75D301-25-R-73216 Amend 0005 (04.11.25).pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE PAGE OF PAGES

1 22

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

04/11/2025

4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (If applicable)

6. ISSUED BY CODE 8219 7. ADMINISTERED BY (If other than Item 6) CODE Centers for Disease Control and Prevention Chamblee Campus Building 102, MS S102-4 4770 Buford Hwy Atlanta, GA 30341-3717

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

X

9A. AMENDMENT OF SOLICITATION NO.

75D301-25-R-73216

9B. DATED (See Item 11)

01/16/2025

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (See Item 13)

CODE FACILITY CODE

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers __ is extended, X is not extended. 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 Items 8 and 15, and returning _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 ACKNOWLEGMENT 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.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

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

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

See page 2 for description of the modification.

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.

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

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA

BY ___________________________________________

(Signature of Contracting Officer)

16C. DATE SIGNED

NSN 7540-01-152-8070 STANDARD FORM 30 (REV. 10-83)

PREVIOUS EDITION UNUSABLE 30-105 Prescribed by GSA

FAR (48 CFR) 53.243

ITEM 10A.

75D301-25-R-73216 Amendment 0005

Block 14 continuation page.

The purpose of this modification is to:

(a) Section E.

(1) Revise the procedures for scheduling a discovery session in Section E3(h)(5).

All other terms and conditions remain unchanged.

E3. Addendum to FAR 52.212-1 Instructions to Offerors—Commercial Products and Commercial Services

(a) Prospective offerors are invited to submit a proposal in response to this solicitation. All proposals received will become part of the official file.

(b) This solicitation is being conducted using the procedures of FAR Part 12 and Subpart 15.3. This is a full and open competition.

(c) In accordance with FAR 52.204-7, System for Award Management, offerors must be registered in

SAM.gov when submitting an offer and at time of award. If an offeror submits a proposal and is not registered in SAM.gov, the Government will reject that offeror’s proposal, the proposal will not receive any further consideration, and offerors will not be permitted an opportunity to revise their proposal.

(d) Offerors shall include their unique entity identifier (UEI) on all submissions.

(e) Summary of acquisition process.

(1) Pre-proposal briefing. Prospective offerors are encouraged to view the pre-proposal briefing

(see Section E3[f]).

(2) Questions-and-answers period. Prospective offerors are encouraged to submit questions to the Government (see Section E3[g]) by May 2, 2025. The Government anticipates answering questions as received, with all questions answered on or before May 9, 2025.

(3) Discovery sessions. Prospective offerors are invited to participate in a discovery session to facilitate offeror learning of the requirement (see Section E3[h]). Discovery sessions are to occur on or between April 14, 2025, and April 24, 2025.

(4) Proposals. Proposals shall consist of a written component and a virtual session (see Section

E3[i]). The written component is due May 30, 2025, with the virtual session occurring on or between June 17, 2025, and June 26, 2025.

(5) Discussions. The Government intends to establish a competitive range and conduct discussions

(see Section E3[j]). Competitive range determinations are anticipated to be made on or before July 29, 2025, with any offerors excluded from the competitive range receiving a pre-award notice of exclusion from the competitive range on or before this date. Discussions are to occur with offerors in the competitive range, with final proposal revisions due on or before August 22, 2025.

(6) Award. CDC intends to make this award on or about October 17, 2025 (see Section E3[k]).

The period of performance for the Transition-In Period starts on October 30, 2025.

(f) Pre-proposal briefing.

(1) The Government will make available for prospective offeror viewing a recorded pre-proposal briefing. The briefing was recorded as a Microsoft Teams meeting and the recording, along with the slide deck used during the briefing, will be made available for download from a link on the SAM.gov solicitation notice.

(2) The Government is not making any changes to the solicitation verbally during the pre-proposal briefing. Any changes to the solicitation following the pre-proposal briefing will be issued by written amendment only and posted to SAM.gov.

(g) Questions-and-answers period.

(1) Prospective offerors are invited to submit questions in writing by e-mail to Joshua Houston, Contract Specialist, at jhouston@cdc.gov. Please use the template provided in Attachment ATT109, Question and

Answer Template, when submitting questions. The deadline for questions to be submitted is May 2, 2025, at 4:30pm ET. The Government may not answer questions received after this date and time.

(2) The Government intends to answer questions as they are received. The Government intends to post final answers not later than May 9, 2025.

(3) A questions-and-answers document containing (A) answers to questions previously received from prospective offerors during the request for information (RFI) period in September 2024 and October 2024, and

(B) answers to prospective offeror questions anticipated by the Government, is provided in Attachment ATT110, Questions and Answers. Prospective offerors are encouraged to review this document prior to submitting new questions. Please note that any changes to the PWS described in the Government’s answers in this document relate to changes made to the version of the PWS published during the RFI period; these changes are incorporated into the version of the PWS published with this RFP.

(h) Discovery sessions.

(1) Prospective offerors are invited to participate in a discovery session with the Government prior to submitting proposals. A discovery session is being made available to prospective offerors given the size and complexity of the Program. The purpose of the discovery session is to facilitate prospective offeror learning of the requirement, with the goal of enhancing the quality of proposals received by the Government.

(2) These sessions are one-on-one meetings between a single offeror and the Government, with no other offerors present. No later than 48 hours prior to its discovery session, the offeror will submit its agenda and any written questions about the requirement to the Government to facilitate the Government’s preparation for the meeting and to maximize the value of the session. During the session, the Government will address the offeror’s questions to the best of its ability (both questions submitted in writing and any additional questions asked by the offeror during the meeting). Please note that this session is not intended to provide feedback on an offeror’s proposed approach.

(3) Questions and answers may differ among offerors. Exchanges between an offeror and the

Government during a discovery session will generally not be shared with other offerors unless those exchanges lead to a change in the solicitation’s requirements, or the Government discloses specific information about the proposed acquisition that would be necessary for other offerors to prepare their proposals. Answers provided during a discovery session are non-binding unless they result in an amendment to the solicitation. If the Government is to change the solicitation or disclose information to other offerors following a discovery session, that will be done in writing through a solicitation amendment issued to the offerors remaining in the competition. Please note that the Government will not disclose information if doing so would reveal an offeror’s confidential business strategy or is protected under FAR 3.104 or FAR Subpart 24.2. The Government assumes no responsibility for any conclusions or interpretations made during a discovery session, or for any representation made by any of its employees or agents during a discovery session.

(4) Each discovery session will be conducted virtually using Microsoft Teams. Each session will be scheduled for a maximum of two hours. The session will be recorded, and the Government will make a recording of the session available to the offeror within 24 hours of the conclusion of the offeror’s discovery session. Each prospective offeror will be provided only one, two-hour session. Discovery sessions are to occur on or between April 14, 2025, and April 24, 2025. Offerors are not restricted in the number of personnel that attend the discovery session; offerors may also have planned subcontractors or partner organizations attend. To safeguard procurement integrity, organizations and individuals may attend only one discovery session (e.g., a planned subcontractor for two different offerors may not attend two separate discovery sessions). Discovery sessions are optional and are not required to submit a quote.

(5) Discovery sessions are available on a first-come, first-served basis. Prospective offerors are to schedule their discovery session by e-mail to Joshua Houston, Contract Specialist, at jhouston@cdc.gov. The following dates and times are the only sessions that remain available: Tuesday, April 22, 2025, between 9:00am ET and 11:00am ET; Wednesday, April 23, 2025, between 9:00am ET and 11:00am ET; and Thursday, April 24, 2025, between 9:00am ET and 11:00am ET. Requests for a discovery session must be received by the Government by

Wednesday, April 16, 2025, at 4:30pm ET. Any requests received after this date and time will not be considered.using the following link, which provides the days and times that the Government team is available for a discovery session call:

https://outlook.office365.com/bookwithme/user/4a25348041ad440c91504db774b3a08e@cdc.gov/meetingtype/_q36 wxrL00miALQRsMp17A2?bookingcode=dd7f682e-cfe5-420c-aa86-10f1828f408f&anonymous&ep=mlink.

Prospective offerors are not guaranteed a discovery session.

(i) Proposals. Proposals include (i) the submission of eight separate technical volumes, a business volume, and a past performance volume (collectively, the “written proposal”), and (ii) participation in a virtual session (the “virtual session”).

(1) Written proposal. The written proposal includes:

(i) Volume 1: Transition-in. This volume shall address the offeror’s approach to accomplish the following tasks in the base year: the kickoff meeting, Section 4.1.1; transition-in, Section 4.1.2;

readiness for SHCD, Section 4.1.3; NYMA EPN adoption under Section 4.4.1; NPN network development before SHCD under Section 4.4.2; and initial provider enrollment and credentialing under Section 4.4.3. Offerors shall address their technical approach to accomplish the transition-in task, including the phasing of tasks and sequencing of activities to prepare the offeror to be ready for SHCD. Offerors shall address their approach to re-affiliate with the current NYMA EPN providers and load providers and facilities into their systems. Offerors shall address their approach to developing the NPN and loading NPN providers and facilities into their systems. The offeror shall identify in their proposal what nationwide network the offeror is proposing to supply to become the NPN, whether this network is owned and operated by the offeror, rented from another entity(ies), or some combination thereof. The offeror shall identify network adequacy gaps in the proposed network based on the network adequacy standards described in Section 4.4.6 of the PWS. For NPA members who utilize the NPN, the acceptable quality level for network adequacy for member travel is 90% of members having access to the required provider within the distance radius standards (30 miles in urban areas and 75 miles in rural areas) unless an exception is granted. The offeror shall address its current prospective network adequacy based on the nationwide network it proposes to supply for the NPN, assuming no exceptions are granted. The offeror shall identify the percentage of NPA members who would have access to the required provider within the distance radius standards under the offeror’s proposed nationwide network. To determine the distance between a member and a provider for the purpose of this volume and the Government’s evaluation, the distance shall be defined as the straight-line distance using statute miles from the geographic center of the five-digit zip code where the member resides to the front door of the provider’s office. The offeror is not necessarily expected to achieve the Government’s network adequacy standard with its proposed nationwide network at the time of proposal submission. However, to the extent the offeror’s proposed nationwide network does not yet meet network adequacy standards, the offeror shall describe in its proposal what recruitment efforts or other steps it will undertake to close its prospective network adequacy gaps and meet the published network adequacy standards by SHCD. The Government intends to negotiate use of the offeror’s proposed nationwide provider network into any resulting contract, in order to ensure that the offeror will deliver the nationwide network promised in its proposal. Offerors shall address how systems and processes will be developed and tested, with particular consideration given to connectivity and information exchanges with other Program contractors. Offerors shall address their staffing approach, including the roles of key personnel and non-key staff, and the labor categories that are to be used for the transition-in work. Offerors are to provide a table of their proposed labor categories and estimated labor hours to perform transition-in under contract line item number (CLIN) 0001 and the basis for the offeror’s estimate. Offerors shall address their management approach to transition-in, including quality assurance and performance tracking, project management tools and techniques, and the resources proposed to accomplish the work. Offerors shall include a robust discussion of transition-in risks and how these risks will be avoided, managed, mitigated, or resolved.

This volume shall be formatted on 8.5 inch x 11 inch pages and submitted as a standalone file in both Adobe “.pdf” and Microsoft Word editable “.docx” formats. The body of the document shall be set with a minimum font size of 10 points, including any charts, tables, or figures. Normal character spacing and a minimum of single line spacing shall be used. Title and heading document elements may use a different font size. Each page shall have a minimum of one-inch margins on all sides of the page. Header and footer information, which does not include any information to be evaluated, may be included within the one-inch margin space and may use a font size other than 10 points.

This volume is limited to 30 pages. This page limitation does not apply to cover pages, a table of contents, or a table of acronyms, if submitted. The Government will count pages of the document in order from the first page, omitting from the count any pages specifically exempted by these instructions. Once the maximum page limit is reached, the Government will not read or evaluate any additional pages in the document. Offerors may incorporate by reference material from one technical volume (i.e., Volumes 1-7 and Volume 10) into another technical volume; any material incorporated by reference will be read as part of the technical volume where it is so incorporated. Offerors shall incorporate by reference only specific, relevant elements of one volume into another. In the event of a discrepancy in the page count or formatting between the Adobe “.pdf” and Microsoft Word editable “.docx” versions of the file, the Adobe “.pdf” version will control.

(ii) Volume 2: Contract management, regulatory compliance, and transition-out. This volume shall address the offeror’s approach to accomplish the contract management task, Section 4.2; regulatory compliance, Section 4.8; and the transition-out of the requirement at the end of contract performance, Section 4.1.6.

(A) For contract management, offerors shall address their technical approach to accomplish this task area, to include managing the overall contract, maintaining adequate staffing, meeting all information security requirements, coordinating and collaborating with the Program, contract-wide risk and issue management, stakeholder engagement and communications, overseeing subcontractor performance, and ensuring quality assurance. Offerors shall address their staffing approach to this task area, including the roles of key personnel and non-key staff, and the labor categories that are to be used for contract management. Offerors are to provide a table of their proposed labor categories and estimated labor hours to perform contract management under CLINs 1001, 2001, 3001, 4001, 5001, 6001, 7001, 8001, and 9001, and the basis for the offeror’s estimate. Offerors shall address their management approach to contract management, including quality assurance and performance tracking, project management tools and techniques, and the resources proposed to accomplish the work.

(B) For regulatory compliance, offerors shall address their technical approach to accomplish this task area, to include how potential HIPAA incidents will be managed should they occur. Offerors shall address their approach to fraud, waste, and abuse (FWA) prevention and detection, to include tools and techniques for identifying potential FWA. Offerors shall address their approach to conducting records management.

Offerors shall address their staffing approach to this task area, including the roles of key personnel and non-key staff, and the labor categories that are to be used for regulatory compliance. Offerors are to provide a table of their proposed labor categories and estimated labor hours to perform regulatory compliance under CLINs 1001, 2001, 3001, 4001, 5001, 6001, 7001, 8001, and 9001, and the basis for the offeror’s estimate. Offerors shall address their management approach to regulatory compliance, including risk management, project management tools and techniques, and the resources proposed to accomplish the work.

(C) For transition-out, offerors shall address their technical approach to accomplish this task area, including the phasing of tasks and sequencing of activities to prepare a successor contractor to be ready for SHCD and transition-out the offeror from the requirement. Offerors shall address how Program records and data will be transferred to an incoming contractor; how the offeror will plan for and conduct ramp-down operations, to include the decommissioning of systems; how continuity of operations will be maintained during the transition; and how the offeror will perform claims runout activities during the Transition-Out Dual Operations Period by processing claims with dates of receipt prior to the successor contractors’ SHCD. Offerors shall address their staffing approach to this task area, including the roles of key personnel and non-key staff, and the labor categories that are to be used for transition-out. Offerors are to provide a table of their proposed labor categories and estimated labor hours to perform the Transition-Out Period under CLIN 8012 and the Transition-Out Dual Operations Period under CLIN 9012 and the basis for the offeror’s estimate. Offerors shall address their management approach to transition, including how performance during transition-out will be tracked and managed.

Offerors shall include a discussion of transition-out risks and how these risks will be avoided, managed, mitigated, or resolved. Please note that, per the description of CLINs 8012 and 9012 in Section B, both the Transition-Out

Period and the Transition-Out Dual Operations Period that would follow it may be exercised at any point in the contract. The services provided under this contract are vital to the Government and must be continued without interruption. In the event the Government terminates this contract early, the TPA Contractor would be required to perform the Transition-Out Period and the Transition-Out Dual Operation Period to ensure the continuity of services to a follow-on contractor. Additionally, please reference the clause at FAR 52.237-3, Continuity of Services, incorporated by reference in Section C1 of this contract.

This volume shall be formatted on 8.5 inch x 11 inch pages and submitted as a standalone file in both Adobe “.pdf” and Microsoft Word editable “.docx” formats. The body of the document shall be set with a minimum font size of 10 points, including any charts, tables, or figures. Normal character spacing and a minimum of single line spacing shall be used. Title and heading document elements may use a different font size. Each page shall have a minimum of one-inch margins on all sides of the page. Header and footer information, which does not include any information to be evaluated, may be included within the one-inch margin space and may use a font size other than 10 points.

This volume is limited to 30 pages. This page limitation does not apply to cover pages, a table of contents, or a table of acronyms, if submitted. The Government will count pages of the document in order from the first page, omitting from the count any pages specifically exempted by these instructions. Once the maximum page limit is reached, the Government will not read or evaluate any additional pages in the document. Offerors may incorporate by reference material from one technical volume (i.e., Volumes 1-7 and Volume 10) into another technical volume; any material incorporated by reference will be read as part of the technical volume where it is so incorporated. Offerors shall incorporate by reference only specific, relevant elements of one volume into another. In the event of a discrepancy in the page count or formatting between the Adobe “.pdf” and Microsoft Word editable “.docx” versions of the file,

(iii) Volume 3: Member services. This volume shall address the offeror’s approach to member services, Section 4.3. Offerors shall address their technical approach to accomplish the member services task. Offerors shall address their proposed systems, tools, techniques, and approaches to perform the following processes: enrollment application processing, certification request processing, member transfer processing, appeals processing, Designated Representative appointment processing, mail processing, collection of other health information, and pharmacy formulary assignment. Offerors shall address their technical approach to customer service support, document processing and mail/document center operations, and the call center. Offerors shall address their staffing approach, including the roles of key personnel and non-key staff, and the labor categories that are to be used for member services. Offerors are to provide a table of their proposed labor categories and estimated labor hours to perform member services, separately for CLINs 1002, 2002, 3002, 4002, 5002, 6002, 7002, 8002, and 9002 (enrollment application processing) and CLINs 1003, 2003, 3003, 4003, 5003, 6003, 7003, 8003, and 9003 (member services for existing members), and the basis for the offeror’s estimate. Offerors shall address their management approach to member services, including quality assurance and performance tracking, risk management, project management tools and techniques, and the resources proposed to accomplish the work.

This volume shall be formatted on 8.5 inch x 11 inch pages and submitted as a standalone file in both Adobe “.pdf” and Microsoft Word editable “.docx” formats. The body of the document shall be set with a minimum font size of 10 points, including any charts, tables, or figures. Normal character spacing and a minimum of single line spacing shall be used. Title and heading document elements may use a different font size. Each page shall have a minimum of one-inch margins on all sides of the page. Header and footer information, which does not include any information to be evaluated, may be included within the one-inch margin space and may use a font size other than 10 points.

This volume is limited to 20 pages. This page limitation does not apply to cover pages, a table of contents, or a table of acronyms, if submitted. The Government will count pages of the document in order from the first page, omitting from the count any pages specifically exempted by these instructions. Once the maximum page limit is reached, the Government will not read or evaluate any additional pages in the document. Offerors may incorporate by reference material from one technical volume (i.e., Volumes 1-7 and Volume 10) into another technical volume; any material incorporated by reference will be read as part of the technical volume where it is so incorporated. Offerors shall incorporate by reference only specific, relevant elements of one volume into another. In the event of a discrepancy in the page count or formatting between the Adobe “.pdf” and Microsoft Word editable “.docx” versions of the file,

(iv) Volume 4: Provider network management. This volume shall address the offeror’s approach to provider network management, Section 4.4, except NYMA EPN adoption under Section 4.4.1; initial NPN network development before SHCD under Section 4.4.2; and initial provider enrollment and credentialing under Section 4.4.3, all of which are performed during the Transition-In Period. Offerors shall address their technical approach to accomplish the provider network management task. Offerors shall address their strategy to ensure an adequate and accessible network of providers to deliver timely access to the full range of WTC-related health benefits in its two geographic areas of responsibility. Offerors shall address their approach to administer the EPN and NPN, including maintaining provider agreement records, monitoring network adequacy, closing network adequacy gaps, and further developing these networks through the recruitment of additional providers. Offerors shall address their approach to provider enrollment and credentialling. Offerors shall address their approach to developing, maintaining, and updating an accurate Provider Directory. Offerors shall address their approach to providing ongoing training and education to providers, including efforts to address adverse patterns and trends in provider behavior, such as a provider regularly submitting claims outside of timely filing guidelines. Offerors shall address their staffing approach, including the roles of key personnel and non-key staff, and the labor categories that are to be used for provider network management. Offerors are to provide a table of their proposed labor categories and estimated labor hours to perform provider network management under CLINs 1004, 2004, 3004, 4004, 5004, 6004, 7004, 8004, and 9004, and the basis for the offeror’s estimate. Offerors shall address their management approach to provider network management, including quality assurance and performance tracking, risk management, project management tools and techniques, and the resources proposed to accomplish the work.

This volume shall be formatted on 8.5 inch x 11 inch pages and submitted as a standalone file in both Adobe “.pdf” and Microsoft Word editable “.docx” formats. The body of the document shall be set with a minimum font size of 10 points, including any charts, tables, or figures. Normal character spacing and a minimum of single line spacing shall be used. Title and heading document elements may use a different font size. Each page shall have a minimum of one-inch margins on all sides of the page. Header and footer information, which does not include any information to be evaluated, may be included within the one-inch margin space and may use a font size other than 10 points.

This volume is limited to 20 pages. This page limitation does not apply to cover pages, a table of contents, or a table of acronyms, if submitted. The Government will count pages of the document in order from the first page, omitting from the count any pages specifically exempted by these instructions. Once the maximum page limit is reached, the Government will not read or evaluate any additional pages in the document. Offerors may incorporate by reference material from one technical volume (i.e., Volumes 1-7 and Volume 10) into another technical volume; any material incorporated by reference will be read as part of the technical volume where it is so incorporated. Offerors shall incorporate by reference only specific, relevant elements of one volume into another. In the event of a discrepancy in the page count or formatting between the Adobe “.pdf” and Microsoft Word editable “.docx” versions of the file,

(v) Volume 5: Medical benefits administration and policy. This volume shall address the offeror’s approach to medical benefits administration and policy, Section 4.5. Offerors shall address their technical approach to accomplish the medical benefits administration and policy task. Offerors shall address their approach to ensuring that member access to services reflects allowable benefits established by member type.

Offerors shall address their technical approach to prospective, concurrent, and retrospective utilization management, including systems and processes for prior authorization processing and utilization review. Offerors shall address their staffing approach, including the roles of key personnel and non-key staff, and the labor categories that are to be used for medical benefits administration and policy. Offerors are to provide a table of their proposed labor categories and estimated labor hours to perform member benefits administration and policy, separately for CLINs 1005, 2005, 3005, 4005, 5005, 6005, 7005, 8005, and 9005 (all tasks in Section 4.5 except Section 4.5.2) and CLINs 1006, 2006, 3006, 4006, 5006, 6006, 7006, 8006, and 9006 (utilization management, Section 4.5.2), and the basis for the offeror’s estimate. Offerors shall address their management approach to medical benefits administration, including quality assurance and performance tracking, risk management, project management tools and techniques, and the resources proposed to accomplish the work.

This volume shall be formatted on 8.5 inch x 11 inch pages and submitted as a standalone file in both Adobe “.pdf” and Microsoft Word editable “.docx” formats. The body of the document shall be set with a minimum font size of 10 points, including any charts, tables, or figures. Normal character spacing and a minimum of single line spacing shall be used. Title and heading document elements may use a different font size. Each page shall have a minimum of one-inch margins on all sides of the page. Header and footer information, which does not include any information to be evaluated, may be included within the one-inch margin space and may use a font size other than 10 points.

This volume is limited to 20 pages. This page limitation does not apply to cover pages, a table of contents, or a table of acronyms, if submitted. The Government will count pages of the document in order from the first page, omitting from the count any pages specifically exempted by these instructions. Once the maximum page limit is reached, the Government will not read or evaluate any additional pages in the document. Offerors may incorporate by reference material from one technical volume (i.e., Volumes 1-7 and Volume 10) into another technical volume; any material incorporated by reference will be read as part of the technical volume where it is so incorporated. Offerors shall incorporate by reference only specific, relevant elements of one volume into another. In the event of a discrepancy in the page count or formatting between the Adobe “.pdf” and Microsoft Word editable “.docx” versions of the file,

(vi) Volume 6: Claims processing. This volume shall address the offeror’s approach to claims processing, Section 4.6. Offerors shall address their technical approach to accomplish the claims processing task. Offerors shall address their approach to receive, process, and accurately adjudicate all medical (to include dental) claims for all services provided to any member. Offerors shall address their approach to accepting electronic and paper-based medical claims and processing these claims using intelligent decisioning and business rules. In particular, offerors shall address how their claims processing system and process auto-adjudicates claims and provides for high-volume data capture and routing in accordance with the Government’s need for continuous delivery. Offerors shall address their software development process and methodology, and how this methodology supports rapid reconfiguration of their claims processing system as needed to meet evolving program needs.

Offerors shall address how they will meet medical claims processing timelines. Offerors shall address how they will submit medical, dental, and pharmacy claims to the Centers for Medicare & Medicaid Services (CMS) for payment, provide an explanation of benefits (EOB) to providers and members, perform coordination of benefits for Survivors, and report on claims data. Offerors shall address their staffing approach, including the roles of key personnel and non-key staff, and the labor categories that are to be used for claims processing. Offerors are to provide a table of their proposed labor categories and estimated labor hours to perform claims processing under CLINs 1007, 2007, 3007, 4007, 5007, 6007, 7007, 8007, and 9007, and the basis for the offeror’s estimate. Offerors shall address their management approach to claims processing, including quality assurance and performance tracking, risk management, project management tools and techniques, and the resources proposed to accomplish the work.

This volume shall be formatted on 8.5 inch x 11 inch pages and submitted as a standalone file in both Adobe “.pdf” and Microsoft Word editable “.docx” formats. The body of the document shall be set with a minimum font size of 10 points, including any charts, tables, or figures. Normal character spacing and a minimum of single line spacing shall be used. Title and heading document elements may use a different font size. Each page shall have a minimum of one-inch margins on all sides of the page. Header and footer information, which does not include any information to be evaluated, may be included within the one-inch margin space and may use a font size other than 10 points.

This volume is limited to 20 pages. This page limitation does not apply to cover pages, a table of contents, or a table of acronyms, if submitted. The Government will count pages of the document in order from the first page, omitting from the count any pages specifically exempted by these instructions. Once the maximum page limit is reached, the Government will not read or evaluate any additional pages in the document. Offerors may incorporate by reference material from one technical volume (i.e., Volumes 1-7 and Volume 10) into another technical volume; any material incorporated by reference will be read as part of the technical volume where it is so incorporated. Offerors shall incorporate by reference only specific, relevant elements of one volume into another. In the event of a discrepancy in the page count or formatting between the Adobe “.pdf” and Microsoft Word editable “.docx” versions of the file,

(vii) Volume 7: Data and business information management. This volume shall address the offeror’s approach to data and business information management, Section 4.7. Offerors shall address their technical approach to accomplish the data and business information management task. Offerors shall address their strategy for transparent data and business information management with the Program. Offerors shall address the technology stacks and architecture on which their software and applications reside and operate. Offerors shall discuss their roadmap for their technology stacks and architecture throughout the ten-year period of performance of this Contract. Offerors shall address their approach to ensure that there is consistency in data across systems.

Offerors shall address their software development process and methodology to ensure systems are configurable to allow for changes to be developed, tested, accepted, and implemented. Offerors shall address their approach to testing software changes. Offerors shall address their approach to ensure that other Program contractors have access to only the data to which they are authorized access. Offerors shall address their approach to ensuring the accuracy of member profiles and the consistency of member profiles across sources and systems. Offerors shall address their approach to the Secure Self-Service Portal and how the offeror’s solution will meet the needs of members, providers, and the Program; desired minimal functionality is described in the form of member and provider user stories in Attachment ATT113, Secure Self-Service Portal User Stories. Offerors shall address their approach to furnish an analytics platform with a self-service functionality to meet the data demands of the Program. Offerors shall attach to this volume up to 15 pages of example reports, dashboards, and visualizations that are supported by the offeror’s platform to demonstrate various reporting functionalities. Offerors shall address how they will accomplish the other reporting requirements of this task. Offerors shall address how their provided systems will meet all operational, security, and availability standards of this Contract, including the security plan and accreditation requirements in Section C31, HHSAR 352.239-71, Security Requirements for Information Technology Resources, in accordance with Section E12, HHSAR 352.239-72, Information System Security Plan and Accreditation. Offerors shall address how they will maintain the bidirectional exchange of information with the Program and other Program contractors. Offerors shall address their approach to both modernize Program data and information exchange over the life of this Contract while also minimizing the impact to other Program contractors of changes to data and information exchange early in contract performance. Offerors shall address their approach to data integrity and governance to ensure the availability, consistency, integrity, and security of data and records.

Offerors shall address their approach to records management and the records repository. Offerors shall address their plans to ensure continuity of operations. Offerors shall address their staffing approach, including the roles of key personnel and non-key staff, and the labor categories that are to be used for data and business information management. Offerors are to provide a table of their proposed labor categories and estimated labor hours to perform data and business information management, separately for CLINs 1008, 2008, 3008, 4008, 5008, 6008, 7008, 8008, and 9008 (all tasks in Section 4.7 except Sections 4.7.5 and 4.7.6) and CLINs 1009, 2009, 3009, 4009, 5009, 6009, 7009, 8009, and 9009 (data and information exchanges, integrity, and governance, Sections 4.7.5 and 4.7.6), and the basis for the offeror’s estimate. Offerors shall address their management approach to data and business information management, including quality assurance and performance tracking, risk management, project management tools and techniques, and the resources proposed to accomplish the work.

This volume shall be formatted on 8.5 inch x 11 inch pages and submitted as a standalone file in both Adobe “.pdf” and Microsoft Word editable “.docx” formats. The body of the document shall be set with a minimum font size of 10 points, including any charts, tables, or figures. Normal character spacing and a minimum of single line spacing shall be used. Title and heading document elements may use a different font size. Each page shall have a minimum of one-inch margins on all sides of the page. Header and footer information, which does not include any information to be evaluated, may be included within the one-inch margin space and may use a font size other than 10 points.

These font and page specifications (i.e., font size, character spacing, line spacing, page margins) do not apply to the analytics platform examples of reports, dashboards, and visualizations that are a required attachment to this volume. This volume is limited to 20 pages. This page limitation does not apply to cover pages, a table of contents, or a table of acronyms, if submitted. This page limitation also does not apply to the analytics platform examples of reports, dashboards, and visualizations that are a required attachment to this volume. The Government will count pages of the document in order from the first page, omitting from the count any pages specifically exempted by these instructions. Once the maximum page limit is reached, the Government will not read or evaluate any additional pages in the document. Offerors may incorporate by reference material from one technical volume (i.e., Volumes 1- 7 and Volume 10) into another technical volume; any material incorporated by reference will be read as part of the technical volume where it is so incorporated. Offerors shall incorporate by reference only specific, relevant elements of one volume into another. In the event of a discrepancy in the page count or formatting between the Adobe “.pdf” and Microsoft Word editable “.docx” versions of the file, the Adobe “.pdf” version will control.

(viii) Volume 8: Business volume. Volume 8 includes five parts:

(A) Part A: Pricing. This part shall include the completed pricing template and a separate basis of estimate document:

(1) The completed pricing template in Attachment ATT107, Pricing

Template. This template contains 14 worksheets.

(a) The first two worksheets in the template file contain a period-level summary and a CLIN-level summary of the offeror’s proposed pricing. These worksheets are locked for editing and populate based upon the information provided in the base and option period worksheets. On the CLIN-level summary worksheet, the unit prices for CLINs that are priced on a firm-fixed-unit-price (FFUP) basis, or a firm-fixed-price (FFP) basis with monthly invoicing, calculate based on the unit prices calculated in the base and option period worksheets, rounded to the nearest cent. On the CLIN-level summary worksheet, the prices to continue services for the maximum six-month extension under FAR 52.217-8, Option to Extend Services, populate based upon a pro rata amount of the offeror’s proposed prices for Option Period 9 (rows 96 through 105, based on CLINs 9001 through 9010) and the Transition-Out Period (row 106, based on CLIN 8012).

(b) For each of the 12 base and option period worksheets, the offeror shall provide its proposed labor costs and other direct costs for each CLIN. While these worksheets are unlocked for editing, the only changes that offerors should make to the template are tailoring the “group” column headings (as described below) or adding additional rows to the labor or other direct costs tables, if so needed. Offerors may also adjust column widths as needed. All other aspects of the template should remain intact and unaltered. For CLINs based on a quantity of units, offerors shall price the CLIN based on the maximum quantity of units provided in Section B of the RFP. Labor costs include all labor performed by either the offeror or a subcontractor. Other direct costs include all non-labor costs to perform this Contract, including materials, subcontracts for supplies or incidental services not priced using labor categories (such as organizational computer use charges), and costs estimated for travel (e.g., airfare, transportation, hotel, meals and incidental expenses). Each base and option period worksheet calculates a unit price for the CLIN, based upon the maximum quantity of units provided in Section B.

(i) The labor table contains the following columns:

(A) Group 1/2. These are optional columns, the headings for which may be tailored by offerors as desired to reflect their organization of labor resources (e.g., to designate an on-site/off-site employee, categorize labor categories by workgroup, or delineate between salaried and hourly wage employees). The use of these columns is optional.

(B) Offeror/Subcontractor. The offeror shall identify whether the labor resource is an employee of the offeror or a subcontractor. If subcontractor, provide the subcontractor company name.

(C) Labor Category. The labor category name.

(D) Unburdened Rate. The unburdened, direct wage rate for the labor category. Offerors shall propose a single labor rate for each labor category proposed in each base and option period. The unburdened rates for proposed subcontractor labor may be submitted under separate cover by the proposed subcontractor directly to the Government. If the proposed subcontractor furnishes this information directly to the Government, it shall do so using Attachment ATT107, Pricing Template, by completing the columns for Offeror/Subcontractor, Labor Category, and Unburdened Rate, only. All other columns and data fields in the template shall be left blank and will not be evaluated by the Government. The proposed subcontractor submitting this information directly to the Government shall follow the proposal submission process and deadlines described in this solicitation and shall clearly indicate to which offeror’s proposal (i.e., the proposed prime contractor) its submission relates by noting this information in the body of the submission e-mail. Offerors bear full responsibility to ensure that unburdened labor rates submitted by their proposed subcontractors are timely submitted to the Government in accordance with all applicable requirements.

(E) Fully Burdened Rate. The fully burdened labor rate for the labor category. Offerors shall propose a single labor rate for each labor category proposed in each base and option period. The rate shall include, as applicable, wages, fringe benefits, overhead, general and administrative expenses, and profit. The Government is not requesting a breakdown of the various components of the labor rate; rather, only the fully burdened rate itself is requested.

(F) Per CLIN Hours (e.g., “CLIN 0001

Hours”). The estimated hours per labor category for each CLIN.

(G) Per CLIN Amount (e.g., “CLIN 0001

Amount”). This column will calculate automatically by multiplying the fully burdened rate by the estimated hours.

(ii) The other direct costs table contains the following columns:

(A) Group 1/2. These are optional columns, the headings for which may be tailored by offerors as desired to reflect any categorization or organization of other direct costs. The use of these columns is optional.

(B) Item Description. The description of the other direct cost. Descriptions should be detailed enough to permit the Government to evaluate the item for reasonableness and realism. Offerors may further elaborate on the description of other directs costs in the basis of estimate document.

(C) Item Direct Cost. The direct cost of the item to the offeror. This cost is requested to facilitate the Government’s price realism evaluation.

(D) Item Indirect Cost. The amount of any indirect costs (e.g., material handling fee, subcontract administration, G&A) or profit the offeror has applied to the item. The Government is not requesting a breakdown of the various components of the indirect costs or a separate amount for any profit; rather, only the total amount of indirect costs and any profit is requested. However, see Section E3(i)(1)(viii)(A)(2)(f) of the basis of estimate Section, below, for additional requirements regarding indirect costs proposed against time-and-materials CLINs.

(E) Total Item Cost. This column will calculate automatically, totaling the sum of the item’s direct and indirect costs.

(F) Per CLIN Quantity. Offerors shall provide the quantity of the item.

(G) Per CLIN…