Att 1 - PWS GNAL Bridge Final Revised 20240311.docx

Department of Defense Defense Health Agency Performance Work Statement

Global Nurse Advice Line Support Services

Healthcare Operations Directorate/DHA Nurse Advice Line Program Management Office

Healthcare Optimization Division, Integrated Referral Management and Appointing Center (IRMAC) Branch

Solicitation Number: HT001124R0017 Version: 2 Date: 29 February 2024

PART 1

1.0 GENERAL INFORMATION

1.1 This is a non-personal services contract to provide Global Nurse Advice Line (GNAL) 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.

1.2 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 Nurse Advice Line services as defined in this Performance Work Statement (PWS) except for those items specified as government furnished property and services. The contractor shall perform to the standards in this PWS.

1.3 Background: The Global Nurse Advice Line (GNAL) is a continued service to the Military Health System’s (MHS) eligible beneficiaries. The GNAL will provide access to telehealth registered nurses for triage services, self-care advice, and general health inquiries 24 hours a day, 7 days a week. The GNAL also offers customer service and care coordination services to include, provider locator support, specified Military Treatment Facility (MTF) appointing services, urgent care referral submissions, and customized MTF transfers to support the MTF’s capability for eligible MHS beneficiaries. The GNAL requires access and interoperability with existing military applications and systems including the Defense Enrollment Eligibility Reporting System (DEERS) and the electronic health record MHS GENESIS. Access and interoperability will allow for eligibility verification of NAL callers, and the ability to book primary care appointments, submit urgent care referrals for ADSMs, and document the GNAL encounters. 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.

The MHS leadership and the Services have requested a GNAL 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 Prime Remote-Active Duty Sponsors, TRICARE Prime Remote-Active Duty Family Members, TRICARE Prime Remote-Young Adult Active Duty, TRICARE Select – Active Duty Family Members, TRICARE Select-TAMP Sponsors and Family Members, TRICARE Select-Retired Sponsors and Family Members, TRICARE Select-Reserve Select Sponsors and Family Members, TRICARE Select-Retired Reserve Sponsors and Family Members, and TRICARE Select- Young Adults beneficiaries are only eligible to use the Global NAL when they are traveling or physically residing in the United States or in countries with an established MTF. Those beneficiaries enrolled to the US Family Health Plan (USFHP) are not eligible to use the GNAL.

1.4 Objectives: The GNAL services aim to achieve the following goals.

1.4.1 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.

1.4.2 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, or guidelines, coupled with the RNs professional experiences and judgement to ensure MHS beneficiaries receive high quality nurse triage services.

1.4.3 The contractor shall work with the MTFs and DHA Networks to provide appointing services 24 hours a day 7 days a week for 24HR, FTR and VIRT (prefix will vary) appointment types (when appropriate based on call disposition and eligibility) and submit referrals for TRICARE authorized (ADSM) civilian urgent care clinics in MHS GENESIS, or another specified system for MTF enrolled beneficiaries, if applicable in order to capture care back to the direct care system and improve access to care.

1.4.4 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.

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

1.4.6 The contractor shall work together with the GNAL 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.

1.4.7 The contractor shall work together with the GNAL PMO to coordinate activities with the MTFs to update MTF instructions and booking protocols for the care coordination process.

1.4.8 The MHS shall work with the contractor to implement the GNAL 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.

1.4.9 All GNAL products of this contract shall reflect generally accepted private sector business practices and applicable Department of Defense policies and regulations.

1.5 Scope: The GNAL services include:

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

· Specified MTF appointing services,

· Customized MTF transfers to support the MTF’s capabilities,

· Civilian TRICARE authorized urgent care referral services,

· Civilian network provider and MTF locator support services, and

· Customer service.

1.5.1 The GNAL 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 GNAL Services.

USFHP Prime-Sponsors and Family Members

X

1.5.1.1 *These beneficiaries are only eligible if they are traveling or physically in the United States or in countries with an established MTF.

1.5.2 Services shall include customized internal processes 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.

1.5.3 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 Enrollment Eligibility Reporting System (DEERS and MHS GENESIS. Interoperability includes: 1) Using DEERS to verify caller eligibility to use the service, 2) Accessing multiple 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 MHS GENESIS.

1.5.4 Eligible MHS beneficiaries shall access the GNAL, if they are physically located within the United States, by calling 1-800-TRICARE (1-800-874-2273), option 1. Once the MHS beneficiary selects option #1, the call will be transferred to the contractor’s supplied telephone number. Services shall include toll free telephone phone numbers for the international countries listed below, or any other country with an established MTF.

· Italy

· United Kingdom

· Germany

· Turkey

· Belgium

· Bahrain

· Spain

· Greece

· Cuba

· Puerto Rico

· Japan

· South Korea

· Guam

1.6 Period of Performance (PoP):

TBD

1.6.1 Transition: Transition-in/transition-out period.

1.6.1.1.1 The contractor shall comply with transition-in requirements of the DHA, as listed in paragraph 1.11.1, for contractors needing to be issued Common Access Card (CAC) identification, including Department of Defense (DoD) and DHA-directed training and forms submission, prior to network access.

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 months after contract award. 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.

1.6.1.2 Transition-out period: The transition-out plan shall facilitate the accomplishment of a seamless transition from the incumbent to an incoming contractor/Government personnel at the expiration of the contract. See (CDRL 1 -Deliverable 1) Part 7, Technical Exhibit 1.

1.6.1.2.1 The contractor shall comply with transition-out requirements of the DHA for contractors who have been issued a CAC or who generate “records”, as defined by DoD (records manual), including DoD-directed disposition of records, and others displayed on the In/Out (I/O) Processing Portal.

1.7 Administrative specifications

1.7.1 Place of performance: The work shall be performed at contractor facilities, either in call center(s) or at remote workstation(s). All contracted employees will be available to meet virtually during the hours of operation provided in PWS section 1.7.3.

1.7.1.1 Alternative work sites may be designated as agreed upon by the contractor and government.

1.7.1.2 The contractor will provide an executed telework agreement for all contract staff with access to DoD business-clinical applications.

1.7.1.3 In some cases, the Government may approve other locations for work to be accomplished remotely such as via a telework set-up. Contractor staff may also telework, on a case-by-case basis. Requests are made to the Contracting Officer’s Representative (COR) and the COR’s recommendation is provided to the Contracting Officer for approval.

1.7.1.4 Telework: The Government COR reserves the right to authorize routine or situational telework on a case-by-case basis. Examples include but are not limited to the following: 1) employee has a short-term need for uninterrupted time to complete work on a complex project or report: 2) employee is recovering from illness or an injury and is temporarily unable to report to the traditional office physically; 3) employee receives word of inclement weather and notifies her/his supervisor that she/he/they would like to opt for unscheduled telework that day; and 4) employee is directed to work from an alternate location because of a local, state, or national event/crisis. The Contractor shall be responsible for safeguarding all issued equipment, information and property provided by the Government. Prior to telework commencing, the employee must have a suitable workspace, utilities adequate for installing equipment and a general work environment that is free from interruptions and provides reasonable security and protection of Government property and information.

1.7.2 Recognized Federal holidays: The GNAL shall operate 24 hours a day, 7 days a week requiring the contractor to provide continuous services, as described in this PWS. The contractor is required to perform services on federal holidays.

Independence Day

1.7.3 Hours of operation: The contractor must always maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS, to include when Government facilities are closed for the above reasons.

1.7.4 Emergency Services: On occasion, increased services may be required to support an activation or exercise of contingency plans in response to emergencies included pandemic and short-term situations. (CDRL 2 -Deliverable 2) See Part 7, Technical Exhibit 1: Deliverables Table

1.8 Contractor travel: Not Applicable

1.9 Other Direct Costs (ODC): Not Applicable

1.10 Quality

1.10.1 Quality Control (QC): The contractor shall develop and maintain an effective QC program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure nonrecurrence of defective services. The contractor’s QC program is how the work complies with stated requirements.

1.10.1.1 The contractor shall prepare and adhere to a Quality Control Plan (QCP), which will be submitted with the contractor’s proposal (CDRL 3 -Deliverable 3) See Part 7, Technical Exhibit 1: Deliverables Table. After contract award, a comprehensive written QCP shall be submitted to the CO and COR within 5 working days when changes are made thereafter. After acceptance of the Quality Control Plan (QCP) the contractor shall receive the CO’s acceptance in writing of any proposed change to his QC system.

1.10.1.2 The contractor shall prepare and adhere to a Quality Control Plan (QCP), which will be submitted with the contractor’s proposal (CDRL 3 -Deliverable 3) See Part 7, Technical Exhibit 1: Deliverables Table. 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. The QCP shall provide the quality standards the contractor will use to ensure optimum beneficiary and government service and satisfaction. The self-inspection plan shall include how the contractor will communicate problems/issues and their appropriate resolutions to the government.

1.10.1.3 A key aspect of the QCP shall be the nursing triage guidelines, algorithms, or protocols utilized for NAL services. The triage algorithms, 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 the top five adult and top five pediatric triage guidelines, algorithms, or protocols expected to be utilized for this service.

1.10.1.4 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) with the contractor’s proposal, within 5 days after contract award, and within 5 working days when changes are made thereafter After acceptance of the Quality Control Plan (QCP) the contractor shall receive the CO’s acceptance in writing of any proposed change to his QC system. See Part 7, Technical Exhibit 1 - CDRL 3.

1.10.1.5 The QCP will have procedures for onboarding and offboarding members.

1.10.2 Quality assurance (QA): The government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). (CDRL 4 -Deliverable 4) See Part 7, Technical Exhibit 1: Deliverables Table This plan provides a systematic method for the Government to evaluate performance and 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).

1.10.2.1 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 within 5 days 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. If the QASP needs updating, the government shall provide written notification to the contractor. Both parties shall mutually agree on a timeframe for the update and the implementation of the new and/or changed areas of the plan.

1.11 Contractor personnel

1.11.1 CAC requirements: For all contractors who will work in Government facilities, the Facilities Security Officer (FSO)/Company's Security point of contact (POC) will provide the Government all the required information per the DHA CAC request process current version 2.1, January 2018, or more recent when updated. See process attached at Part 7 Section 7.1.1 of the PWS. A CAC is the standard identification for eligible DoD contractor personnel.

1.11.1.1 The contractor shall return all CACs to the COR upon the departure of the contractor(s). All ID cards are property of the U.S. Government and shall be returned upon separation, resignation, firing, termination of contract or affiliation with the DoD, or upon any other event in which the individual no longer requires the use of an ID card. The ID card may be returned to your nearest RAPIDS Site, which can be found using the ID Card Office Locator, or via mail to DMDC - DSC, ATTN: CAC Returns, 2102 E 21st Street N, Wichita, Kansas 67214. Note: CACs may be collected by the FSO and returned in a batch as indicated above

1.11.2 Contractor onboarding and training. The contractor shall complete all requirements, training, and forms as prescribed in the following requirements:

1.11.2.2 The DHA’s contractor training instructions - See Part 7 Section 7.1.2.

1.11.2.3 The contractor shall comply with onboarding requirements of the DHA for contractors needing to be issued CAC identification, including DoD- and DHA-directed training and forms submission, prior to network access, as displayed in the In/Out-Processing Portal at: https://info.health.mil/cos/admin/hr/IO/SitePages/home.aspx (note: Public Key Infrastructure (PKI)-restricted, printed versions available).

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

1.11.4 Key control: Reserved

1.11.5 Lock combinations: Reserved

1.12 Key personnel (Contractor): 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 key personnel must meet or exceed the education, experience, and other technical requirements of the key personnel being replaced. No change in key 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 key 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 modified from time to time during the course of the Contract to either add or delete personnel as appropriate. (CDRL 8 -Deliverable 8) See Part 7, Technical Exhibit 1: Deliverables Table

At a minimum, the following Key Personnel qualifications shall include:

work experience A minimum of six years contract management experience required.

positions.

Show examples of how the individual has applied interpersonal, analytical, organizational, and communication skills in managing a QA program. Demonstrate knowledge of quality assurance best practices.

Demonstrate strong interpersonal and communication skills. Demonstrate experience in large volume staff training and coaching.

Specialized experience providing oversight of projects to ensure that developed solutions meet customer requirements. Demonstrate experience in implementing appropriate security measures for IT systems.

Demonstrate experience in identifying security risks and recommending solutions to optimize IT and/or cybersecurity initiatives.

1.12.1 The contractor shall provide a senior program manager, contract manager, telehealth RN program manager, quality assurance program manager, call center program 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. in the CONUS time zone they are located, Monday thru Friday except Federal holidays or when the government facility is closed for administrative reasons. The Contracting Officer representative will be available during those times based on the CONUS time zone they are located.

1.12.2 The contractor shall provide a program management plan (CDRL 7 - Deliverable 7), See Part 7, Technical Exhibit 1: Deliverables Table. describing its approach to maintaining, for the life of the contract, qualified, experienced personnel. The program management plan shall also include sustainment milestones, tasks, and timelines, as well as the management approach regarding their subcontractors.

1.13 Data rights: The Government retains all ownership of the categories of protected personally identifying and protected health information listed below. The Contractor's right to use the confidential data shall be limited to those necessary to perform its obligations under the contract. Upon conclusion or termination of this contract, the Contractor shall deliver and/or dispose of all copies of the confidential data, in accordance with directions it receives from the Contracting Officer.

· Personally Identifying Information ("PII"),

· Protected Health Information ("PHI"), and

· Business Associate Agreement (BAA)

1.14 Reporting

1.14.1 Contractor Manpower Reporting (CMR): Please refer to DFAR 252.204-7023 REPORTING REQUIREMENTS FOR CONTRACTED SERVICES (JUL 2021) and DFAR 252.204-7023 REPORTING REQUIREMENTS FOR CONTRACTED SERVICES--ALTERNATE I (JUL 2021) which are incorporated into the Contract for specific manpower reporting requirement.

1.14.2 Service Contract Reporting: The awardee is required to report certain contracted services in accordance with 10 U.S.C. 2330a and DFARS 204.17 – Services Contracts Inventory if the resulting award meets the reporting requirements for contracted services. (CDRL 22 -Deliverable 22) See Part 7, Technical Exhibit 1: Deliverables Table

1.14.3 Non-Disclosure Agreement (NDA): All contractor personnel who will obtain access to proprietary, classified, or confidential information or any information release of which is protected or governed by law or regulation associated with DHA acquisitions shall be required to complete and sign a DHA contractor NDA (DHA Form 49) prior to beginning work on the subject contract. The contractor shall execute an NDA on behalf of the company and shall ensure that all staff assigned to, including all subcontractors and consultants, or other personnel performing on contract/Task order execute an NDA protecting the procurement sensitive information of the Government and the proprietary information of other contractors. The NDA shall be executed not later than first day of employment and to be renewed upon exercising a contract option period. Assignment of staff who has not executed this statement or failure to adhere to this statement shall constitute default on the part of the contractor. The contractor shall maintain originally signed NDAs of individual employees and provide copy to the COR. (CDRL 21 -Deliverable 21) See Part 7, Technical Exhibit 1: Deliverables Table

1.14.4 Government’s COR: 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 CO 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 regarding 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 contract.

1.14.4 Post award conference/periodic progress meetings: The contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with FAR Subpart 42.5. The CO, COR, and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the CO 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.

1.15 Contractor Identification

1.15.1 Contractor personnel performing services in a contractor capacity in a government facility are required to possess and wear an identification badge that displays his or her name and the name of their company. All contractor personnel shall identify themselves as contractor support personnel in all forms of communication with all entities with whom DHA/Deputy Assistant Director for Acquisition (DAD-A)/Head of the Contracting Activity (HCA) has business dealings. The contractor shall: Answer all telephone calls and have a personalized voice message with an introductory statement that includes the fact that the person is contractor support personnel. Ensure all those with whom the person interacts in any face-to-face dealings while supporting the DAD-A understands that the person is contractor support personnel. Include a title block in all emails that states the fact that the person is contractor support personnel. Ensure all those with whom the person interacts in any face-to-face dealings while supporting DHA/DAD-A/HCA understands that the person is contractor support personnel.

1.15.2 Contractor personnel will be required to attend meetings or otherwise communicate with Government and/or other contract representatives to meet the requirements of this order. Contractor personnel shall make their contractor status known during introductions.

1.15.3 Contractor personnel, while performing in a contractor capacity, are prohibited from using their retired or reserve component military rank or title in any written or verbal communications associated with the contracts in which they provide services.

1.16 Contractor Access to Health Affairs (HA)/DHA Network(s)

1.16.1 FSO/Company's Security POC shall notify the DHA Personnel Security Office after being awarded a contract that requires access to a DoD system (If applicable, if not delete 1.16.1 and 1.16.2 and replace to 1.16 Reserved). Contractor personnel requiring access to the HA/DHA networks for performance of their tasks require a background investigation and the security awareness training. The contractor shall be prepared for this process as it could take two (2) or more weeks. The FSO/Security POC shall submit a Standard Form (SF) 85/86 to DHA's Personnel Security Office for a background investigation.

1.16.2 Company's FSO/Security POC must notify the Personnel Security Office when the contractor has submitted the SF-85/86. The FSO/Security POC, or the COR must notify the DHA Personnel Security Office in writing of a contractor's termination from the contract, including the termination date.

1.17 Personnel Security

1.17.1 The contractor shall comply with DoD 8570.01-M, “Information Assurance Workforce Improvement Program, CH4” November 10, 2015 as amended; 8500.01, “Cybersecurity”, dated March 14, 2014; DoD Manual (DoDM) 6025.18, “Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule Compliance in DoD Health Care Programs” dated March 3, 2019, Department of Defense Instruction (DoDI) 6025.18 “HIPAA Privacy Rule Compliance in DoD Health Care Programs”, dated March 13, 2019; and DoDM 5200.02 “Procedures for the DoD Personnel Security Program (PSP),” incorporation change 3, effective September 24, 2020. Contractor responsibilities for ensuring personnel security include, but are not limited to, meeting the following requirements:

1.17.1.1 Follow the DHA Personnel Security Office guidelines for submittal of security clearances. Contact the DHA Personnel Security Office for guidance on the appropriate background investigation required for personnel on the contract. The DHA Personnel Security Office can be reached at (703) 275-6038.

1.17.1.2 Initiate, maintain, and document personnel security investigations appropriate to the individual’s responsibilities and required access to Controlled Unclassified Information (CUI).

1.17.1.3 DHA Personnel Security Office does not deny any access to any automated information system (AIS), network, or Controlled Unclassified Information (CUI). If a contractor receives an unfavorable background investigation, the request for access will be sent back to the FSO for further action. Any unfavorable adjudication will result in DHA Personnel Security Office not signing off on any access request.

1.18 Contingency for Surges

1.18.1 In the event that offered call volumes are projected to surge above the planned capacity for the month, the government will adjust monthly service levels to mitigate the increased call volumes. The nurses average speed to answer (ASA) for the month will be adjusted to provide relief at increments of 5K offered calls per month.

1.18.1.1 The government decision to adjust service levels should be determined proactively for the contractor to be able to manage the situation accordingly. Concurrently, this will also allow the government to notify stakeholders and take available actions to mitigate surge. Surges will be determined by evaluating day-of-the-week call volumes from the previous week. This will account for Mondays typically being the busiest day of the week.

1.18.1.2 As an example, if the call volume for the first Monday of the month was 2000 offered calls per day and it increased by 25% the next week, this would be an indicator of surge activity.

The changes in call volumes from week to week typically go up and down by as much as 10%. An increase in the weekly call volume of more than 10% is uncommon and an indicator of surge and that the monthly offered call volume is at risk to exceed the normal monthly capacity.

The table below is the adjusted service levels for surge activity.

(Minutes)

1.18.2 The contractor shall notify government when there are risks for surges by email with the data of daily call volumes and average speed to answer for the last 14 days.

1.18.3 When this surge structure is activated, 85% of the individual offered calls shall meet the adjusted ASA. As an example, if offered call volume for the month was 125K, 85% of the offered calls will have been answered within 32.5 minutes.

1.18.4 The contractor shall provide individual callers with their anticipated combined wait times to speak to the care coordinator (for eligibility determination) and nurses, so that the beneficiary understands it will be that approximated amount of time before they can speak to the nurse.

1.18.5 Other mitigations to deal with surges can be granted by the government as requested by the contractor.

1.19 Interactive Voice Recording (IVR)

1.19.1 The contractor shall make changes to the IVR tree and messaging to accommodate mission needs.

PART 2

2.0 DEFINITIONS, ACRONYMS, AND APPLICABLE PUBLICATIONS/INSTRUCTIONS

2.1 Definitions:

2.1.1 Category D: Information Technology (IT) and Telecommunications Services (called D-Services)

2.1.2 Category R: Support (Professional/Administrative/Management) Services (called R-Services)

2.1.3 Contracting Officer (CO): A person with the authority to enter, administer, and/or terminate contracts and make related determinations and findings.

2.1.4 Contracting Officer’s Representative (COR): An individual, including a contracting officer’s technical representative (COTR), designated, and authorized in writing by the CO to perform specific technical or administrative functions. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.5 Contractor’s Technical Proposal: If there are any statements therein that conflict with the terms and conditions of the Government’s contractual document, the Government’s contractual documents will take precedence.

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

2.1.7 Defective Service: A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.8 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.

2.1.9 Nonpersonal services contract: a contract under which the personnel rendering the services are not subject, either by the contract’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees.

2.1.10 OCI Mitigation Plan: Upon award of the contract, the contractor will provide an Organizational Conflict of Interest that will be incorporated by reference. (CDRL 9 – Deliverable 9) See Part 7, Technical Exhibit 1: Deliverables Table.

2.1.11 Physical Security: Actions that prevent the loss or damage of Government property.

2.1.12 Quality Assurance: The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.13 Quality Assurance Surveillance Plan (QASP): An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance. The Government may either prepare the QASP or require the offerors to submit a proposed quality assurance surveillance plan for the Government’s consideration in development of the Government’s plan.

2.1.14 Quality Control: All necessary measures taken by the Contractor to assure that the quality of a product or service shall meet contract requirements.

2.1.15 Subcontractor: One that enters a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.1.16 Workday: The number of hours per day the Contractor provides services in accordance with the contract.

2.1.17 Work Week: Monday through Friday, unless specified otherwise.

2.1.18 Military Health Systems Beneficiary: Any individual who is eligible to receive health care services from the Military Health System. 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.

2.1.19 Eligible MHS Beneficiaries: Individuals enrolled in Defense Enrollment Eligibility Reporting System (DEERS) described in paragraph 2.3 and 5.2.13

2.1.20 Military Treatment Facility: A U.S. Military medical facility treating MHS beneficiaries ranging in size from large hospitals to small clinics.

2.1.21 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/)

2.2 Acronyms:

2.3 Applicable Publications, DHA Administrative Instructions (AI), etc.

2.3.1 The Contractor must abide by all applicable regulations, publications, manuals, and local policies and procedures.

1. TRICARE Program Manuals – 2015 Edition; http://manuals.health.mil/

2. TRICARE Operations Manual 6010.62-M, April 2021, or current edition for T-5

3. TRICARE Policy Manual 6010.63-M, April 1, 2021, or current edition for T-5

4. TRICARE Reimbursement Manual 6010.64-M, April 2021, or current edition for T-5

5. TRICARE Systems Manual 7950.4-M, April 2021, or current edition for T-5

6. Health Affairs Policy Memorandum 11-005, TRICARE Policy for Access to Care,

7. Guide to the Defense Information Infrastructure (DII) Common Operating Environment (COE) for the Military Health System (MHS), Current Version (https https://discover.dtic.mil /)

8. DoD Regulation 5200.2-R, DoD Personnel Security Program, Current Version (https://www.esd.whs.mil/directives/issuances/dodi/).

9. PL 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 (http://aspe.hhs.gov/admnsimp/pl104191.htm)

10. OMB Circular A-130, “Management of Federal Information Resources", 11/28/2000. https://www.cio.gov/policies-and-priorities/circular-a-130/

11. Title 10 U.S.C. 1102 - Confidentiality of medical quality assurance records: qualified immunity for participants, (https://www.govinfo.gov/)

12. URAC accreditation for patient health care line services, (https://www.urac.org/)

13. Electronic and Information Technology Accessibility Standards (36 CFR 1194)

14. DoDD 5000.01, The Defense Acquisition System, September 9, 2020

15. Title 40, United States Code

16. DoD Directive 3020.42, “Department of Defense Continuity Programs,” January 9, 2009

17. DoDD 8140.02, "Cyberspace Workforce Management," December 21, 2021, as amended

18. DoDI 8582.01 “Security of Non-DoD Information Systems Processing Unclassified Nonpublic DoD Information”, December 9, 2019

19. DoDI 8551.01 “Ports, Protocols, and Services Management (PPSM),” May 31, 2023, as amended.

20. DoDI 8520.02, “Public Key Infrastructure (PKI) and Public Key (PK) Enabling,” May 18, 2023, as amended

21. DoDI 8520.03 “Identity Authentication for Information Systems,” May 19, 2023, as amended

22. DoD Instruction 8550.01, “DoD Internet Services and Internet-Based Capabilities,” September 11, 2012

23. DoD Manual, 5200.01, Volume 3, “DoD Information Security Program: Protection of Classified Information,” October 1, 2020, as amended

24. DoD 5220.22-M, “National Industrial Security Program Operating Manual,” May 9, 2023, as…