HT0011-13-R-0001_(Conformed_Copy).pdf

TRICARE MANAGEMENT ACTIVITY

7700 ARLINGTON BLVD

FALLS CHURCH VA 22042

UNDER DPAS (15 CFR 700)

11. DELIVERY FOR FOB

RFQ

SEE SCHEDULE

14. METHOD OF SOLICITATION

IFB RFP

CODE

SEE ADDENDUM

BLOCK IS MARKED

DESTINATION UNLESS

12. DISCOUNT TERMS

(No Collect Calls)

$14.0M

13b. RATING

13a. THIS CONTRACT IS A RATED ORDER

X

CODE

HT0011-13-R-0001 26-Feb-2013

b. TELEPHONE NUMBER 8. OFFER DUE DATE/LOCAL TIME

12:00 PM 18 Mar 2013

5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV 3/2005)

Prescribed by GSA

FAR (48 CFR) 53.212

(TYPE OR PRINT)

(SIGNATURE OF CONTRACTING OFFICER) 31c. DATE SIGNED

ADDENDA ARE

26. TOTAL AWARD AMOUNT (For Gov t. Use Only )

22. UNIT 23. UNIT PRICE 24. AMOUNT21. QUANTITY

CODE 10. THIS ACQUISITION IS

UNRESTRICTED

FAX: NAICS:

TEL:

CODE 18a. PAYMENT WILL BE MADE BYOFFEROR

SUCH ADDRESS IN OFFER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT

BELOW IS CHECKED

TEL.

HT0011

SIZE STD:

9. ISSUED BY

FACILITY

CODE

17a.CONTRACTOR/

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a. UNLESS BLOCK

15. DELIVER TO CODE HT0003 16. ADMINISTERED BY

TRICARE MANAGEMENT ACTIVITY

POLICY & OPERATIONS DIRECTORATE - POD

DHHQ BUILDING

7700 ARLINGTON BLVD, SUITE 5101

FALLS CHURCH VA 22042-5101

TEL: FAX:

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

MIKE FOX

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER

(TYPE OR PRINT)

30b. NAME AND TITLE OF SIGNER 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a.UNITED STATES OF AMERICA

0 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1. 52.212-4. FAR 52.212-3. 52.212-5 ARE ATTACHED.

25. ACCOUNTING AND APPROPRIATION DATA

1. REQUISITION NUMBER

19. ITEM NO. 20. SCHEDULE OF SUPPLIES/ SERVICES

SEE SCHEDULE

541611

TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS

SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS

SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED HEREIN.

SB

HUBZONE SB

SET ASIDE: 100 % FOR

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

TEL: EMAIL:

0 COPIES

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

.OFFER DATED YOUR OFFER ON SOLICITATION

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 29. AWARD OF CONTRACT: REFERENCE

8(A)

SVC-DISABLED VET-OWNED SB

EMERGING SB

X

X

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

(CONTINUED)

SEE SCHEDULE

19. ITEM NO. 20. SCHEDULE OF SUPPLIES/ SERVICES 21. QUANTITY 22. UNIT 24. AMOUNT

PAGE 2 OF

23. UNIT PRICE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: ______________________________________________________

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f . TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

37. CHECK NUMBER

FINALPARTIALCOMPLETE

36. PAYMENT35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER

FINAL

33. SHIP NUMBER

PARTIAL

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV 3/2005) BACK

Prescribed by GSA

FAR (48 CFR) 53.212

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

HT0011-13-R-0001

Section SF 1449 - CONTINUATION SHEET

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 6 Months Transition-In - Labor

FFP

FOB: Destination

NET AMT

0002 Cost Transition-In – ODC's

COST

ESTIMATED COST

0003 6 Months Base Year - Labor

0004 Months Base Year - ODC's

0005 6 Months On-site Testing & Support (Optional)

FFP

In accordance with section 2.2.1.20 of the PWS.

1001 12 Months OPTION Option 1 - Labor

1002 Cost OPTION Option 1 - ODC's

1003 12 Months OPTION On-site Testing & Support (Optional)

FFP

2001 12 Months OPTION Option 2 - Labor

2002 Cost OPTION Option 2 - ODC's

2003 12 Months OPTION On-site Testing & Support (Optional)

FFP

3001 12 Months OPTION Option 3 - Labor

3002 Cost OPTION Option 3 - ODC's

3003 12 Months OPTION On-site Testing & Support (Optional)

FFP

4001 6 Months OPTION Option 4 - Labor

4002 Cost OPTION Option 4 - ODC's

4003 6 Months OPTION On-site Testing & Support (Optional)

FFP

4004 6 Months OPTION Tansition Out - Labor

4005 Cost OPTION Transition Out - ODC's

PERFORMANCE WORK STATEMENT (PWS)

Title: DESIGNATED PROVIDER/USFHP DATA SUPPORT Requiring Activity Name: TRICARE Policy and Operations Directorate

1.0 SCOPE

This award provides information technology support services to the Department of Defense (DoD) for the Designated Provider (DP) health care delivery system in support of the Military Health System (MHS) system. This contract award will result in services to collect DP submitted data monthly, interface with Defense Enrollment and Eligibility Reporting System (DEERS) for the purpose of collecting enrollment and eligibility data and to send enrollment fee and catastrophic capitation information on DP beneficiaries, report monthly results for enrollment and capitation, maintain a database of all enrollment demographics for the DP population, perform audits and reviews, and report results of the data collection and comparison.

1.0.1 Background

The National Defense Authorization Act for Fiscal Year 1997 directed the DoD to include the DPs (formerly called the Uniformed Services Treatment Facilities) in the health care delivery system of the uniformed services. In 1998 each of the DPs entered sole source contracts to provide the TRICARE Prime benefit to beneficiaries of the uniformed services. The DPs administer a health care program called the Uniformed Services Family Health Plan, providing the TRICARE prime benefit to approximately 120,000 enrolled members. The DP Program Office within the TRICARE Policy and Operations Directorate is the organization that is responsible for the oversight and operations of the six DPs contract and the data support contract.

1.0.2 Objectives

Objective 1. In partnership with the Military Health System (MHS), operate and support an information technology system capable of receiving and storing electronic data from multiple sources (government and private). Use a cost effective management approach to employ adequate hardware, software, personnel, procedures, controls, contingency plans, and documentation to satisfy TRICARE Management Activity (TMA) data processing and reporting requirements this contract, the TRICARE Systems Manual, and the DP’s contract.

Objective 2. Maintain a managed, stable, high-quality information technology system capable of collecting valid input and producing accurate and valid output. The database system must be capable of maintaining current and historical data over the life of the DP program.

System must be able to reconcile enrollment and payment throughout the contract period.

System must be capable of collecting clinical and pharmacy encounter data in accordance with DoD guidance referenced in this contract. System must be able to interface with DEERS in accordance with the TRICARE Systems Manual, Chapter 3.

Objective 3. Develop a system that will provide accurate, consistent, and timely electronic reports using a media that is compatible with the receiving systems of the government, the DPs, or other sources as directed by the Contracting Officer on a monthly, quarterly, and/or annual basis. The resulting contract will require monthly reporting of enrollment, eligibility, encounter, and information to the DPs and the government. The contractor’s system must have the capability to consistently produce electronic enrollment and eligibility reports with varying demographics consistent with the requirements of this contract. The formats of the reports required will be provided upon contract award. Defined tasks are detailed in Section 2.2.

Objective 4. To install the necessary hardware and software during the life of the contract ensuring compliance with the requirements of the Privacy Act, Health Insurance Portability and Accountability Act (HIPAA), National Institute of Standards and Technology (NIST) and the Personnel Security Program. The data collection requirements resulting from this contract instrument will result in the collection and maintenance of sensitive patient and personnel information. The contractor must demonstrate the ability to collect, maintain, and pass sensitive information in accordance with statutory legislation and regulatory requirements. All Contractor personnel working on government networks shall complete the ADP II Security package and shall be approved for working on information systems. The contractor shall implement and maintain information security in its enterprise or company-wide unclassified information technology system(s). Data or other electronic information obtained through this contract instrument is for the sole purpose of successfully completing contract performance as detailed in or modified to this document. This data or information is not for the use of accomplishing other government or private work or performance.

1.1 Non-Personal Services

This award identifies services that are strictly non-personal in nature.

1.2 Severable / Non-Severable Services

This award identifies services that are severable in nature.

1.3 Inherently Governmental Functions

This requirement has been reviewed and contains no services that are inherently governmental functions.

1.4 Acquisition Functions Closely Associated with Inherently Governmental Functions

This award has been reviewed and contains no services that are inherently governmental functions.

1.5 Organizational Conflict of Interest (OCI) Category

The Offeror’s attention is directed to FAR, Subpart 9.5, “Organizational and Consultant

Conflicts of Interest.” For the purpose of these provisions, the term “Offeror” means the offeror, its subsidiaries, affiliates, partners, marketing consultants, as defined by FAR, Subpart 9.501, or any of its successors or assignees. The Offeror is hereby notified that the nature of the work to be performed may create an actual or potential organizational conflict of interest in future acquisitions.

The contractor will participate in the evaluation of the proposals, products or services of other companies. To avoid conflicts which may create bias, impair the contractor’s objectivity, or give the contractor an unfair competitive advantage, it is agreed that the contractor is precluded from award of any supply or service contract or subcontract related to said technical evaluations. This restriction shall be effective for the entire period of performance and two years after.

The contractor may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications) or perform evaluation services which may create a current or subsequent OCI.

To avoid conflicts which may create bias ground rules, impair the contractor’s objectivity, or give the contractor an unfair competitive advantage, it is agreed that the contractor will notify the Contracting Officer immediately of such an actual or potential OCI throughout the duration of the period of performance.

The Offeror is hereby notified that an actual or potential conflict of interest may exist with Covered DoD officials, as defined by DFARS 252.203-7000. The Offeror shall not knowingly provide compensation to a former Covered DoD official within 2 years after the official leaves DoD service, without first determining that the official has sought and received, or has not received after 30 days of seeking, a written opinion from the appropriate DoD ethics counselor regarding the applicability of post-employment restrictions to the activities that the official is expected to undertake on behalf of the Offeror. Additionally, the Offeror must disclose all intended employees on solicitation that are potential Covered DoD Officials, and get approval from the Contracting Officer prior to the involvement of Covered DoD Officials in the development of a response to the solicitation or a mitigation plan.

The Offeror shall represent in writing within the proposal that, to the best of the Offeror’s knowledge, there are no relevant facts or circumstances concerning any past, present, or potential contracts or financial interest relating to the work to be performed, which could give rise to an organizational conflict of interest, as described in FAR, Subpart 9.5. In the event an actual or potential organizational conflict of interest exist, the Offeror shall submit a mitigation plan to the Contracting Officer, no later than 10 calendar days prior to the proposal due date, that effectively demonstrates how the Offeror will mitigate any actual or potential organizational conflict of interest while supporting this contract and any other TMA contract. As a part of the proposal, the Offeror shall provide the Contracting Officer with information of previous or ongoing work that is in any way associated with this solicitation.

The Contracting Officer will review all mitigation plans to determine whether award to the Offeror is consistent with FAR, Subpart 9.5. If the Contracting Officer determines that no conflict would arise or that the mitigation plan adequately protects the interest of the

Government, the Offeror will be eligible for award (assuming no other impediment). If the Contracting Officer determines that the mitigation plan is inadequate, remedial actions will be considered, including elimination from the solicitation process, termination of related contract efforts already awarded, or negotiation of the mitigation plan.

The above restrictions shall be included in all subcontracts, teaming arrangements, and other agreements calling for performance of work which is subject to the organizational conflict of interest restrictions identified in these provisions.

The Offeror acknowledges the full force and effect of these provisions. The above provisions may be modified or deleted at the discretion of the Government. The Government reserves the right, in case of a breach, misrepresentation or nondisclosure, to terminate the resultant contract, disqualify the Offeror from subsequent related contractual efforts, or pursue any remedy permitted by law, regulation or the terms and conditions of this solicitation.

1.6 Capability Maturity Model Integration (CMMI) Level 2 Certification – Deliverable 1

As part of industry's best practices a Capability Maturity Model Integration (CMMI) Level 2 certification will be required at award (Deliverable 1).

2.1 Task Management

The Contractor shall provide sufficient management to ensure that this task is performed efficiently, accurately, on time, and in compliance with the requirements of this document.

Specifically, the Contractor shall designate a single manager to oversee this task and supervise staff assigned to this task. The Contractor shall ensure that a Monthly Progress Report is submitted outlining the expenditures, billings, progress, status, and any problems/ issues encountered in the performance of this task.

The Government will utilize a Quality Assurance Surveillance Plan (QASP) to monitor the quality of the Contractor’s performance. The Government oversight provided for in the order and in the QASP will help to ensure that service levels reach and maintain the required levels throughout the contract term. Further, the QASP provides the Government COR with a proactive way to avoid unacceptable or deficient performance, and provides verifiable input for the required Past Performance Information Assessments. The QASP is a living document and may be updated by the Government as necessary. The Government COR on a quarterly basis will provide the contractor a QASP.

2.1.1 Monthly Progress Report (MPR) – Deliverable 2

The Contractor shall ensure that a MPR is submitted outlining the expenditures, billings, progress, status, and any problems/ issues encountered in the performance of this task (Deliverable 2), in accordance with the format located at:

http://www.tricare.mil/ams/downloads/MonthlyProgressReport.doc

The MPR shall include the labor hours expended, by labor category, for each task and sub-task.

The MPR shall measure the Contractor’s cost and schedule performance using either the Government-approved Work Breakdown Structure (WBS) or a separate arrangement as mutually agreed upon by the Government and the Contractor.

The Contractor shall require all subcontractors to provide input to the MPR where there are critical or significant tasks related to the prime contract. Critical or significant tasks shall be defined by mutual agreement between the Government and Contractor.

2.1.2 Subcontractor Expenditures Report – Deliverable 3

If Subcontractors are used, the Contractor shall prepare and deliver a Subcontract Expenditures Report (Deliverable 3) that discloses actual subcontract expenditures by company name, business size standard (i.e. Woman Owned Business, Veteran Owned Business, etc.), and other socioeconomic programs (i.e. Indian Incentive Program, Historically Black Colleges and Universities and Minority Institutions, etc.).

2.1.3 Contract Work Breakdown Structure (CWBS) – Deliverable 4/Deliverable 5

The Contractor shall create a Contract Work Breakdown Structure (CWBS) in accordance with Data Item Description (DID) DI-MGMT-81334C, extending the Government WBS to the task level. This CWBS (Deliverable 4) shall represent how the Contractor plans to accomplish the entire work scope and be consistent with Government organizations and processes. The CWBS shall serve as the framework for contract planning, budgeting, and reporting of cost/price and schedule status to the Government. The Contractor shall identify major elements of subcontracted work in the CWBS. The Contractor shall produce definitions for CWBS elements in accordance with MIL-HDBK-881 and USD(AT&L) memorandum of January 9, 2009 (Subject: Standardization of Work Breakdown Structures to Support Acquisition Program Management), preparing a CWBS Dictionary (Deliverable 5) describing the efforts under this contract associated with each CWBS element. The Contractor shall ensure that the IMS and Contract Performance Report (CPR) (if applicable), are derived from and traceable to the

CWBS.

2.1.4 Transition Support

a. Incoming Transition Plan– Deliverable 6

In accordance with the solicitation, the Contractor shall provide a plan for 6 month incoming transition from contract to contract. The Contractor shall coordinate with the Government in planning and implementing a complete transition to the Contractor's support model. The Contractor shall collaborate with the Government to develop and deliver an Incoming Transition Plan (Deliverable 6). The Government will designate a transition period for the incoming Contractor to coordinate and work with the incumbent Contractor. This transition plan shall include, but is not limited to:

Coordination with Government representatives, Review, evaluation and transition of current support services, Transition of historic data to new Contractor system, Government-approved training and certification process, Transfer of hardware warranties and software licenses (if applicable), Transfer of all necessary business and/or technical documentation, Transfer of compiled and uncompiled source code, to include all versions, maintenance updates and patches (if applicable), Orientation phase and program to introduce Government personnel, programs, and users to the Contractor's team, tools, methodologies, and business processes, Distribution of Contractor purchased Government owned assets, including facilities, equipment, furniture, phone lines, computer equipment, etc., Transfer of Government Furnished Equipment (GFE) and Government Furnished Information (GFI), and GFE inventory management assistance, Applicable TMA briefing and personnel in-processing procedures, Coordinate with the Government to account for government keys, ID/access cards, and security codes.

b. Option Item: Outgoing Transition Plan – Deliverable 7

In accordance with the solicitation, the Contractor shall provide a plan (Deliverable 7) for 6 months outgoing transition for transitioning work from an active task order to a follow-on contract. This transition may be to a Government entity, another Contractor or to the incumbent Contractor under a new contract/order. In accordance with the Government-approved plan, the Contractor shall assist the Government in planning and implementing a complete transition from this Contract and/or orders issued under this Contract to a successful provider. This shall include formal coordination with Government staff and successor staff and management. It shall also include delivery of copies of existing policies and procedures, and delivery of required metrics and statistics. This transition plan shall include, but is not limited to:

Coordination with Government representatives, Review, evaluation and transition of current support services, Transition of historic data to new Contractor system, Government-approved training and certification process, Transfer of hardware warranties and software licenses (if applicable), Transfer of all necessary business and/or technical documentation, Transfer of compiled and uncompiled source code, to include all versions, maintenance updates and patches (if applicable), Orientation phase and program to introduce Government personnel, programs, and users to the Contractor's team, tools, methodologies, and business processes, Disposition of Contractor purchased Government owned assets, including facilities, equipment, furniture, phone lines, computer equipment, etc., Transfer of Government Furnished Equipment (GFE) and Government Furnished Information (GFI), and GFE inventory management assistance.

Applicable TMA debriefing and personnel out-processing procedures.

Turn-in of all government keys, ID/access cards, and security codes.

2.1.5 Program Management Plan – Deliverable 8

The Contractor shall develop a Program Management Plan (Deliverable 8) that shall require Government approval. This plan shall be applied by the Contractor to manage, track and evaluate the Contract performance. The Program Management Plan shall consist of control policies and procedures in accordance with standard industry practices for project administration, execution and tracking.

The Program Management Plan shall include the following:

Identification of milestones where Government information/activity is required and timeline dependencies for subsequent Contractor activities;

An Integrated Master Management Plan (IMMP) describing the Contractor’s overall management approaches, policies and procedures including suggested project metrics;

and, A detailed staffing plan.

The Program Management Plan shall be due five (5) calendar days after the award of the order.

2.1.6 Quality Control Plan – Deliverable 9

The Contractor shall prepare and adhere to a Quality Control Plan (QCP). The QCP will initially be submitted with the vendor’s quote and shall be updated following award (Deliverable 9).

The QCP shall document how the Contractor will meet and comply with the quality standards established in this statement of work. At a minimum, the QCP must include a self-inspection plan, an internal staffing plan, and an outline of the procedures that the Contractor will use to maintain quality, timeliness, responsiveness, customer satisfaction, and any other requirements set forth in this solicitation. Quality Control is an important aspect to managing the lifecycle of this project and producing the expected results of the Government.

2.1.7 Contingency Operations Plan – Deliverable 10

The Contractor shall develop and submit a Contingency Operations Plan to the Government.

The Contingency Operations Plan shall be due ten (10) calendar days after the award of the order, and will be updated on a quarterly basis (Deliverable 10). The Contingency Operations Plan shall document Contractor plans and procedures to maintain TMA support during an emergency. The Contingency Operations Plan shall include the following:

A description of the Contractor’s emergency management procedures and policy A description of how the Contractor will account for their employees during an emergency Planned temporary work locations or alternate facilities How the Contractor will communicate with TMA during emergencies A list of primary and alternate Contractor points of contact, each with primary and alternate:

Telephone numbers E-mail addresses

Procedures for protecting Government furnished equipment (if any) Procedures for safeguarding sensitive and/or classified Government information (if applicable)

2.1.8 Operations During Emergency Situations

Individual contingency operation plans shall be activated immediately after determining that an emergency has occurred, shall be operational within twelve (12) hours of activation, and shall be sustainable until the emergency situation is resolved and normal conditions are restored or the contract is terminated, whichever comes first. In case of a life threatening emergency, the COR shall immediately make contact with the Contractor Task Manager to ascertain the status of any Contractor personnel who were located in Government controlled space affected by the emergency. When any disruption of normal, daily operations occur, the Contractor Task Manager shall promptly open an effective means of communication and verify:

Key points of contact (Government and Contractor)

Temporary work locations (alternate office spaces, telework, virtual offices, etc.)

Means of communication available under the circumstances (e.g. email, webmail, telephone, FAX, courier, etc.)

Essential work products expected to continue production by priority

The Contractor Task Manager, in coordination with the COR, must make use of the resources and tools available to continue TMA contracted functions to the maximum extent possible under emergency circumstances. The Contractor must obtain approval from the COR and Contracting Officer prior to incurring costs over and above those allowed for under the terms of this contract.

Regardless of contract type, and of work location, Contractors performing work in support of authorized tasks within the scope of their contract shall charge those hours accurately in accordance with the terms of this contract.

2.1.9 Contractor Personnel Performance/Replacement

Substitutions of quoted Key Personnel shall not be allowed for a period of one year after award, except under extreme circumstances at the Contracting Officer’s discretion. Any substitution or replacement Key Personnel shall have qualifications equal to or greater than the individuals quoted. For temporary and/or permanent replacement of Key Personnel, the Contractor shall provide a resume for each individual to the COR. Resumes shall be provided at least two weeks (or as mutually agreed upon) prior to making any personnel changes. The Government reserves the right to pre-approve any replacement or substitution of Key Personnel. Contractor personnel must submit necessary information to be issued a clearance prior to reporting for performance.

2.1.10 Performance Requirements Matrix

By monitoring the Contractor, the COR will determine whether the performance levels set forth in the order have been attained. Performance standards are specified in the following Performance Requirements Summary Matrix in the Standard and Acceptable Quality Level columns.

Task Indicator Standard Acceptable Quality Level

Method of Surveillance

Incentive

1. Provide timely and accurate reporting of

DP

beneficiary enrollment and capitation amounts

The contractor shall collect enrollment information from DEERS for the purpose of reporting to the DoD

No more than 2 reports may be later than the specified time period or be inaccurate

No more than 2 reports to the appropriate government contact may be later than the specified time period or be inaccurate

Feedback from COR and date stamp on the reports

Past Performance Rating for future tasks and contracts

2. Provide technical support for the various

DEERS

interfaces

The contractor shall serve as the technical expert on all DEERS interfaces and provide interpretation and clarification of requirements to the TMA Program Office

The connectivity to the DEERS interfaces should be operating 99% of the time.

All connectivity to DEERS will be operating 99% of the time.

Feedback from COR and monthly reports

Past Performance Rating for future tasks and contracts

3. Monitor and maintain

DEERS

interfaces

The contractor shall continually monitor and maintain connectivity to various DEERS interfaces

The connectivity to the DEERS interfaces should be operating 99% of the time

All connectivity to DEERS will be operating 99% of the time.

Feedback from COR and monthly reports

Past Performance Rating for future tasks and contracts

4. Display PNT data real-time on a secure website

The contractor shall collect PNT data from DEERS, process and display the data on a secure website

The data should be processed and displayed within 5 processing minutes

No more than 2 reports from the users that the data is not available

Feedback from COR and from the six DP plans

Past Performance Rating for future tasks and contracts

5. PNT

reports provided to the DPs daily

The contractor shall collect PNT data from DEERS, process and make available daily reports to the six DP plans via a secure website

The data should be processed and sent daily (business days)

No more than 5 times can the reports not be available to the DPs (technical issues on the DP side will not count against the contractor)

Feedback from COR and from the six DP plans

Past Performance Rating for future tasks and contracts

6. Provide test environment for the DPs

The contractor shall provide a test environment for the DPs to mirror production

Any test results/reports should be provided to the DPs/TMA within 5 business days

No more than 2 times can the test reports be provided past 5 business days

Feedback from COR and from the six DP plans

Past Performance Rating for future tasks and contracts

7. Collect data from the six DP plans and provide analysis and reports

On a monthly basis, the contractor shall process data submitted by the DPs and provide an analysis/reports of the data

The data should be processed with reports provided to TMA and the six DP plans within 5 calendar days of receipt of data

No more than 2 times can the reports/analysis be provided past 5 calendar days

Feedback from COR and from the six DP plans

Past Performance Rating for

8. Issue Reports

The contractor shall report all incidents such as system failures, deliverables not met, etc.

Within 48 hours of an incident being discovered, the contractor shall prepare an Issue Report

No more than 4 Issue Reports annually

Feedback from COR and from the six DPs

Past Performance Rating for

2.2 Specific Tasks

2.2.1 Reporting – Deliverables 11, 12, 13, 14, and 15

No later than the 10th day of each month, the contractor shall make the standard enrollment and capitation payment reports available on the secure website or portal to each DP and TMA. Each DP will receive records for their facility ONLY. The contractor shall work with the program office to determine the specific criteria for required enrollment and capitation reports.

(Deliverable 11)

The contractor will receive a complete list of all DP beneficiaries who are enrolled and eligible in the DEERS as of the start of the contract. The data will be used as a base line from which the contractor must track enrollment changes as determined by daily receipt of Policy Notification Transfers (PNTs). The contractor shall report monthly the number of beneficiaries enrolled in the DP program.

The contractor shall be required to compute monthly capitation payment by age and gender for enrollees of the DP. The specific capitation rates will be furnished to the contractor as the rates are developed. The government expects the capitation rates to change for the initial and each option period for each of the DP contracts. When capitation rates are adjusted for a specific population and previous period of time, the contractor shall be able to re-calculate the previous capitation amounts and provide reports detailing the adjustments.

The contractor shall receive a complete list of eligible uniformed service beneficiaries residing within the DP’s service area. This will be received each month from DMDC. The contractor shall submit this data to the appropriate DP by the 15th of the month. The DP uses this data for educating beneficiaries only. (Deliverable 12)

The contractor shall collect daily policy notifications transfers (PNTs) from DEERS for DP beneficiaries. The contractor shall begin collecting PNTs the first month following transition-in period. Notification records are generated when changes affecting enrollment or eligibility are applied in DEERS. Notification records are sent electronically to the contractor from DMDC.

The target processing speed of PNTs shall be at a minimum of 2000 per hour. The information is accumulated throughout the day. Notification summary and detail reports shall be posted on the contractor’s secured web application (Deliverable 13). The DMDC technical specification is attached for the PNTs that the contractor shall implement to be able to receive and acknowledge PNTs.

On a quarterly basis the contractor will reconcile each DP enrollment and capitation to the beginning of the DP current contract period. Enrollment changes can cause a positive or negative adjustment to the original capitation calculation. There are specific end reason codes that are the exception to the reconciliation, and a recoupment of funds shall not be calculated.

The end reason code recoupment logic will be provided at the kick-off award meeting. The reconciliation reports and files shall be available to the program office no later than the 20th day of the first month following the end of the quarter. For example, for quarter period June 1 through August 31, the reconciliation shall be completed by September 20th. (Deliverable 14)

The contractor will be asked to produce special miscellaneous reports and/or upon request from the Contracting Officer’ Representative and/or TOs. It is anticipated that 24 miscellaneous reports may be requested annually. These reports will be related to the data collected from the DP and/or current data in the DEERS database. (Deliverable 15)

The contractor shall coordinate with the Designated Provider Program Office to implement revisions to the monthly and quarterly reports in support of the Fiscal Year 2013 required enrollment premium changes.

2.2.1.1 Secure Website

The contractor shall create and maintain a secure website or portal that will be the central report repository for the DPs. The website or portal capability shall include at minimum, file transfer, electronic copies of monthly reports, error reports, miscellaneous reports, and data maintained in the data warehouse such as enrollment information, payment history, and DEERS notifications.

The data warehouse data should be available to the DPs and TMA via a query tool accessible through the website. The website shall be Common Access Card (CAC) enabled for access.

Access to the secure website or portal will be granted to the DPs and shall have access to all DP reports and data.

2.2.1.2 Data Collection – Deliverables 16, 17, 18, 19, 20 and 21

The contractor shall collect enrollment fee data weekly as reported by the six DPs using existing file layouts that shall be provided by the government at the kick-off award meeting. This information is used to report and monitor enrollment fees paid for each family unit. This data will be submitted detailing all enrollment fees received from the enrollees during the previous week. This file should contain all fee payment transactions for enrollees including routine transactions, adjustments, and credits. The DP will report enrollment fees collected in a timely manner. The contractor will report enrollment fee information to DEERS. Reporting fee information to DEERS is a key component in timely portability for beneficiaries. (Deliverable 16)

The contractor shall collect data from the six DPs using existing file layouts that shall be provided by the government at the kick-off award meeting. The data submission will include medical and pharmacy encounter data, OHI/PCM data and provider data. The data will be submitted from each DP by the 15th of each month or the last business day before the 15th of the month. Processing shall begin on the 16th, or the first day following the last business day prior to the 15th. The contractor shall not be liable for the data not received from the DPs by the 15th of the month. (Deliverable 17)

After monthly collection of the DP data, the contractor shall process the data in accordance with data specifications accepted by the government and DPs and provide summary and error reports by the 20th of the month to each DP. The contractor shall also be responsible for providing assistance and education to the DPs when errors are encountered. (Deliverable 18)

The contractor shall also provide a monthly synopsis to the COR-TO on the errors encountered by each DP. (Deliverable 19)

Within five days after receipt of the DPs data, the contractor must provide data to the Military Data Repository (MDR) database located in Falls Church, Virginia. The data shall be pushed to the MDR via FTP process. Upon award of the contract, the COR-TO, the contractor, and the MDR office shall meet to discuss the technical requirements necessary to pass the data.

(Deliverable 20)

The data specifications and data dictionary shall be maintained and updated by the contractor as requirements are changed based on the TRICARE System Manuals, DEERS Technical Specifications, DEERS Data Dictionary or direction by the COR-TO. (Deliverable 21) The specifications and dictionary are not to be implemented by the contractor or DPs until final approval is received via a contract modification.

2.2.1.3 Conditional Enrollment

The contractor shall develop a systematic method on the website, where the DP can conditionally enroll newborns, if the mother is enrolled, for a period of 60 days from date of birth, or adoption. Capitation shall be paid for a period of 60-days for those months a child is conditionally enrolled in the data warehouse. Capitation is only paid for those months when the newborn is conditionally enrolled during the first of the month.

The DPs shall use the data warehouse enrollment screen to conditionally enroll the newborn.

The enrollment screen shall allow the DP to enter the newborn’s name (if known), gender (if known), and Date of Birth. The enrollment screen shall automatically populate the conditionally enrollment end date, 60 days from the date of birth. The enrollment screen shall allow the users to view all current conditional enrollments at their site. The newborn’s mother must be enrolled with the DP in order for the newborn to be conditionally enrolled.

2.2.1.4 Interfaces with DEERS

The contractor shall use the following system to system interfaces with DEERS on behalf of the six DPs. The contractor shall use the most current versions are included in this PWS.

2.2.1.5 Patient Notification Transfers (PNTs)

Notifications are received daily when current enrollment or specific demographic information regarding a beneficiary changes in DEERS. Formally called Patient Notification Transfers (PNTs), these notifications are sent real-time from DEERS. The target processing speed of PNTs shall be at a minimum of 2000 per hour. The contractor shall apply them in their database.

The notifications shall be displayed real-time on their website. In support of the premium model changes occurring for fee and premiums for the enrollment year starting with Fiscal Year 2013, the contractor shall implement the revised PNT layout in the attached Premium Medical Policy Notification (PNT) External Technical Specifications.

2.2.1.6 Claims Eligibility Interface to DEERS

This interface will provide the contractor with eligibility and enrollment details for those beneficiaries enrolled in a DP program. The contractor shall collect specific enrollment and eligibility information to include: other government program data such as Medicare, fiscal year-to-date totals for catastrophic capitation, person identification, sponsor personnel data, eligibility status, and enrollment details. The contractor shall begin collecting enrollment and eligibility information the first monthly following transition-in period. The contractor shall send health care coverage inquiries to DEERS via the DEERS Health Care Coverage Inquiry for Claims. In response, DEERS will send the DEERS Health Care Coverage for Claims Response to the contractor to acknowledge the inquiry and to indicate success or failure of the transaction. The Technical Specifications for Claims Coverage Eligibility shall be used to develop the interfaces to DEERS. See the attached Claims Technical Specifications.

2.2.1.7 Patient ID Change Notification (PIDS update)

The patient ID is a common identifier to uniquely identify beneficiaries in DEERS. When there are changes to the Patient ID, DEERS will evaluate which is the correct Patient ID and identify which one is correct. The contractor shall inquiry DEERS to obtain PIDS changes for a given date. The contractor shall report these changes to the DPs on a monthly basis immediately before the ENR/FIN/TMA cycle through the monthly routine printing and via the contractor’s website. See attached technical specifications.

2.2.1.8 Catastrophic Cap and Deductible Database (CCDD)

The contractor shall be responsible for sending catastrophic capitation and deductible (CC&D) information to DEERS. The contractor shall begin sending CC&D information to DEERS the first month following transition-in period. It shall be sent on a monthly basis after the DPs submitted encounter data is collected and processed and the co-payment is extracted. There are no deductibles in the DP program. The contractor shall utilize the CCDD system for the purpose of retrieving patient IDs for conditional enrollees. See attached Catastrophic Cap and Deductible Database for technical specifications.

2.2.1.9 Batch Enrollment Fee

The contractor shall be responsible for sending enrollment fee information to DEERS. The contractor shall begin sending enrollment fee information to DEERS the first month following transition-in period. It shall be sent on a weekly basis after the DPs submitted enrollment fee data is collected and processed. See attached for technical specifications (the batch process for disenrollment for failure to pay fees shall be excluded). See attached Fee Interface Technical Specification for technical specifications that are to be followed for any fee payment for FY12 and prior. For any enrollment premiums for FY13 and beyond, the contractor shall use the attached Fee Interface (Premium Version to send premium information to DEERS on behalf of the DPs. The batch process for disenrollment due to failure to pay; fees shall be excluded from processing.

2.2.1.10 Beneficiary Web Enrollment (BWE)

The contractor shall build an interface to collect fee information from BWE Fee Gateway that must be operational by the end of the base period. The credit card processing will remain a function of the six DPs. The contractor shall acknowledge receipt of the fee transaction information. The data shall be displayed on the USFHP website for the six DPs to access their beneficiary’s fee information. The fee information shall not be stored nor displayed longer than the six day period allowed for pending BWE enrollments. See attached for the BWE Fee Gateway Technical Specifications.

The contractor shall process the associated BWE notifications in accordance with Appendix B of the BWE System Implementation Plan (attached). The contractor shall utilize the codes to identify all pending and related BWE notifications. These notifications shall be displayed in a BWE module on the secure website.

2.2.1.11 Business to Business Gateway (B2B Gateway)

The contractor shall communicate with the DEERS system via the established Military Health System B2B gateway. The contractor shall begin communications with DEERS by the first month following transition-in period. The B2B gateway specifications are located in the TRICARE Systems Manual, Chapter 1, Section 1.1, Paragraph 11.0.

2.2.1.12 Test Environment

The contractor shall provide a test environment for the DPs to be able to submit test files for routine monthly submissions. The test environment must be operational by the first month following transition-in period. The test results/reports shall be available within 5 business days of submitted test files. The test environment shall be accessible through a secure test website.

2.2.1.13 Premium Billing Interface

The contractor shall be responsible for exchanging data with the DEERS Premium Billing Service, to provide the DPs with information to use for their quarterly billing cycle. This exchange shall occur quarterly, with an optional of ad hoc requests in between billing quarters.

The contractor shall provide the DPs with a quarterly report detailing the specific billing information available. See attached Premium Billing Service External Technical Specification.

2.2.1.14 Program/System Security – Deliverable 22

In accordance with the Government’s Program Protection Plan or other Program Security Plan to be provided at the contract kick-off meeting, the Contractor shall identify as security-critical those core items (hardware, software, or business process) whose failure could lead to a breach of system security. For each risk identified, the Contractor shall develop a security assurance strategy to ensure that the requirements, design, implementation, and operating procedures for the identified product minimize or eliminate the potential for breaches of system security. The Contractor shall record the strategy in the Security Management Plan (Deliverable 22), implement the strategy, and produce evidence, as part of required software products, that the security assurance strategy has been carried out.

2.2.1.15 Configuration Management (CM) – Deliverable 23

The Contractor shall conduct CM on all software, systems, and documentation called for hereunder in accordance with the program CM plan. The Contractor shall develop a CM Compliance Plan (Deliverable 23), describing procedures and policies that will ensure that the Contractor, as well as all subcontractors performing under this contract, will perform in full compliance with the Government approved CM Compliance Plan and Policies.

2.2.1.16 Test Program – Deliverables 24 and 25

The Contractor shall develop and implement a test and evaluation program to ensure that all services, deliverables, and documents called for under this contract meet MHS and program requirements prior to delivery to the Government. The Contractor shall develop a Test Evaluation Program Plan (TEPP) (Deliverable 24), in accordance with the Government’s Test Plan to be provided at the contract kick-off meeting, to describe the methodology and approach that will be used by the Contractor to validate product performance internally, prior to “walk-through” and evaluation by the Government or its designated independent verification and validation (IV&V) agent. Following Government approval of this plan, the Contractor shall develop detailed test procedures for each proposed product release. The Contractor shall conduct an internal test in compliance with the approved procedures, and report test results to the Government (Deliverable 25). The Government shall have rights to witness all Contractor testing without providing prior notice.

2.2.1.17 System Updates/Migration

The Contractor shall apply processes and procedures that ensure all system and system component maintenance updates and versions are designed and developed in a manner such that each product update or version builds on the preceding version and in no way deletes or diminishes previous functionality unless specifically directed or approved otherwise by the Government. This incremental build process shall provide for implementation of the new/upgraded product without loss of functionality which is "in process" at the time of update.

Specifically, the Contractor shall provide for the automatic transfer of "in process" functions from the "old" version to the new or upgraded version.

2.2.1.18 Documentation

Reports and documents delivered by the Contractor in performance of this contract shall be considered “Technical Data” as defined in the applicable “Rights in Data” clause of the General Provisions. All documentation shall reflect the latest approved version number, unless specifically directed otherwise by the Government. All documentation shall be prepared in accordance with standard industry practices, ensuring electronically produced documents which reflect logical flow of material, tables of contents, indexes and page numbering. Where applicable, the Contractor’s attention is called to the availability of commercial, industry, federal, and military guides, instructions, and standards for many of the topics addressed in this contract.

2.2.1.19 Common Access Card

The contractor must identify all employees who will require a Common Access Card (CAC) prior to authorization for access to any DoD Information System. CAC issuance is limited to contractor employees with job requirements to for access to DoD Information Systems. The contractor shall ensure all employees accessing the DEERS database or the B2B Gateway must have and use a DoD issued CAC.