Attachment_1_-_Global_Nurse_Advice_Line_PWS_2016_0817.docx

PERFORMANCE WORK STATEMENT (PWS)

Global Nurse Advice Line

Part 1

General Information

1 General: This is a non-personal services contract to provide Global Nurse Advice Line (NAL) services. The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1 Description of Services/Introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform Global NAL services as defined in this Performance Work Statement, except for those items specified as government furnished property and services. The contractor shall perform to the standards in this contract.

2 Background:

2.1 Currently, the CONUS NAL offers TRICARE beneficiaries located in the United States toll free telephone access to a telehealth registered nurse for triage services, self-care advice, and general health inquiries 24 hours a day, 7 days a week. If necessary, the NAL also offers civilian network provider locator support and specified Military Treatment Facility (MTF) appointing services for the Military Health System (MHS) beneficiaries, except those enrolled to the US Family Health Plan. Eligible MHS beneficiaries can access the NAL by calling 1-800-TRICARE (1-800-874-2273).

2.2 The MHS implemented the NAL in August 2014 in order to achieve the following goals:

i. Direct patients to the most clinically appropriate level of care.

ii. Enhance access to care, especially after hours and when the beneficiaries are traveling.

iii. Reduce unnecessary emergency department and urgent care utilization.

iv. Capture MTF enrolled beneficiary care back to the direct care system in order to reduce purchased care costs.

v. Improve the patient’s continuous healthcare relationship with his/her MTF or civilian healthcare team and Primary Care Manager (PCM).

vi. Maximize patient satisfaction.

2.3 The MHS leadership and the Services have requested a Global NAL to cover eligible MHS beneficiaries enrolled to both CONUS and OCONUS MTFs (TRICARE Prime and Plus) and TRICARE Prime beneficiaries enrolled to CONUS Managed Care Support Contractors. TRICARE Overseas Program Prime Remote, TRICARE Standard, TRICARE For Life, TRICARE Reserve Select, TRICARE Retired Reserve, and TRICARE Young Adult beneficiaries are only eligible to use the Global NAL when they are traveling or physically residing in the United States. Those beneficiaries enrolled to the US Family Health Plan (USFHP) are not eligible to use the Global NAL.

3 Objectives:

3.1 The Global NAL services aim to achieve the same set of goals, as articulated in paragraph 2.2.

3.2 The contractor shall provide reliable, timely, professional, and courteous nurse triage, care advice, care coordination, and customer service, 24 hours a day, 7 days a week to eligible MHS beneficiaries, as described in this PWS in order to improve healthcare and lower costs.

3.3 The contractor’s telehealth qualified registered nurses (RNs) shall provide all eligible MHS beneficiaries with clinical advice based on the United States of America nationally recognized telehealth nursing standards, protocols and/or guidelines, coupled with the RNs professional experiences and judgement to ensure MHS beneficiaries receive high quality nurse triage services.

3.4 The contractor shall work with the MTFs to provide appointing services 24 hours a day 7 days a week for 24 HRS appointment types (when appropriate based on call disposition and eligibility) and submit referrals for network urgent care clinics in CHCS, the new electronic health record, MHS Genesis, or another specified system for MTF enrolled beneficiaries in order to capture care back to the direct care system and improve access to care.

3.5 The contractor shall offer post-telehealth RN triage provider network / MTF locator services and contact information assistance for urgent and emergent triage end points and otherwise, as needed to provide timely and reliable care coordination and maximize beneficiary satisfaction.

3.6 The contractor shall comply with MHS directives, Defense Health Agency (DHA), and Department of Defense (DOD) polices as written, when applicable to the NAL services they provide in order to ensure Global NAL systems and processes conform to the appropriate standards and requirements.

3.7 The contractor shall work together with the NAL program management office (PMO) to ensure the triage-based determinations for advising patients in pursuing an appropriate level of care (triage end points) are consistent with the current standards of care and MHS goals / standards for assigning patients to emergency care, urgent care, MTF-based care, and self-care.

3.8 The MHS shall work with the contractor to implement the Global NAL according to the specifications listed within this document. In support of implementation, the MHS shall provide the contract awardee with access to the appropriate government systems, subject to terms of required non-disclosure agreements, data use agreements, and organization conflict of interest filings.

3.9 All Global NAL products of this contract shall reflect generally accepted private sector business practices and applicable Department of Defense policies and regulations. The contractor may propose changes to DoD policies, regulations, and/or legal authorities as part of the NAL process. All assumptions, factors, and estimates shall be fully documented.

4 Scope:

4.1 The Global NAL services include:

i. Continuous telehealth registered nurse triage based on evidence based guidelines to direct patients to the most clinically appropriate level of care including self-care, urgent care, and emergent care.

ii. Specified MTF appointing services,

iii. Customized MTF transfers to support the MTF’s capabilities,

iv. Civilian TRICARE authorized urgent care referral services,

v. Civilian network provider and MTF locator support services, and

vi. Customer service.

4.2 The Global NAL service shall be offered 24 hours a day, 7 days a week for all eligible MHS beneficiaries. The below chart shows the MHS beneficiaries by TRICARE Health Plan, which are eligible to receive Global NAL Services.

US Family Health Plan

X

*These beneficiaries are only eligible if they are traveling or physically residing in the United States.

4.3 Customized internal processes will be required to direct callers based on their beneficiary status (Active Duty, Active Duty Family Member, Retiree, and Retiree Family Member) and TRICARE health plan. More information on TRICARE health plans can be found at: http://www.tricare.mil/Plans/HealthPlans.aspx.

4.4 Other capabilities include the ability to provide real time information sharing, business intelligence, reporting, and archiving of documented call encounters at a corporate, regional, and local level and interoperability with existing military applications and systems to include the Defense Eligibility Enrolled Reporting System (DEERS), Composite Health Care System (CHCS), and the new military electronic health record called MHS Genesis. Interoperability includes: 1) Using DEERS to verify caller eligibility to use the service, 2) Accessing multiple CHCS hosts to make appointments with callers’ Primary Care Manager, Primary Care Team, or Primary Care Clinic or submitting TRICARE authorized urgent care referrals, and documenting caller information, triage notes, 3) booking appointments and submitting TRICARE authorized urgent care referrals in the new MHS Genesis.

4.5 The contractor shall provide toll free telephone phone numbers for CONUS, through the 1-800-TRICARE number, and the international countries listed below, or any other country with an established MTF.

i. Italy

ii. United Kingdom

iii. Germany

iv. Turkey

v. Belgium

vi. Bahrain

vii. Spain

viii. Greece

ix. Cuba

x. Puerto Rico

xi. Japan

xii. South Korea

xiii. Guam

4.6 Period of Performance: The period of performance shall be for one (1) Base Period of 12 months, which includes an implementation period and four (4) 12-month option years. The Period of Performance reads as follows:

Base Year Option Year I Option Year II Option Year III Option Year IV

5 General Information

5.1 Quality Control:

5.1.1 The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s quality control program is the means by which he/she assures himself/herself that the work complies with the requirement of the contract.

5.1.2 The contractor shall prepare and adhere to a Quality Control Plan (QCP), which will be submitted with the contractor’s proposal (Deliverable 12). The QCP shall document how the contractor shall meet and comply with the NAL personnel certification and experience requirements and other quality standards established in this performance work statement. At a minimum, the QCP must include a self-inspection plan, an internal staffing plan, a call encounter review plan, and an outline of the procedures that the contractor shall use to maintain quality, timeliness, responsiveness, customer satisfaction, and any other requirements set forth in this solicitation.

5.1.3 A key aspect of the QCP shall be the nursing triage guidelines, algorithms, or protocols utilized for NAL services. The triage guidelines or protocols shall have medical review, updates and approval at least annually. These reviews, updates, and approvals shall be performed by both the contractor and the government. As part of the QCP, the contractor shall provide detailed examples of ten of the most common triage guidelines, algorithms, or protocols expected to be utilized for this service. These examples must address the more commonly experienced call types, including: upper respiratory, infection, emergency, and behavioral / mental health.

5.1.4 The QCP shall demonstrate areas where the QCP can be modified and customized for the government. A comprehensive written QCP shall be submitted to the contracting officer and contracting officer representative (COR) within 5 working days when changes are made thereafter. After acceptance of the QCP the contractor shall receive the contracting officer’s acceptance in writing of any proposed change to the QC system.

5.2 Quality Assurance:

5.2.1 The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP) (Deliverable 2). This plan is primarily focused on what the government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

5.2.2 The QASP provides the COR with a proactive way to avoid unacceptable or deficient performance, and provides verifiable input for the required Past Performance Information Assessments. The QASP shall be finalized immediately following award and a copy provided to the Contractor after award. The QASP is a living document and may be updated by the government as necessary.

5.3 Recognized Holidays: The Global NAL shall operate 24 hours a day, 7 days a week requiring the contractor to provide continuous services, as described in this PWS.

5.4 Hours of Operation: The contractor is responsible for conducting business, 24 hours a day, 7 days a week and shall maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS, at all times. When hiring personnel, the contractor shall keep in mind that the stability and continuity of the workforce are essential.

5.5 Place of Performance: The work to be performed under this contract shall be performed at contractor facilities.

5.6 Type of Contract: The government will award a firm fixed price contract with optional cost line item numbers (CLINs) to give the government flexibility in adding on additional services as required with the approval of funding.

5.7 Security Requirements: Contractor personnel performing work under this contract must be able to obtain common access cards (CACs) or provide a certificate of authentication to gain access to government systems at the time of the proposal submission, and must maintain the level of security required for the life of the contract. The contractor shall have a facility security officer (FSO). The contractor FSO shall:

5.7.1 Identify contractor support personnel who require a CAC for accessing DoD networks, systems, and facilities.

5.7.2 Verify the applicant’s background investigation by submitting a request to PSB.

5.7.3 Complete Sections I and III of the Defense Health Agency (DHA) Form 33, for the initial and/or renewal CAC.

5.7.4 Submit the form (DHA Form 33) to the COR for approval.

5.7.5 Fax the completed form to (703-681-5207) ATTN: PSB/-TASS/Common Access Card Branch (CACB) or e-mail to (Dha.ncr.security.mbx.personnel-security-tass@mail.mil).

5.7.6 Establish out-processing procedures to collect the CAC when an employee quits, is terminated from the company, or when the CAC is no longer required.

5.7.7 The contractor shall procure, install, and maintain desktop level CAC readers and middleware. The middleware software must run on the desktop and cannot be run from the LAN. The contractor FSO shall ensure that CACs are only used by the individual to whom the CAC was issued. Individuals must protect their PIN and not allow it to be discovered or allow the use of their CAC by anyone other than him/herself. The contractor shall ensure access to DoD systems applications and data is only provided to individuals who have been issued a CAC and whose CAC has been validated by the desktop middleware, including use of a card reader. Sharing of CACs, PINs, and other access codes is expressly prohibited.

5.7.8 If the contractor chooses to use a cloud service provider or cloud service offering (CSP/CSO), the CSP/CSO must be Federal Risk and Authorization Management Program (FedRAMP) DoD Impact Level 4 certified. The contractor shall provide a security assessment report upon contract award and annually thereafter (Deliverable 15).

5.8 Physical Security: The contractor shall be responsible for safeguarding all government equipment, information and property provided for contractor use.

5.9 Key Control: The contractor shall follow the key management control under the Organization Best Business Practices list in the National Institute of Standards and Technology Special Publication 800-53. The contractor shall provide a copy of their security assessment report (SAR) for key control.

5.10 Lock Combinations: The contractor shall follow the key management control under the Organization Best Business Practices list in the National Institute of Standards and Technology Special Publication 800-53. The contractor shall provide a copy of their security assessment report (SAR) for key control.

5.11 Special Qualifications: The NAL contractor must provide a pool of qualified and state licensed telehealth RNs. Telehealth RNs must be licensed to provide healthcare advice to beneficiaries within specific states. All telehealth RNs shall have at least three years of clinical experience. In order for telehealth RNs to be considered specialized for skill based routing of calls for pediatrics, mental health, or obstetric, they must either have either a certification or at least three years of clinical experience in that specialized area.

5.12 Post Award Conference/Periodic Progress Meetings: The Contractor shall attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The contracting officer, Contracting Officers Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the contracting officer will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

5.13 Contracting Officer Representative (COR): The (COR) will be identified by separate letter. The COR monitors all technical aspects of the contract and assists in contract administration. The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract: perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, including Government drawings, designs, specifications; monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

6 Key Personnel: The personnel listed below are considered essential to the work being performed hereunder. Prior to substituting, removing, replacing, or diverting any of the specified individuals, the Contractor shall notify the Contracting Officer 15 working days in advance and shall submit a written request and justification (including proposed substitutions) in sufficient detail to permit evaluation of the impact on this Contract. The proposed substitution of personnel must meet or exceed the education, experience, and other technical requirements of the personnel being replaced. No change in personnel shall be made by the Contractor without the prior written consent of the Contracting Officer. However, in urgent situations, as determined or agreed to by the Contracting Officer, an oral request to substitute key personnel may be approved and subsequently ratified by the Contracting Officer in writing. Such ratification shall constitute the consent of the Contracting Officer required by this paragraph. The Contracting Officer will notify the Contractor within 10 working days after receipt of all required information of the decision on the substitution(s). In the event the proposed substitution of key personnel does not meet or exceed the education, experience, and other technical requirements of the personnel being replaced, the Government reserves the right to require continued performance of previously approved key personnel or to require substitution of acceptable replacements for the individuals specified below. The key personnel listed below may, with the consent of the contracting parties, be amended from time to time during the course of the Contract to either add or delete personnel as appropriate.

Sr. Program Manager – Global Nurse Advice Line

Contracts Manager

Program Manager – Telehealth Registered Nurse (RN)

Program Manager – Quality Assurance

Program Manager – Call Center

Security / Information Technology Manager

6.1 The contractor shall provide a senior program manager, contract manager, telehealth RN manager, quality assurance manager, call center manager, and security / information technology manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The contract manager or alternate shall be available between 8:00a.m. to 4:30 p.m., Monday thru Friday except Federal holidays or when the government facility is closed for administrative reasons.

7 Identification of Contractor Employees: All contract personnel attending meetings, answering Government telephones, and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. They must also ensure that all documents or reports produced by contractors are suitably marked as contractor products or that contractor participation is appropriately disclosed.

8 Contractor Travel: The contractor may be required to travel during the performance of this contract to attend working meetings and to conduct quality assurance site visits. The contractor will be authorized travel expenses consistent with the substantive provisions of the Joint Travel Regulation (JTR) and the limitation of funds specified in this contract. All travel requires Government approval/authorization and notification to the COR. Period of performance travel shall not exceed $15,000.

9 Other Direct Costs: This category includes travel (outlined in paragraph 8), reproduction, and shipping expenses associated with training activities and visits to contractor facilities. It could also entail the renting of suitable training venues.

10 Data Rights: The Government has unlimited rights to all documents/material produced under this contract. All documents and materials, to include the source codes of any software, produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor without written permission from the Contracting Officer. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

11 Organizational Conflict of Interest: The contractor and subcontractor personnel performing work under this contract 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 work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational Conflict of Interests (OCI) as defined in FAR Subpart 9.5. The Contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The Contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may affect other remedies as he or she deems necessary, including prohibiting the Contractor from participation in subsequent contracted requirements which may be affected by the OCI.

12 Phase In / Phase Out Period:

12.1 The contractor shall reach full operating capability within six months after contract award. The implementation period includes any necessary pilots, tests, or soft launches necessary to ensure a successful deployment. To minimize any decreases in productivity and to prevent possible negative impacts on additional services, the contractor shall have personnel on board, during the six month phase in period. During the phase in period, the contractor shall become familiar with performance requirements in order to commence full performance of services within six months after contract award. The contractor shall produce an incoming operational transition plan identifying the approach to be fully operational within six months of contract award (Deliverable 10).

12.2 During the phase out period the Contractor shall maintain staffing and services to prevent possible negative impact on services. During the phase out period the telephone numbers shall be transferable at the needs of the Government; at the completion of the contract; and at no additional charge to the Government. The contractor shall provide an outgoing transition plan 90 days prior to contract expiration (Deliverable 11).

PART 2

DEFINITIONS & ACRONYMS

DEFINITIONS AND ACRONYMS:

DEFINITIONS:

CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime.

CONTRACTING OFFICER. A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the contracting officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

DELIVERABLE. Anything that can be physically delivered, but may include non-manufactured things such as meeting minutes or reports.

KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

QUALITY ASSURANCE SURVEILLANCE PLAN (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

WORK WEEK. Monday through Friday, unless specified otherwise.

MILITARY HEALTH SYSTEM BENEFICIARY. Any individual who is eligible to receive treatment in a Military Treatment Facility (MTF). The categories of MHS beneficiaries shall be broadly interpreted unless otherwise specifically restricted. (For example: Authorized parents and parents-in-law are not eligible for TRICARE purchased care, but may receive treatment in an MTF (on a space available basis) and may access the Global NAL.

ELIGIBLE MHS BENEFICIARIES: Individuals enrolled in Defense Eligibility Enrolled Reporting System (DEERS).

ENROLLED BENEFICIARY. An MHS eligible beneficiary who is registered in DEERS and who is enrolled in TRICARE Prime, including Active Duty Service members.

NON-ENROLLED BENEFICIARY. An MHS eligible beneficiary who is registered in DEERS and not enrolled in TRICARE Prime.

MILITARY TREATMENT FACILITY. A U.S. Military medical facility treating MHS beneficiaries ranging in size from large hospitals to small clinics.

UTILIZATION REVIEW ACCREDITATION COMMISSION (URAC). A non-profit charitable organization founded in 1990 to establish standards for the managed care industry. URAC’s broad-based membership includes representation from all the constituencies affected by managed care ─ employers, consumers, regulators, health care providers, and the worker’s compensation and managed care industries. Member organizations of URAC participate in the development of standards, and are eligible to sit on the Board of Directors. http://www.urac.org/

ACRONYMS:

of Columbia)

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

3. GOVERNMENT FURNISHED ITEMS AND SERVICES:

3.1. Services: The Government will provide the Global NAL toll free telephone number, 1-800-TRICARE (874-2273). The Government shall also provide customized MTF instructions for care coordination, which will be updated on a regular basis. Customized MTF instructions will include, but not limited to the hours of operation, telephone numbers, and specific appointing procedures for MTF primary care and urgent care clinics.

3.2. Facilities: Reserved.

3.3. Utilities: Reserved.

3.4. Equipment: Reserved.

3.5. Materials: Reserved.

PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES:

4.1. General: The Contractor shall furnish all supplies, equipment, facilities and services required to perform work under this contract that are not listed under Section 3 of this PWS, including national and international telephone lines and international numbers, to perform the task of a continual Global NAL and an established robust network of licensed, specialized registered and experienced nurses for all MHS eligible beneficiaries.

4.2. The Contractor shall also be responsible for updating the call encounter data monthly with the updated Defense Medical Information System (DMIS) Identifier (ID) table, which is found at: http://health.mil/Military-Health-Topics/Technology/Support-Areas/Geographic-Reference-Information/DMIS-ID-Tables.

PART 5

SPECIFIC TASKS

5. Task

5.1. Basic Services.

5.1.1. The contractor shall provide nurse triage and care advice, as well as appointing and care coordination services, as outlined below, for all eligible MHS beneficiaries. The contractor shall provide customer service to all callers.

5.1.2. The contractor shall operate with the goal of single-call resolution for all beneficiary health advice, appointing and scheduling support. All eligible beneficiary calls shall be serviced immediately with minimal handoffs between staff and call backs to the beneficiary.

5.1.3. The contractor shall provide services in compliance with current URAC Health Call Center standards as well as maintain URAC’s Health Call Center accreditation for the duration of the contract - https://www.urac.org/accreditation-and-measurement/accreditation-programs/all-programs/health-call-center/.

5.1.4. The contractor’s Global NAL call documentation must be clear, consistent, and sufficient, with respect to caller's pre-intent, telehealth registered nurse endpoint, and final disposition.

5.1.5. The contractor shall provide a Board Certified Physician with current clinical practice of a minimum three to five years post residency experience in family medicine, internal medicine or emergency medicine available 24 hours a day, 7 days a week on-call to support and provide consultation to the telehealth RNs, as required.

5.1.6. The contractor shall offer multiple modalities to access Nurse Advice Line services, as well as transfer callers to MTFs, such as through the telephone, through a mobile application, web-chat, and/or video conferencing.

5.1.7. The contractor shall maintain an Average Speed of Answer (ASA) within a 30 second standard at the beginning of the call and at all exchange points (e.g. a call transfer during the call), with a performance standard of 90 percent of Global NAL calls are answered within 30 seconds.

5.1.8. The contractor shall provide a sufficient number of staff at all call stages to maintain the ASA within 30 seconds and prevent eligible MHS beneficiaries being placed on hold.

5.1.9. The contractor shall provide sufficient number of telephone lines into the system to prevent busy signals. Less than 1% of the calls will have a busy signal as indicated in the telephone records.

5.1.10. The contractor shall maintain an abandonment / drop rate of less than 5%, where abandonment is defined as: Calls which end prior to the initial answer by the customer service representative, calls that reach the initial stage with the customer service representative, but terminate prior to completing nurse-triage, and calls which reach nurse triage but terminate prior to completing the care coordination process.

5.1.11. The contractor shall electronically record, both written documentation and oral communication (digital audio recording) between all parties for the entire duration of each call, for 100% of the NAL call encounters.

5.1.12. The contractor shall maintain a secure data repository and business intelligence reporting capability for real-time (RT) sharing between / within the contractor’s personnel and government personnel. The system must have the ability to flag or highlight specific types of calls to easily identify trends and alert the government to take action, e.g. crisis calls, epidemics, caller complaints, and disconnected calls.

5.1.13. The contractor shall provide 24 sessions of NAL sustainment training on a yearly basis to the government. This training will be interactive and conducted online and/or over the phone. Training will be adjusted as the program develops. It will include the current state of the NAL, the specific NAL process for handling NAL calls and documenting NAL encounters, services offered and services not covered, and a tutorial on how to navigate the real time database, how to pull custom and canned reports, export data, and other functionality. The contractor shall develop a NAL sustainment training plan after contract award (Deliverable 13).

5.1.14. The contractor is responsible for appropriately training their personnel on all of the processes and systems required to perform the Global NAL mission.

5.1.15. The contractor shall achieve and maintain a high level of beneficiary satisfaction. Beneficiary satisfaction shall be measured by both the contractor and the government and evaluated by a mutual agreed upon process with no less than a quarterly review.

5.1.16. The contractor shall provide a monthly progress report (Deliverable 8) summarizing the analysis of the business intelligence reports (Deliverable 14), as well as the status of any tasks and/or major milestones for outstanding projects or process improvement initiatives.

5.1.17. The contractor shall provide customer service, telehealth RN triage, and care coordination services in English and Spanish and have on-demand access to interpreter services for other languages as needed.

5.1.18. The contractor shall provide the appropriate country based contact phone number for any beneficiary who calls the NAL while travelling in a country not covered by the NAL (a country that does not have an MTF) or is located in a remote OCONUS environment by utilizing this website: http://www.tricare-overseas.com/ContactUs/.

5.2. Eligibility Verification.

5.2.1. The contractor shall verify the eligibility of all Global NAL callers through the Defense Eligibility Enrollment Reporting System (DEERS) in accordance with TRICARE Systems Manual 7950.3-M, April 2015. The contractor shall build a system to system interface that would query DEERS and save the data received into the contractor’s system within six to nine months after contract award. The contractor’s internal system would also serve as a back-up system when DEERS is down. DEERS is the system of record for eligibility; the contractor shall always make eligibility determinations based on what is returned in Defense Manpower Data Center’s (DMDC's) web and system to system interfaces. The contractor shall use the General Inquiry of DEERS (GIQD) system until the automated integrated system is fully operational.

5.2.2. The contractor shall verify eligibility for each beneficiary as directed by the government using government systems, for example using their first and last name, date of birth, and either their DOD Benefit Number (DBN) (11 digit number printed on the back of their military ID card), or, less optimally, their sponsor's social security number. The contractor shall identify the beneficiary by their DoD Identification Number (EDIPI) (10 digit number) in the system and it should always be the primary identifier used. The contractor shall then, by automated means (not by hand typing or copy/paste), transfer the following demographic information from DEERS into the real time NAL database: the beneficiary’s first and last name, middle initial, date of birth, DoD ID#, DBN, benefit type, enrollment location (DMIS ID and MTF Name, if MTF enrolled), beneficiary category code, PCM clinic name, and PCM name. If the patient is Active Duty, the contractor shall record any special military duty status (such as flying, diving, ordinance, personnel reliability program (PRP)). The contractor shall obtain and document in the system, as precisely as possible, the beneficiary’s physical location at the time of the call, and the caller’s first and last name, relationship to the beneficiary, and best callback number.

5.2.3. During periods of system outage, the contractor shall assume eligibility. If caller cannot identify benefit type, the contractor shall assume TRICARE Prime. During periods of system outage, the contractor shall be responsible for verifying caller data retroactively either through GIQD or their internal DEERS automated querying system by close of business the next business day. DEERS has a regularly scheduled maintenance window, which may result in system downtimes each Saturday evening starting at 9:00PM EST and ending at 6:00AM EST Sunday morning. The contractor shall be responsible for retroactively verifying caller eligibility by close of business on the following Monday for these regularly scheduled outages. In the event the contractor cannot verify eligibility via GIQD or their system to system interface, the contractor shall attempt to call the beneficiary three times to confirm beneficiary status with at least a two hour gap between calls, between 8am and 8pm in the beneficiary’s current time zone.

5.2.4. The contractor shall document the caller’s reason for calling the Global NAL. There are two broad categories, unrelated to chief complaint, that depict the caller’s reason to call the NAL, which are listed here, and explained below:

i. Customer Service

ii. Speak to a Nurse

5.2.5. The call shall then follow the applicable process based upon beneficiary status and reason for call.

5.2.6. Call Type Customer Service: If the beneficiary calls the Global NAL for any of the below reasons, the Contractor shall ensure the call is documented as a “Customer Service” type of call in the real time database. The contractor shall route “Customer Service” type calls to the appropriate service when possible, or give instructions to the caller when call routing is not possible. The contractor shall cancel, and if appropriate, reschedule an MTF enrolled caller’s primary care appointments at the request of the beneficiary as part of customer service. The details of “Customer Service” type calls shall be documented in the real time database.

5.2.7. Examples of “Customer Service” type calls:

i. Prescription authorization / refills, pharmacy locator services. Note that this does not preclude nurse advice for callers with medication questions

ii. Referrals for other services (specialty care). Note that this does not preclude symptom-based triage of problems that may require specialty care (in particular, OB/GYN, mental health, surgery, dental)

iii. Taking messages to pass on to providers or other clinical staff

iv. Benefits and claims information, including billing related issues or revision to DEERS information

v. Orders for ancillary service tests or test results

vi. Scheduling MTF appointments without first completing nurse triage process

vii. Scheduling follow up appointments to include post ER treatment or post-surgical procedure. Note that this does not preclude nurse triage of problems related to a recent surgery or ER visit

viii. Support for medical record requests

ix. Retroactive urgent care referrals for network urgent care visits that were not initiated by NAL

5.2.8. Call Type Speak to a Nurse: All “Speak to a Nurse” calls will be transferred to the telehealth Registered Nurse (RN) utilizing a skill based routing system to ensure that callers who require specialized pediatric, mental health, or obstetric telehealth RNs, based on their health care concerns, are connected to an appropriately trained or experienced nurse. Triage assessments when the patient is not present shall be considered a “Speak to a Nurse” type of call. The contractor shall make the beneficiary aware it is strongly recommended, but not a requirement, to have the patient physically present at the time of the call.

5.2.9. Specific Eligibility Processes for MTF TRICARE Prime and Plus beneficiaries. If the caller is identified as an Active Duty Service Member enrolled to an MTF, the contractor shall follow and instruct the caller using MTF specific guidelines, which the government will provide.

5.2.10. Specific Eligibility Processes for Civilian TRICARE Prime beneficiaries. Reserved.

5.2.11. Specific Eligibility Processes for TRICARE Standard beneficiaries. Reserved.

5.2.12. If a Reserve Component beneficiary calls the Global NAL and shows up ineligible in DEERS, the caller should not be utilizing the Global NAL. The contractor shall defer Reserve Component members, ineligible in DEERS to their Reserve Unit (responsible for establishing a Line of Duty (LOD) and coordinating care with an MTF.

5.2.13. If a non-enrolled and/or TRICARE ineligible personnel who receive services at a CONUS or OCONUS MTF calls the Global NAL, they are eligible to use the Global NAL. Examples of these beneficiaries include the following list:

i. Other Federal Agencies/Depts. U.S. Civilian Employee

ii. Other Federal Agencies/Depts. U.S. Civilian Dependent

iii. Foreign Nationals/Dependents Foreign Civilian

iv. DOD U.S. Civilian Employees/Dependents Occupational Health

v. Other Beneficiaries Of U.S. Govt. Contract Employee

vi. Foreign Nationals/Dependents Non-Nato Military

vii. NATO Recipient Agreement - Family Member

viii. NATO Recipient Agreement

ix. Other Beneficiaries Of U.S. Govt. Veterans Administration

x. Civilian, No Govt. Connection Emergency

xi. Army Applicant/Registrant

xii. Foreign Nationals/Dependents Nato Military

xiii. Foreign Nationals/Dependents Nato Dependent

xiv. Air Force Applicant/Registrant

xv. Defense Department Designee Secretary Of Navy

xvi. State Department U.S. Civilian Dependent-Overseas

xvii. Other Beneficiaries Of U.S. Govt.

5.2.14. If the call is dropped prior to the telehealth RN involvement, the contractor shall ensure the call record is flagged for follow-up, and the contractor shall call back the dropped caller at least three times, with at least a two hour gap in between call back attempts, if a call back number was documented in the real time database. Additionally, if a call is terminated prematurely (“hung-up”) by the caller, either during or after RN involvement, and there is reasonable concern for the caller’s safety, the contractor shall make three callback attempts, to ensure the disconnection wasn’t accidental, and to give instructions as indicated.

5.2.15. If the caller is not registered in DEERS and the caller feels they should be eligible, the contractor shall provide the caller with information to verify and update their DEERS information.

5.3. Telehealth RN Triage

5.3.1. Global NAL telehealth qualified RNs shall provide all eligible MHS beneficiaries with clinical advice based on the United States of America nationally recognized telehealth nursing standards, protocols, guidelines, and/or algorithms, coupled with the RNs professional experiences and judgment. Solutions which fully employ RN critical thinking will be viewed in higher regard than those that restrict RN critical thinking.

5.3.2. Each NAL encounter shall be documented electronically, in real-time (RT), for sharing between NAL contractor personnel, and shall be stored, in near real-time (NRT), into a secure data repository for retrieval and review by NAL PMO, Service, eMSM, and MTF clinic staff.

5.3.3. The contractor shall further categorize the “Speak to a Nurse” calls as either “Symptomatic” or “Asymptomatic”.

5.3.4. If the call is “Asymptomatic”, the telehealth RN provides the requested information, documents call summary and any pertinent details, including advice given, and then ends the call.

5.3.5. If the call is “Symptomatic” the telehealth RN obtains and documents (in the real time database) sufficient information from the caller to follow an acceptable clinical pathway based on triage guidelines, and tailored by the nurses own critical thinking. The telehealth RN, based on the information provided by the caller, determines if the beneficiary would be best served by self-care, urgent primary care, or emergency care skills, or by contacting their provider by telephone or other means (secure messaging, web visit, etc.).

5.3.6. The Global NAL system shall allow for callers to disagree with clinical pathways and nurse advice, and record of call must clearly document both the clinical pathway outcome and the callers’ stated or implied post-call intent.

5.3.7. Details of clinical pathways and/or guidelines shall be available for review upon request of the government. The contractor shall allow the MHS the ability to customize guidelines and clinical pathways, as needed, for MHS beneficiaries.

5.3.8. Timeframes for when a caller needs to be seen shall not be communicated to the caller in the NAL advice “endpoints”, but rather used as a guideline for appropriate level of care.

5.3.9. Pre-intent: At some point during the telehealth nurse triage the nurse shall ask the caller what they would have done if they hadn’t spoken to the nurse. At a minimum, possible caller responses should include: ED visit, UC visit, called or visited MTF or PCM, and Self-Care. Calls that are not triaged by the nurse shall be documented as pre-intent of not assessed.

5.3.10. Documentation: Documentation must be clear, consistent, and sufficient, using subject, objective, assessment, and plan (SOAP), situation, background, assessment, and recommendation (SBAR), or similar (industry-standard) format. In addition to demographic data, call flow information, and call outcome, records of calls must contain relevant clinical information, such as a SOAP/SBAR note or step by step clinical pathway questions and answers. For the triage stage, call records should consist mainly of clinically-relevant information, either free-text in a SOAP, SBAR, or similar format, or a sequential list of questions asked and caller’s answers, with free-text to clarify.

5.3.11. Call documentation must clearly differentiate between caller disagreeing with (nurse-approved) outcome of clinical pathway vs. nurse deviating from clinical pathway outcome using their critical thinking and nursing judgment.

5.3.12. All symptomatic callers, other than self-care and 911 emergency dispositions shall receive care coordination services and/or provider locator services, as detailed below.

5.4. Care-Coordination

5.4.1. MTF TRICARE Prime and Plus Beneficiaries and Direct Care Only Eligible MHS Beneficiaries:

5.4.1.1. If the caller is an MTF TRICARE Prime and/or Plus beneficiary or receives direct care only services from an MTF the Global NAL shall offer the caller 24HR appointing services and care coordination.