Attachment 001 - Statement of Work (SOW).docx

Statement of Work (SOW) for ASPE Program Accident and Sickness Program for Exchanges (ASPE) Health Benefits Plan

U.S. Department of State, Bureau of Educational and Cultural Affairs (ECA) Executive Office (EX)

Overview The United States Department of State (DoS), Bureau of Educational and Cultural Affairs (ECA), Executive Office (EX), administers the Accident and Sickness Program for Exchanges (ASPE) as a self-funded, short-term, limited-duration health benefits policy. The ASPE program is a crucial element in supporting the health, safety, security, and welfare of participants on domestic and international ECA-funded exchange programs, ensuring they have access to necessary medical care, mental health & crisis support services, and medical evacuation and repatriation services for emergent accidents and sicknesses that may present while actively participating in these programs in their host countries.

ASPE is a health benefits plan designed to support participants on exchange programs funded by ECA. These exchange programs contribute to the Bureau’s mission of increasing mutual understanding between the people of the United States and other countries through academic, cultural, sports, and professional exchanges. The ASPE program provides limited health benefits for the participants during their time abroad, ensuring they have access to essential medical services and support, directly supporting E.O. 14161: “Protecting the United States from Foreign Terrorists and Other National Security and Public Safety Threats”; and E.O. 14165: “Securing Our Borders”. ASPE complies with the Exchange Visitor Program statutes, in particular 22 CFR 62.14 for health insurance coverage of exchange participants and the Smith-Mundt Act, Section 804(9) (22 USC § 1474) which grants the DOS authority to self-insure. ASPE is secondary to any primary coverage that a participant may carry.

The primary purpose of the ASPE Health Benefits Plan is to provide emergent, limited health benefits to exchange participants during their active participation in exchange programs while in their host countries. This program ensures that participants have access to necessary medical care without facing undue hardship, allowing them to fully engage in their exchange activities and contribute to ECA's mission of fostering mutual understanding between the people of the United States and those of other nations.

The scope of the ASPE program Third Party Administrator (TPA) role includes health benefits management for emergent healthcare, mental health and crisis management issues, mental health and crisis support hotline and services, global pharmacy services, healthcare consultation, emergency medical evacuation and repatriation services, provider network management, 24-hour multilingual support, digital engagement tools, serving as an interlocutor between ECA, exchange program participants and healthcare, mental health, crisis support entities, and medical evacuation and repatriation services, coordination of benefits when participants carry other healthcare coverage, and participant feedback collection. The TPA will be responsible for the effective implementation and administration of these services, ensuring seamless, 24/7/365 health support for over 24,000 participants worldwide.

The TPA will be responsible for the efficient administration and execution of this self-funded health benefits program, which includes participant enrollment, eligibility verification, claims processing, healthcare provider network management, coordination of benefits, crisis intervention, mental health support and mental health and crisis support hotline, medevac and repatriation services, and participant support services.

The TPA will play a critical role in managing ASPE to ensure exchange participants receive high-quality health, mental health, and crisis support services that align with the program’s objectives and the Department of State’s standards. By offering health benefits tailored to the needs of international exchange participants, the ASPE program enables them to focus on their exchange experiences while ensuring their health and well-being are protected.

ASPE Program Coverage and Scope The Key characteristics of the ASPE Health Benefits Plan include:

· Self-Funded Model: ASPE operates as a self-funded health benefits policy administered directly by the Department of State through ECA. This model allows for greater control over coverage specifics and flexibility in addressing participants' unique needs.

· Short-Term Limited Duration: Coverage is provided for the duration of the participant's active involvement in their exchange program while in the host country. Limitations of Coverage are detailed below and in the current ASPE Health Benefits Guide.

· Limited Health Benefits: ASPE is designed to cover a broad range of necessary medical services related to emergent accidents or illnesses that occur during the exchange program but does not cover routine healthcare. ASPE is secondary to any primary coverage that an exchange participant may carry.

This coverage is not equivalent to comprehensive health insurance, but instead offers limited benefits aimed at addressing emergent medical, evacuation, and repatriation needs arising during the exchange period in the host country and is secondary to any healthcare coverage that the participant carries. Coverage includes:

· Emergency Medical Care:

· Coverage for emergency medical treatment, hospitalizations, surgeries, and other necessary medical interventions resulting from accidents or illnesses occurring during the participant’s stay in the host country that are within the scope of the coverage policy.

· Behavioral and Mental Health Services:

· Access to a range of mental health services, including short-term counseling, therapy, psychiatric care, and crisis support and mental health support hotline to support participants’ mental well-being during their program. This aligns with ECA's emphasis on participant health, safety, and welfare as key factors in the success of its exchanges.

· Crisis Support and Medical Evacuations:

· Coverage for crisis intervention, including mental health support, mental health support hotline, and medical evacuation (medevac) and repatriation services for participants who need to be transported to suitable medical facilities, either within their host country or back to their home country.

· Repatriation of Mortal Remains: In the unfortunate event of a participant's death, ASPE provides coverage for the repatriation of remains, ensuring that the process is handled with dignity and in compliance with international regulations.

· Pharmacy Benefits:

· The TPA will manage claims for prescription medications, ensuring participants have access to the medications they need without undue logistical or financial barriers.

· Limitations of Coverage:

· Routine Healthcare Exclusions: ASPE does not cover routine healthcare services such as annual physical, preventive care, vaccinations, dental, optical, or other regular health maintenance. Participants are strongly encouraged to maintain any primary health insurance they have, as ASPE acts as secondary coverage and supplements primary insurance where applicable.

· Coverage Duration: Coverage is strictly limited to the period when participants are actively engaged in their exchange activities and physically present in their host countries. This also includes travel directly to and from the host country for program orientations, official events, or other activities sanctioned by the exchange program. ASPE does not cover participants outside of this active period, outside of their host countries, or in their home countries.

· Post-Program Coverage: After the participant’s exchange program has concluded, ASPE will extend coverage for the treatment of any covered injury or illness that began during the exchange program and that was not determined to have been a pre-existing condition, for up to one (1) calendar year from the date of onset. However, this extended coverage is subject to the following restrictions:

1. It does not apply to acupuncture, chiropractic care, massage therapy, maternity care, or pre-existing conditions. Coverage for these services terminates at the end of the participant's active enrollment in the program.

2. All extended coverage is subject to the same exclusions, limitations, and benefit maximums as specified in the ASPE plan policy.

Legal Requirements and Compliance Standards ASPE directly supports ECA’s strategic objectives by ensuring that exchange participants are protected from health-related risks. This is essential for their full engagement and success in the exchange experience, by offering health benefits and support services that address the unique challenges faced by exchange participants, including the logistical challenges of accessing healthcare in foreign countries and emergent medical evacuation and repatriation services.

Program Implementation ASPE is structured to comply with relevant legal requirements, including those applicable to health benefits provided to international visitors participating in exchange programs. The TPA must ensure compliance with the following laws and regulations:

· Americans with Disabilities Act (ADA):

· In accordance with the Americans with Disabilities Act of 1990, the ASPE program must be accessible to all participants, including those with disabilities. The TPA is responsible for ensuring that all services, including digital platforms, customer support, and medical facilities within the provider network, comply with ADA standards to provide equal access and eliminate barriers to care. All program-related materials, formats, and platforms must be 508 compliant and screen reader accessible

· Health Insurance Portability and Accountability Act (HIPAA):

· The TPA must ensure that all participant data, including personal health information, is handled in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and other relevant privacy regulations. This includes implementing safeguards to protect participant data, providing participants with access to their medical information, and ensuring that data is only shared with authorized entities.

· Personally Identifiable Information (PII)

· The TPA must ensure that all participant Personally Identifiable Information (PII) is protected. The term “PII,” as defined in OMB Memorandum M-07-1616 refers to information that can be used to distinguish or trace an individual’s identity, either alone or when combined with other personal or identifying information that is linked or linkable to a specific individual. The definition of PII is not anchored to any single category of information or technology. Rather, it requires a case-by-case assessment of the specific risk that an individual can be identified. In performing this assessment, it is important for TPA’s to recognize that non-PII can become PII whenever additional information is made publicly available - in any medium and from any source - that, when combined with other available information, could be used to identify an individual.

· Federal Acquisition Regulations (FAR):

· The procurement and administration of the ASPE contract must comply with the Federal Acquisition Regulations (FAR). Specific FAR clauses, such as those governing data rights, ownership, and protection, apply to the management of ASPE participant data, ensuring that all information generated under the contract remains the property of the U.S. Government.

Key Responsibilities of the TPA The selected TPA will be responsible for a comprehensive suite of services essential to the effective administration of the ASPE Health Benefits Plan. These responsibilities include:

Participant Enrollment and Eligibility Management

· Enrollment Processing: Develop and manage a secure, efficient enrollment system for all ASPE-covered participants. Ensure that enrollment is completed prior to participants' arrival in their host countries. Primary responsibility for enrollment is designated representatives from recipients of ECA federal awards (grants).

· Eligibility Verification: Maintain accurate records and verify that participants meet the eligibility criteria for coverage, which is permitted only while they are active exchange program participants in a host country.

· Health Coverage Certificates: Prepare and issue certificates of health coverage and identification cards to participants, adhering to the policies issued by ECA. These documents serve as proof of coverage and are essential for compliance with visa and program requirements.

Claims Processing, Adjudication, and Coordination of Benefits

· Comprehensive Claims Management and Coordination of Benefits: Process and adjudicate claims for covered medical expenses, including medical care, mental health services, crisis support, mental health and crisis support hotline, medevacs, repatriation, and pharmacy services. Ensure that claims are handled promptly and accurately in accordance with ASPE policies and procedures. Manage coordination of benefits when participants are eligible for payment of claims under more than one health care benefit plan (their primary coverage). Manage and apply all program cost-containment processes and strategies, including re-pricing and related services for all ASPE-related claims, services, and expenditures. Provide payments to provider entities in local currencies.

· Policy Adherence: Verify that all claims align with the scope of coverage defined by EX Executive Director, assessing the necessity and appropriateness of services claimed, and ensuring costs are reasonable and customary for the location where services were provided.

· Denial Management: Manage claims denials by providing clear explanations to participants, detailing reasons for denial, and guiding them through any available appeals processes.

Customer Service and Support

· 24/7 Multilingual Support: Provide around-the-clock customer service in multiple languages to assist participants with inquiries about their health benefits, claim status, accessing medical care, and other support needs. Availability of translation services to provide customer service, support, and translation of documentation and related materials for claims, case management, and exchange participant support.

· Multiple Communication Channels: Offer support through various platforms, including telephone, email, live chat, and a secure online portal and mobile application, ensuring accessibility for all participants regardless of their location or time zone.

Healthcare Provider Network Management

· Global Network Development: Establish and maintain extensive primary and secondary healthcare provider networks, within the U.S and globally, ensuring participants have access to high-quality medical services without the need for upfront payments.

· Guaranteed Payment Arrangements: Secure guarantee of payment (GOP) agreements with network providers to facilitate seamless access to care for participants. This includes GOP to “non-network” providers within the U.S. and overseas locations providing care top program participants.

· Credentialing and Quality Assurance: Implement a robust credentialing process to verify the qualifications and compliance of all network providers, ensuring they meet the required standards of care and service and will accept ASPE for coverage. Verify qualifications and compliance of domestic and overseas providers as part of customer support.

Digital Platform and Technology Integration

· Secure Online Portal and Mobile Application: Develop and maintain a user-friendly digital platform that allows participants to manage their health benefits, submit and track claims, access telehealth services, and receive important updates.

· Data Security and Compliance: Ensure that all digital systems comply with federal regulations regarding data ownership, privacy, and security, including adherence to the Health Insurance Portability and Accountability Act (HIPAA) and other relevant rules and laws.

Emergency and Crisis Management

· Medical Evacuation and Repatriation Services: Coordinate emergency and routine medical evacuations (medevacs) and repatriation of mortal remains as needed, operating with global capability and sensitivity to participants' needs during critical situations.

· Crisis Intervention Support: Provide immediate assistance and coordination during medical or security crises, including licensed medical and mental health professional support and mental health and crisis support hotline and related services, liaison with local authorities, emergency services, and providers to coordinate emergent care for program participants and serve as an interlocutor between program participants, providers, services, and more.

Participant, Program Staff, and Program Partner Education and Engagement

· Education and Marketing Campaign: Develop and execute an education campaign that is tailored to each group to inform participants, program staff, and program partners about their ASPE health benefits, how to access services, and their responsibilities under the ASPE policy, and more. Materials must be clear, accessible, and available in multiple formats, media, platforms, and languages as necessary. All materials, formats, and platforms must be 508 compliant and screen reader accessible. Education and marketing campaigns will include but will not be limited to crisis management and intervention training for program staff and program partners (i.e., offering courses taught by licensed and experienced professionals on topics such as mental health first aid for non-mental health professionals, education on the basics of the US healthcare system and healthcare systems globally, and more.

· Orientation Sessions: Coordinate with the relevant stakeholders to conduct pre-departure and ongoing information sessions to guide participants in understanding and utilizing their health benefits effectively.

· Feedback Mechanisms: Implement bi-annual electronic surveys and other feedback tools to gather participants input on the quality of services provided, using this data to drive continuous improvement and provide the results of these surveys to ECA Data Management, Reporting, and Compliance

· Advanced Data Analytics: Utilize sophisticated data management systems to collect, categorize, and analyze claims data and other relevant metrics. Provide detailed and finished reports (to include dashboards, graphs, and charts that illustrate metrics) to ECA on a regular basis (monthly, quarterly, bi-annually, and annually), regarding all ASPE program activity and data collection points and elements, highlighting trends, utilization patterns, all program activity and related expenditures, claims denial types and reasons, and areas for potential policy adjustments. These reports will be considered routine reporting and not “ad-hoc” reporting. The vendor must have the ability to access and maintain all program data for the entire life of the contract and be able to fulfill all reporting requests for all segments of the contract during the life of the contract, to any requests for reporting for base and option years that have been concluded. All reports will be accompanied with finished visual reporting – including graphs, charts, and dashboards to illustrate trends to include all program names and types, locations, types of claims, including pharmacy claims, costs, consultations / reasons for consultations and advice provided, and more, and will be provided as standard and routine reporting deliverables and not ad-hoc reporting.

· Regulatory Compliance: Ensure all operations comply with applicable federal, state, and local laws, including policies issued by ECA under the authority of the Executive Director. Maintain up-to-date knowledge of regulations affecting the ASPE program and implement necessary adjustments promptly.

· Data Ownership: Acknowledge that all data generated under this contract is the property of the U.S. Government and must be handled in accordance with federal rules on data ownership and privacy.

Adaptability and Continuous Improvement

· Service Adaptation: Be prepared to adjust services and coverage options to meet the evolving needs of participants and the ASPE program, including managing multiple tiers of service coverage if required.

· Innovation: Introduce innovative solutions and technologies to enhance the efficiency and effectiveness of program administration, such as telehealth services, mobile health applications, and predictive analytics.

· Health and Travel Insurance Industry Expertise and Consultation: Provide health insurance expertise and related consultation capabilities on industry standards, laws, trends, and more, as needs arise from the ASPE Program.

Objectives of the Third-Party Administrator The TPA is expected to achieve the following objectives:

· Efficiency and Accuracy: Implement efficient processes for enrollment, claims processing, and customer support to ensure services are delivered promptly and accurately.

· Participant-Centered Service: Provide high-quality, accessible services that prioritize the needs and experiences of participants, including culturally competent support and communication.

· Compliance and Integrity: Maintain strict adherence to all policies and procedures issued by ECA under the authority of the Executive Director, as well as all applicable laws and regulations.

· Data Security and Ownership: Protect all participant data in compliance with federal regulations, recognizing that all data generated under this contract is the property of the U.S. Government.

· Continuous Improvement: Utilize participant feedback and data analytics to continuously improve services, adapt to changing needs, and introduce innovations that enhance program effectiveness.

Health Benefits Management

1. Processing and Adjudication

· Detailed Claims Adjudication: The TPA is responsible for processing claims (domestic and international) related to medical care, mental health services, mental health support hotline usage, crisis support, pharmacy services, and more. Claims processing includes verifying eligibility, ensuring that the services provided are necessary and covered under the ASPE policy, and confirming that the costs are reasonable and align with customary local healthcare rates.

· Claims Categorization and Related Reporting: Claims must be categorized based on multiple parameters, such as:

· Type of Service: Medical, mental health, crisis management, mental health support services hotline, pharmacy/medications, emergencies, consultations and advice services, types, and reasons

· Geographic Location: Country of treatment and specific provider details.

· Program Names and Categories: Title of ECA exchange program and location

· Denial Reasons: Provide specific categories for claims that are denied, including reasons such as non-covered services, eligibility issues, or policy limitations.

· Adjudication Timelines: The TPA must establish and adhere to clear timelines for claims adjudication, including:

· Initial Processing: Complete processing of initial claims submissions within 10 business days of receipt.

· Review and Appeal: Complete reviews and appeals of claims denied within 15 business days.

2. Claims Denial and Appeals Process

· Claims Denial Communication: When a claim is denied, the TPA must provide a detailed explanation of the denial, including the specific reason, policy reference, and guidance on how to appeal the decision.

· Appeals Management: Participants must be given a fair opportunity to appeal denied claims. The TPA will manage an organized appeals process, ensuring all appeals are reviewed by qualified personnel and resolved promptly. The TPA must track and report on appeals outcomes to ECA for continuous improvement.

3. Sophisticated Data Management for Reporting

· Data Analytics: The TPA must use advanced data analytics to manage all claims data, including prescriptions, categorize claims, and generate insights for program improvements. Reporting must be specific to different parameters such as participant demographics, claim types, ECA program titles and locations, and geographic trends, including denied claims, types, and reasons for denial. All data analytics and reporting must be provided in both raw and finished formats, to include visual graphs that illustrate program usage and expenditures, trends, and more. All reporting and categories will be provided as routine and not “ad hoc.”

· Reporting Requirements: The TPA must generate regular reports, including:

· Monthly Claims Report: Includes a summary of paid and denied claims, categorized by exchange program, type, country, costs, and participant demographics, consultations, and more.

· Quarterly Performance Report: Evaluates claims turnaround time, customer service response, and program utilization trends.

· Annual Summary Report: Provides a comprehensive overview of program usage, participant satisfaction, financial performance, and recommended improvements.

Global Pharmacy and Medical Benefit Services Management

1. Pharmacy Claims Management

· Prescription Processing: Manage prescription claims and ensure participants have access to required medications without hardship and in compliance with legal limitations that exist in program host countries. The TPA must work with a global network of pharmacies to negotiate rates and ensure timely access to medications.

· Specialty Medications: Establish systems for handling claims related to specialty medications, including those that require specific storage or handling. The TPA must ensure participants have access to these medications in a timely manner, regardless of their location.

· Formulary Management: Maintain a formulary that ensures participants can access the most required medications at a reasonable cost and assist with alternatives if a prescribed medication is unavailable.

· Participant Prescription and Medication Consultation Services: Provide customer service and support to participants in addressing questions and potential solutions regarding the availability of medications within their host countries and / or ability to ship medications to host countries

2. Seamless Access to Healthcare Globally

· Global Provider Network Development: Develop and maintain an extensive network of healthcare providers globally, including general practitioners, specialists, hospitals, and emergency care providers. Ensure coverage in both urban and rural areas to meet participants' needs.

· Guaranteed Payment Arrangements: Establish guarantee of payment (GOP) agreements with network providers to facilitate seamless access to care for participants, ensuring they are not required to make upfront payments.

· Clinical Programs: Implement clinical programs that support the appropriate use of prescription drugs and optimize participants’ health outcomes. This includes utilizing real-time analytics to identify opportunities for intervention and support.

Healthcare Consultation and Support

1. Pre-Departure and Ongoing Healthcare Support

· Pre-Departure Orientation: Provide participants with detailed information on the healthcare system in their host country, including how to access services, what to expect, and any special considerations, mental health, safety, security, and self-care planning advice. This includes guidance/advice on obtaining necessary vaccinations, medications, medical records, and submitting claims, prior to departure to the host country

· Ongoing Healthcare Advice: Offer continuous support and consultation services for participants throughout their stay, including consultation on accessing healthcare providers, understanding their benefits, and managing any chronic conditions under the limitations of the ASPE policy and local rules, laws, and customs, world-wide. Support must be available in multiple languages and ADA accessible formats, with culturally competent representatives who understand the unique challenges of accessing healthcare in a foreign country.

2. Telehealth Services

· Telehealth Capabilities: Provide a secure telehealth platform that enables participants to consult with licensed healthcare professionals remotely. Telehealth should be available to program participants for general medical consultations, mental health services, mental health and crisis support hotline, and follow-up appointments.

· Accessibility and Availability: Ensure telehealth services are accessible 24/7, particularly for participants in remote, rural, or underserved areas where in-person care is not readily available.

Emergency and Routine Medical Evacuation and Repatriation

1. Medical Evacuation (Medevac)

· Emergency Coordination: Coordinate and manage medical evacuations for participants who require urgent medical care that cannot be provided in their host country. The TPA must have the capability to arrange air or ground transportation, including professional medical and non-medical escorts if necessary.

· Global Operational Capability: The TPA must maintain partnerships with international medevac service providers to ensure rapid response capabilities and seamless coordination in the event of an emergency, in any area of the world where ECA exchanges operate, including remote and rural locations and areas of political instability.

2. Repatriation of Mortal Remains

1. Compassionate Management: In the unfortunate event of a participant's death, the TPA must manage the repatriation of mortal remains with sensitivity and respect. This includes coordination with local authorities, compliance with international laws, and providing support to the participant's family.

2. Regulatory Compliance: Ensure compliance with all relevant laws and regulations related to the repatriation process, including obtaining permits and handling logistics across jurisdictions.

Extensive Provider Networks

1. Establishment and Management of Networks

· Primary and Secondary Provider Networks: Develop both primary and secondary healthcare provider networks to provide participants with multiple options for medical care. This should include hospitals, specialists, and primary care providers who meet quality standards. Assist participants with locating local providers in network that will accept ASPE for coverage, for exchange program participants who are on program within the US or outside of the US.

· Credentialing Providers: Implement a comprehensive credentialing process to verify that all providers within the network have the necessary qualifications and comply with local regulations and ASPE standards.

Quality Assurance and Network Expansion

· Quality Control: Conduct regular audits of healthcare providers to ensure quality of care and adherence to contractual obligations. The TPA must establish mechanisms to monitor provider performance and address any deficiencies. This should include inclusion of program participant feedback and at least monthly updates to any websites or reference points that participants may use to locate providers who will accept ASPE (i.e., provider network websites and more).

· Network Flexibility: The TPA must be able to expand the network to meet evolving participant needs, including adding specialized providers in response to emerging health trends or specific participant needs.

24-Hour Multilingual Support

1. Around-the-Clock Assistance

· Multilingual Contact Center: Operate a contact and customer service and support center that provides 24/7 support in multiple languages, helping with claims, accessing medical care, medical care and records translation, and other medical related services. This support should include phone, email, chat, and digital self-service options.

· Crisis Response Team: Ensure that crisis intervention services are available 24/7, including access to mental health professionals and mental health and crisis support hotline who can assist participants in emergency situations, worldwide

· Readiness: All support representatives must be trained in crisis communications and readiness competence, ensuring that participants receive support that respects their collective and varied backgrounds.

· Support Platforms: Provide multiple and ADA-compliant platforms for participants to access support, including mobile apps, secure messaging, and traditional contact methods to accommodate collective and varied situations.

Digital Engagement and Data Management

1. Digital Platform for Participant Engagement

· Health Benefits Portal: Develop and maintain a secure digital platform that enables participants to view their coverage, submit claims, track claims status, access telehealth services, and find network providers. The portal must be accessible 24 hours per day, 365 days a year (unless down for planned maintenance).

· Mobile Application: Provide a mobile app with similar functionality to ensure participants can easily access their health benefits, support services, and submit claims on the go. The application must be accessible 24 hours per day, 365 days a year (unless down for planned maintenance).

2. Data Security and Privacy

· HIPAA and PII Compliance: Ensure that all unclassified data systems comply with HIPAA, PII, and other relevant data protection laws and rules. The TPA must implement encryption, access controls, and data integrity measures to protect participant information.

· Data Reporting and Analytics: Utilize data analytics to monitor medical and mental health service, mental health and crisis support hotline, and pharmacy utilization, claims processing, costs, locations, exchange programs, and participant outcomes. Reports must be generated and submitted to the ECA on a regular basis, providing insights that support decision-making and policy adjustments.

Participant Engagement and Feedback

1. Participant Education and Awareness Campaign

· Education Materials: Develop accessible, easy-to-understand materials that explain the ASPE benefits, coverage limitations, and how to access services. These materials should be available in multiple languages and formats, including print, online, and video, as well as ADA and 508 compliant. These materials will be reviewed and updated at least once per year, depending on changes that are present and need to update on a more frequent basis.

· Pre-Departure and In-Program Sessions: In consultation with and through the ECA ASPE Program Manager, conduct information sessions before departure and during the exchange program to educate participants on accessing healthcare, submitting claims, and using telehealth services.

2. Feedback Collection and Analysis

· Surveys: Administer bi-annual electronic surveys to collect feedback from participants on the quality of service, accessibility of services, and any challenges they experienced. Surveys must be analyzed, and results should be used to identify areas for improvement. ECA will have access to ALL surveys and ALL results and data that is collected by the TPA through any feedback mechanisms that the TPA utilizes for the ASPE program.

Adaptability to Service Needs

1. Tiered Service Options

· Service Flexibility: Offer multiple service tiers that cater to the diverse needs of participants.

· Customizable Coverage: Allow for customization of health benefits to meet the specific needs of different participant groups, such as those traveling to high-risk areas or requiring additional mental health and crisis support.

Predictive Analytics for Service Adjustments

· Data-Driven Decisions: Use predictive analytics to forecast participants' needs and recommend adjustment of services accordingly. For instance, if data indicates an increase in mental health claims and mental health and crisis support hotline usage, the TPA should increase mental health resources and outreach availability and accessibility to ensure adequate support.

Compliance and Accessibility Expertise

1. Accessibility Compliance

· Americans with Disabilities Act (ADA): Ensure that all services, including the digital platform and provider network, are fully accessible to participants with disabilities, in accordance with ADA requirements and similar international accessibility standards, to include 508 compliance and reader accessible compliance

· Advisory Services: Provide ongoing support to participants with disabilities, including helping them navigate healthcare facilities, access appropriate accommodations, and utilize digital tools effectively.

2. Information Accessibility

· Accessible Formats: Develop all program informational and functional materials in accessible formats, such as braille, audio, and large print, to ensure that participants with disabilities have equal access to important program information. All ASPE-related program information and formats must be 508 compliant.

· Culturally Appropriate Communication: Ensure that communication materials are adapted to different cultural contexts to enhance participant understanding and engagement.

Communication Strategies

1. Multi-Platform Communication

· Regular Updates and Alerts: Provide regular updates to participants on their health coverage, policy changes, availability and limitations of benefits, and important healthcare information. Alerts should be delivered through multiple channels, including email, mobile app notifications, and newsletters.

· Healthcare Provider Communication: Engage with healthcare providers regularly to ensure they understand ASPE requirements, provide the necessary support to participants, and comply with program guidelines. Ensure that all reference resources are kept current, at least monthly, whenever providers enter or leave the ASPE networks.

2. Coordination with Implementing Partners

· Engagement with Implementing Partners: Through the ECA ASPE Program Manager, coordinate with educational institutions, non-profits, and other implementing partners to keep them informed about the ASPE program and have a user-friendly portal for participant registration, ensuring they can support participants effectively as approved by ECA.

· Training for Partners: Through the ECA ASPE Program Manager, offer training sessions for implementing partners on how ASPE operates, how to assist participants, how to interact with the digital platform and what resources are available to them, mental health first aid for non-mental health professionals, crisis management and more, as approved by ECA.

Training/Information Sessions

1. Participant Training and Orientation

· Comprehensive Training: Conduct training sessions that cover all aspects of the ASPE program, including accessing healthcare, healthcare systems of the US and globally, mental health and crisis support resources and hotline, understanding benefits, submitting claims and dealing with emergencies, to include mental health, medevac, and repatriation processes, self-care plans, and more. Training must be offered in multiple formats, such as webinars, in-person workshops, and online self-paced courses and must be 508 compliant. All training materials must be reviewed and updated at least annually, more frequently, if needed.

· Role-Specific Information: Tailor training to the specific needs of participants, healthcare providers, and administrative staff, ensuring everyone involved in the program understands their role and responsibilities.

2. Crisis Communication and Preparedness

· Crisis Response Training: Develop and implement a crisis communication plan, including training for participants and program partners on how to respond to emergencies, mental health first aid for non-mental health professionals training, contact relevant support services, and access medevac or other urgent services.

· Simulations and Drills: Conduct regular crisis response simulations to test the preparedness of all stakeholders, including participants, healthcare providers, and program administrators.

Transition Plan

· Transition Management: Develop a detailed transition plan to ensure the seamless transfer of responsibilities from the incumbent contractor. The plan must include timelines, milestones, and risk mitigation strategies to prevent any service disruption during the transition. For Incumbent: Plan how services will be updated and tailored to meet the new requirements in the SOW. The plan must include timelines, milestones, and risk mitigation strategies to prevent any service disruption during the transition

· Training and Onboarding: Train new staff and onboard existing contractor personnel to ensure they understand the policies and procedures of the ASPE program and ECA exchange programs.

Handling of Unclassified Personally Identifiable Information (PII) and Protected Health Information (PHI) The TPA must comply with additional special handling requirements for specific deliverables to ensure the safety, security, and confidentiality of sensitive information, particularly personal health information (PHI).

· Confidentiality and Privacy Standards: All materials containing PII or PHI must be clearly marked and packaged in a manner that ensures confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and relevant privacy regulations.

· Double Layer Packaging: For physical documents containing PII or PHI, double-layer packaging must be used, with both internal and external layers marked appropriately to indicate the sensitivity of the content.

· Access Restrictions: Only individuals authorized by the Contracting Officer’s Representative (COR) or the Contracting Officer (CO) may access or handle deliverables containing PII or PHI via ECA’s COINS system (the ASPE enrollment system). The TPA must maintain records of individuals accessing such information for audit purposes.

· Media / Outside Organization Queries: Any media or outside organization queries regarding ASPE and any related participant information, records, or cases will be referred by the vendor directly to ECA for further action.

Handling of Sensitive and Classified Deliverables

· Sensitive Information: Deliverables marked as "Sensitive but Unclassified (SBU)" must be securely packaged and transmitted using methods approved by the Department of State. For electronic transmission, secure encrypted channels must be used.

Delivery Instructions and Acknowledgment All deliverables must be delivered according to the agreed-upon schedule and the following requirements:

1. Delivery Locations

· Physical Deliveries: All physical deliverables must be sent to the designated office at the Department of State as specified in the contract. A signed delivery receipt is required to verify successful delivery.

· Electronic Deliveries: Electronic deliverables must be uploaded to the secure portal designated by the Department of State. The TPA must notify the COR via email once the files have been uploaded, including a reference to the contract and CLIN number.

2. Delivery Acknowledgment

· Receipt Confirmation: The TPA must request and receive acknowledgment of receipt for all deliverables from the COR or CO. This acknowledgment must include the date of receipt, the name of the recipient, and a summary of the contents delivered.

· Recordkeeping: The TPA must maintain accurate records of all deliveries, including tracking numbers for physical shipments, email confirmations for electronic deliveries, and copies of signed receipts. These records must be made available to the Department of State upon request for audit purposes.

3. Missed or Late Deliveries

· Notification Requirements: If a delivery is delayed or cannot be completed as scheduled, the TPA must notify the COR and CO immediately, providing the reason for the delay and an estimated revised delivery date.

· Penalty Provisions: Repeated delays in deliverable submissions may result in penalties as per the terms and conditions of the contract. The TPA is expected to adhere to all delivery timelines to ensure project success.

Packaging and Marking Non-Compliance

· Failure to comply with the packaging and marking requirements outlined in this section may result in the rejection of deliverables, additional costs for re-packaging, or penalties as stipulated in the contract. The TPA is required to adhere strictly to these requirements to maintain the integrity of the ASPE Health Benefits Plan and ensure the safety and security of participant information.

Inspection Methods

1. Direct Inspection by Government Personnel

· The COR or their designated personnel will conduct direct inspections of all services and deliverables. These inspections may occur remotely as required. Inspections will focus on evaluating the quality, timeliness, and completeness of each deliverable.

2. Remote Inspection and System Monitoring

· For services delivered electronically or performed remotely (e.g., digital platform maintenance, data processing), the DoS may conduct system monitoring and remote assessments. This may include reviewing reports, monitoring real-time performance, and conducting periodic evaluations using the TPA’s digital platform.

3. Participant Feedback and Surveys

· Participant feedback will be used as an additional method for inspecting the quality of services provided by the TPA. Surveys, focus groups, and other feedback mechanisms may be employed to gather input on the TPA's performance, responsiveness, and participant satisfaction. All results of these evaluation tools will be provided to ECA.

Scope of Inspection The scope of inspection will encompass the following key areas:

· Accuracy: Ensuring that data and reports provided are complete, accurate, and in compliance with contract requirements.

· Timeliness: Assessing whether the TPA adheres to the submission timelines specified for deliverables.

· Compliance: Evaluating compliance with federal regulations, such as HIPAA for personal health information (PHI) and J-Visa requirements.

· Service Quality: Reviewing customer service interactions to ensure responsiveness, professionalism, and support quality in line with contractual standards.

Acceptance of Deliverables Deliverables under this contract will only be accepted if they meet the quality standards, specifications, and timelines outlined in the SOW. Acceptance is determined solely by the Government and is necessary before any invoices for payment are approved.

Government's Right to Reject The Government reserves the right to reject any deliverable that fails to meet the requirements. Deliverables that do not conform to the agreed specifications, quality standards, or delivery schedule may result in the withholding of payments or contract termination.

Government Quality Assurance The Government shall utilize the Quality Assurance Surveillance Plan (QASP) to monitor TPA’s compliance with contract requirements. The QASP outlines specific metrics and methods for evaluating the TPA’s performance against established criteria, ensuring a systematic approach to quality control.

1. Key Performance Indicators (KPIs)

· KPIs will include metrics such as response times for customer inquiries, accuracy of claims processing, percentage of accepted deliverables on first submission, and participant satisfaction rates.

2. Corrective Action Process

· The Government will require corrective action if performance falls below acceptable standards. The TPA must submit a Corrective Action Plan (CAP) outlining how deficiencies will be addressed and prevented in the future.

Transition Period

1. Transition In

· The transition period will begin immediately upon contract award and last for a period of up to 90 days. During this time, the TPA will coordinate with the Government to ensure a seamless transition from the incumbent contractor, establish systems, migrate data, and train personnel as necessary.

2. Transition Out

· A transition-out period of up to 90 days will be provided at the end of the contract to facilitate the handover of responsibilities, data, and documentation to the Government or a successor contractor.

Place of Performance The majority of the TPA’s work, including claims processing, customer support, and system maintenance, shall be performed at the TPA’s facilities or virtually interfacing with ECA’s COINS system (the ASPE enrollment system).

Travel Requirements

1. Travel to Department of State

· The TPA must arrange travel to the Department of State in Washington, D.C., for quarterly review meetings as directed by the COR. Travel must be approved in advance and comply with the Federal Travel Regulations (FTR).

2. International Travel

· As needed, the TPA may be required to travel internationally for the purposes of provider network development, participant engagement, or addressing critical health concerns. All international travel must be approved by the COR and included in the relevant CLIN for reimbursement.

Delivery Schedule All deliverables must be provided in accordance with the schedule specified in the contract. The TPA is expected to adhere to the following delivery schedule to ensure timely and efficient performance:

Regular Reports and Deliverables

· Monthly Claims Processing Report: Due by the 15th of each month following the reporting period.

· This reporting requirement can be augmented by providing a frequently updated dashboard, with capabilities to produce charts and graphs to illustrate program usage and trends.

· Quarterly Performance Review Report: Due by the 15th of the first month of the following quarter.

· Annual Summary Report: Due by January 31 of each year, summarizing the previous calendar year’s activities.

· All required, routine reporting categories and parameters and will be addressed in the required deliverables template provided to the TPA by the Program Manager. These reporting categories and parameters will be required for all routine reporting and will not be considered ad-hoc reporting. The TPA must possess the necessary technological compatibility and qualified staff to consistently gather, analyze, and deliver this information to the Program Manager.