gov

2. PSC DAM mailbox: pscsas.invoices@psc.hhs.gov

3. Contracting Officer's Representative (COR): TBD

4. Financial Management Service (FMS): psc_invoices@psc.hhs.gov

* No other non-invoice related documents (i.e. deliverables, reports, balance statements) shall be sent to the DAM and FMS mailboxes. Invoices Only.

The subject line of your email invoice submission shall contain the contract number, contract line item number, the order number, if applicable, and the number of invoices. The Contractor shall send one email per contract per month. The email may have multiple invoices for the contract. Invoices must be in the following formats: PDF, TIFF, or Word. No Excel formats will be accepted. The electronic file cannot contain multiple invoices; example, 10 invoices requires 10 separate files (PDF or TIFF or Word).

Invoices shall be submitted in accordance with the contract terms, i.e. payment schedule, progress payments, partial payments, deliverables, etc.

All calls concerning contract payment shall be directed to the COR.

In accordance with FAR 52.212-4, Contract Terms and Conditions-Commercial Items, a proper invoice must include the following items:

FAR 52.212-4(g) Invoice.

(1) The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include:

(i) Name and address of the Contractor;

(ii) Invoice date and number;

(iii) Contract number, contract line item number and, if applicable, the order number;

(iv) Description, quantity, unit of measure, unit price and extended price of the items delivered;

(v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading;

(vi) Terms of any discount for prompt payment offered;

(vii) Name and address of official to whom payment is to be sent;

(viii) Name, title, and phone number of person to notify in event of defective invoice; and

(ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract.

(x) Electronic funds transfer (EFT) banking information.

(A) The Contractor shall include EFT banking information on the invoice only if required elsewhere in this contract.

(B) If EFT banking information is not required to be on the invoice, in order for the invoice to be a proper invoice, the Contractor shall have submitted correct EFT banking information in accordance with the applicable solicitation provision, contract clause (e.g., 52.232-33, Payment by Electronic Funds Transfer, System for Award Management, or 52.232-34, Payment by Electronic Funds Transfer, Other Than System for Award Management), or applicable agency procedures.

(C) EFT banking information is not required if the Government waived the requirement to pay by EFT.

(2) Invoices will be handled in accordance with the Prompt Payment Act (31 U.S.C. 3903) and Office of Management and Budget (OMB) prompt payment regulations at 5 CFR Part 1315.

mailto:Jessica.Treanor@psc.hhs.gov mailto:pscsas.invoices@psc.hhs.gov mailto:psc_invoices@psc.hhs.gov

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Additionally, the FMS requires the contractor to include its Dun & Bradstreet Number (DUNS) on each invoice.

In accordance with OMB Memorandum, M-11-32, Agencies shall make payments to small businesses as soon as practicable, with the goal of making payments within 15 days of receipt of a proper invoice. If a small business contractor is not paid within this (15 day) accelerated period, the contractor will not be given a late-payment interest penalty. Interest penalties, as prescribed by the Prompt Payment Act, remain unchanged by means of this memorandum. All small businesses shall label all invoices as "Small Business."

Additionally, in accordance with OMB Memorandum, M-12-16, all prime contractors are encouraged to disburse funds received from the Federal Government to their small business subcontractors in a prompt manner. To assist prime contractors in expediting contractor payments to small business subcontractors, Agencies shall, to the full extent permitted by law, temporarily establish an earlier, accelerated date for making agency payments to all prime contractors. Consistent with OMB Memorandum M-11-32 above, Agencies shall have a goal of paying all prime contractors within 15 days of receiving proper documentation. In an effort to support small business growth, drive economic activity and job creation, the Contractor is encouraged to accelerate payments to their small business subcontractors.

In accordance with the requirements of the Debt Collection Improvement Act of 1996, all payments under this order will be made by electronic funds transfer (EFT). The Contractor shall provide financial institution information to the Finance Office designated above in accordance with FAR 52.232-33 Payment by Electronic Funds Transfer - System for Award Management.

G.6 ELECTRONIC SUBCONTRACTING REPORTING SYSTEM (eSRS) REPORTING

The Contractor shall report all subcontract awards to small, small disadvantaged, women-owned, HUBZones, veteran-owned and service-disabled veteran-owned small business concerns.