GNAL PWS Draft 20240813.pdf

DHA PWS Template V1

July 31, 2024

Department of Defense

Defense Health Agency

Performance Work Statement

Global Nurse Advice Line Next Generation (GNAL-NG)

Healthcare Operations Directorate/DHA Nurse Advice Line Program Management Office

Healthcare Optimization Division, Integrated Referral Management and Appointing Center

(IRMAC) Branch

Solicitation Number: HT0011-24-RFI-0196

Version: 1

Date: 31 July 2024

July 31, 2024

PART 1

1.0 GENERAL INFORMATION

1.1 This is a non-personal services contract to provide: Global Nurse Advice Line-Next

Generation (GNAL-NG) 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 GNAL-NG 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 GNAL-NG is an available service to the Military Health System’s (MHS) eligible beneficiaries. The GNAL-NG contractor provides 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-NG contractor provides customer service and care coordination services to include provider locator support, specified Military Medical Treatment Facility (MTF) appointing services, Active Duty Service Member (ADSM) urgent care referral submissions, and customized MTF transfers to support the MTF’s capability. In order to successfully perform, the

GNAL-NG contractor must have access to and interoperability with existing military applications and systems including, but not limited to, the Defense Enrollment Eligibility

Reporting System (DEERS); the MHS electronic health record (MHS GENESIS); patient portals; and any Digital Front Door (DFD) platforms (e.g., Amwell's platforms). Such access and interoperability will allow for the contractor to conduct eligibility verification of GNAL-NG contacts and the ability to book primary care appointments, submit urgent care referrals for

ADSMs, document GNAL-NG encounters, and review past medical information. The contractor must also deliver other capabilities, including providing real-time information sharing, business intelligence, reporting, and archiving of documented call encounters at a corporate, regional, and local level.

MHS beneficiaries enrolled to both CONUS and OCONUS MTFs (TRICARE Prime and

TRICARE Plus) and TRICARE Prime beneficiaries enrolled to CONUS Managed Care Support

Contractors are eligible to use the GNAL-NG. TRICARE Prime Remote-Active Duty Sponsors, TRICARE Prime Remote-Active Duty Family Members, TRICARE Prime Remote-Young

Adult, 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 also are eligible to use the

Global NAL, but only if they physically reside in, or are traveling 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-NG.

1.4 Objectives: The GNAL-NG contractor shall meet the following program objectives:

1.4.1 The contractor shall provide reliable, timely, professional, and courteous registered nurse

(RN) 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 outcomes and lower MHS healthcare costs.

1.4.2 The contractor’s telehealth qualified RNs shall provide all eligible MHS beneficiaries with clinical advice based on the Schmitt-Thompson Protocols or equivalent telehealth nursing standards, protocols, or guidelines, coupled with each RN’s professional experience and judgment, to ensure MHS beneficiaries receive high quality nurse triage services.

1.4.3 The contractor shall work with the MTFs and the Defense Health Agency (DHA) Networks to provide appointing services 24 hours a day, 7 days a week for appropriate appointing types

(based on call disposition and eligibility) and submit referrals (only required for ADSMs) for

TRICARE authorized private sector urgent care clinics in MHS GENESIS or another specified system for MTF enrolled beneficiaries, if applicable, in order to keep care in 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, DHA and Department of Defense (DoD) polices (when such directives and polices are applicable to the GNAL-NG services they provide) in order to ensure systems and processes conform to the appropriate standards and requirements.

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

1.4.8 The contractor shall ensure that all services delivered under this contract reflect generally accepted private sector business practices, comport with applicable DoD policies and regulations to integrate with the Government systems, and remain up to date with modern technological advances (as applicable).

1.5 Scope: The GNAL-NG requirement is for the continued provision of the following services:

▪ Continuous telehealth RN triage services and advice 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 ADSM urgent care referral entry.

July 31, 2024

▪ Civilian network provider and MTF locator support services.

▪ Customer service.

▪ Connectivity with and utilization of government information and other systems (as described within the PWS) including, but not limited to MHS GENESIS, Patient

Portal, and My Military Health.

▪ Access to care through various modalities: portal, call center, chat, email, and virtual

1.5.1 The contractor shall provide optional services capabilities, including virtual scheduling, AI-driven patient triage, and diagnostic support solutions. These services shall be integrated through a platform that connects with MHS GENESIS, allowing seamless access to DHA platforms. The platform shall facilitate access, enabling beneficiaries to schedule appointments, receive automated triage and diagnostic support, and access their records. The integration with MHS

GENESIS must ensure that all interactions are securely documented and synchronized with the patient’s medical history, providing comprehensive and coordinated care.

1.5.2 The contractor shall offer GNAL-NG service 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-NG Services.

1.5.3 Services shall include customized internal processes to direct callers based on their beneficiary status (e.g., Active Duty, Active-Duty Family Member, Retiree, and Retiree Family

Member) and TRICARE health plan enrollment status. More information on TRICARE health plans can be found at: http://www.tricare.mil/Plans/HealthPlans.aspx.

1.5.4 Other capabilities include the ability to provide real time information sharing, business intelligence, reporting (refer to Report table), archiving of documented call encounters at a corporate, regional, and local level, and interoperability with existing military applications and systems to include DEERS and MHS GENESIS. Interoperability includes: 1) Using DEERS to verify caller eligibility to use the service, 2) Accessing MHS GENESIS 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

ADSM urgent care referrals in MHS GENESIS, and 4) creating custom DFD solutions including online symptom checkers, appointment scheduling, and personalized health recommendations.

1.5.5 Eligible MHS beneficiaries, while physically located within the United States, access the

GNAL-NG, by calling 1-800-TRICARE (1-800-874-2273) and selecting option 1. Services shall also include toll-free numbers for the international countries listed below or any other country with an established MTF. In addition to telephonic access, the GNAL-NG shall offer multiple technology and web-based options, including but not limited to mobile applications, web portals, and computer-based platforms. These options will enable beneficiaries to access services via various modalities such as video calls, chat, email, ensuring comprehensive access to telehealth solutions, regardless of location as provided by the contractor.

http://www.tricare.mil/Plans/HealthPlans.aspx

July 31, 2024

• Italy

• United Kingdom

• Germany

• Turkey

• Belgium

• Bahrain

• Spain

• Greece

• Cuba

• Puerto Rico

• Japan

• South Korea

• Guam

1.6 Period of Performance (PoP):

Period of Performance (PoP) (MM/DD/YY – MM/DD/YY) Major Deliverables

Transition-in Period (03/18/25 – 05/17/2025) GNAL-NG Services

Base Year (05/18/2025 - 05/17/2026) GNAL-NG Services

Option Year 1 (05/18/2026 – 05/17/2027) GNAL-NG Services

Option Year 2 (05/18/2027 – 05/17/2028) GNAL-NG Services

Option Year 3 (05/18/2028 – 05/17/2029) GNAL-NG Services

Option Year 4 (05/18/2029 - 05/17/2030) GNAL-NG Services

Option to Extend (05/18/2030 - 11/17/2030) GNAL-NG Services

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

1.6.1.1 Transition-in period: The full performance start date is, 03/18/25. The transition-in phase is defined as the period during which the contractor prepares to meet all contract requirements, ensuring that all incoming personnel are functionally trained and qualified by the full performance start date. During this period, the contractor shall fully adhere to cybersecurity requirements, which are critical throughout both the transition-in and full performance phases.

To ensure a seamless transition, the contractor shall provide the Government with a comprehensive transition plan detailing the phased implementation of contractor performance.

This plan should include milestones for the training and qualification of personnel, as well as the establishment of operational capabilities necessary for full performance. All remaining incoming personnel must be trained and fully qualified no later than the full performance start date. If the

Government opts to implement a phased approach, the contractor shall provide a detailed

Transition Plan as part of the Contract Data Requirement List (CDRL) to be included in

Technical Exhibit

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.

1.6.1.1.2 The contractor, within 60 days after contract award, shall build and deploy a system-to-system interface, as working software, that would query DEERS and save the data received into the contractor’s system. 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) as approved by the Government. 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 Reserved

1.7.1.3 Reserved

1.7.1.4 Alternate location because of 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-NG 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.

New Year’s Day Labor Day

Martin Luther King Jr.’s Birthday Columbus Day

President’s Day Veteran’s Day

Memorial Day Thanksgiving Day

Juneteenth Day Christmas Day

Independence Day

1.7.3 Hours of operation: The contractor must always maintain an adequate workforce for the

July 31, 2024 uninterrupted performance of all tasks defined within this PWS, to include but not limited to 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 including pandemic and other 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 ensures the services comply 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 of and 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 the GNAL-NG. The triage algorithms, guidelines or protocols shall have documentation of medical review, updates, and approval performed at least annually. 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

July 31, 2024 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).

1.11 Contractor personnel

1.11.1 CAC requirements: The contract 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). All contractors, whether working in

Government facilities or from home, are required to obtain a CAC. Contractors must coordinate with their company’s designated Security point of contact (POC) and the employee’s

DEERS/Real-Time Automated Personnel Identification System (RAPIDS) site to complete the necessary procedures for obtaining a CAC. The company’s POC must provide the Government with all required information IAW the DHA CAC request process, as outlined in the most recent version (currently version 2.1, January 2018, or newer if updated). For more details, refer to the process attached in 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 CACs 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 a CAC. The contractor shall coordinate with the Government’s security office to facilitate the return of CACs, ensuring they are collected and returned to the nearest DEERS/Real-Time Automated Personnel Identification System

(RAPIDS) issuing office or other designated location. The contractor shall provide written confirmation to the Government of the return of all CACs within five business days of the contractor’s departure. Failure to return CACs in a timely manner may result in penalties or other contractual remedies.

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

https://info.health.mil/cos/admin/hr/IO/SitePages/home.aspx

July 31, 2024

1.11.2.1 The DHA’s “Onboarding Checklist for Contractor Employees” is located at the DHA

Onboarding and Offboarding Portal at https://info.health.mil/cos/admin/hr/IO/SitePages/Home.aspx

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

https://info.health.mil/sites/DOP/OnboardingCtr/Contractor_OnBoarding_Checklist.pdf

1.11.2.3 Removed

1.11.2.4 The DHA’s new employee handbook at Part 7 Section 7.1.4.

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 contractor shall provide personnel with requisite qualifications to fill the positions listed in the Table 1. All of the listed personnel are considered essential to the work being performed described in this PWS. 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 substitute key person must meet or exceed the education, experience, and other technical qualifications described in the table below. 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, the

Contracting Officer may approve an oral request to substitute key personnel and later ratify the substitution 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 substitute does not meet or exceed the education, experience, and other technical qualifications described in the table, the Government reserves the right to require continued performance of previously approved key personnel or to require substitution of acceptable a replacement for the individuals specified below. The key personnel list may, with the consent of the contracting parties, be modified from time to time during the course of the Contract. (CDRL

8 -Deliverable 8) See Part 7, Technical Exhibit 1: Deliverables Table

Table 1: Key Personnel minimum qualifications

Position/Labor Category Education Minimum Requirements https://info.health.mil/cos/admin/hr/IO/SitePages/Home.aspx https://info.health.mil/sites/DOP/OnboardingCtr/Contractor_OnBoarding_Checklist.pdf

July 31, 2024

Sr. Program Manager –

Global Nurse Advice Line

Bachelor’s degree in healthcare management, business administration, communication, IT, social science, or a related field

A minimum of 10 years progressive project and/or program management experience to include managing a health care call center or nurse triage program. Must have served in supervisory positions and show examples of how the individual has applied strong leadership, interpersonal, organizational, and communication skills in implementing programs and projects. Demonstrated experience managing and implementing programs, including identifying, maintaining, and/or adjusting the resources;

overseeing the formal planning, tracking, and reporting of program performance.

Contract Manager Bachelor’s degree in business administration, contract management, legal studies, or a related field.

A minimum of six years contract management experience.

Program Manager –

Telehealth RN

Bachelor’s degree in nursing from an accredited school of nursing.

Must have current licensure as a Registered Nurse.

A minimum of 15 years’ experience coordinating telehealth services or managing telehealth programs, including 5 years of nursing leadership/ supervisory role(s). Call center experience is required. Show examples of how the individual applied strong communication, program management and customer service skills in past positions.

Program Manager –

Quality Assurance (QA)

Bachelor’s degree in healthcare management, business administration, communication, IT, social science, or a related field

Clinical background required. Experience in QA within healthcare or telehealth settings. Knowledge of quality metrics, auditing processes, and performance improvement methodologies. Ability to develop and implement QA protocols and conduct regular reviews. A minimum of 3 years of experience managing a QA program. Show examples of how the individual has applied interpersonal, analytical, organizational, and communication skills in managing a QA program.

Demonstrate knowledge of QA best practices.

Program Manager – Call

Center

Bachelor’s degree in healthcare management, business administration, communication, IT, social science, or a related field

A minimum of 5 years of experience in managing call centers. Demonstrate knowledge of URAC

Health Call Center Standards, experience in customer service, performance evaluation, and process improvement. Demonstrated strong interpersonal and communication skills.

Demonstrated experience in large volume staff training and coaching.

July 31, 2024

Security / Information

Technology Manager

Bachelor’s degree in business, communication, IT, and social science or equivalent government or private-sector work experience

A minimum of 5 years of experience with government or private-sector related information technology, cybersecurity, and/or system integration projects.

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

Familiarity with technical integration requirements and interoperability standards for the GNAL-NG.

Demonstrated experience in identifying security risks and recommending solutions to optimize IT systems, including EHRs, telehealth platforms and/or cybersecurity initiatives.

Board Certified

Physician

Doctor of

Medicine (MD) or

Doctor of

Osteopathic

Medicine (DO) degree from an accredited medical school.

A minimum of 5 years of experience in clinical practice, with specific expertise in telehealth or remote clinical consultations. Prior experience with nurse advice lines or similar telehealth service is a plus. Board certification in a relevant specialty, such as family medicine, internal medicine, or emergency medicine or other fields pertinent to telehealth and clinical advice. Possesses an active, unrestricted medical license in the relevant state or jurisdiction where services will be provided

1.12.1 The contractor shall provide the name of the contract manager and an alternate who shall act for the contract manager when the manager is absent 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 8:00 a.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.

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: All documents and materials delivered to the Government under this contract shall become the property of the U.S. Government. Deliverables may not be further used or disclosed by the contractor without prior permission from the Contracting Officer.

1.14 Reporting

1.14.1 Contractor Manpower Reporting (CMR): RESERVED.

1.14.2 Non-Disclosure Agreement (NDA): Reserved

1.14.3 Government’s COR: The COR monitors technical and performance aspects of the contract

July 31, 2024 and assists in contract administration. The COR is authorized to perform the following functions:

Request information from the contractor to 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 as approved by the

CO, including Government drawings, designs, specifications; notifies both the CO and contractor of any observed deficiencies; coordinates availability of government furnished property; and ensures site entry processes 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 shall 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 Reserved

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 Reserved

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:

July 31, 2024

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 Primary Modality and Technological Integration: While the contractor shall incorporate new technology capabilities, such as chat, portals, and AI-driven tools, phone calls will remain the predominant modality of communication with the GNAL-NG because of their accessibility, the importance of personal interaction for understanding complex medical issues, and the need for comprehensive assessments. The contractor shall ensure that its phone-based services (and associated systems) are robust and capable of handling the majority of patient interactions.

Simultaneously, the contractor shall integrate advanced technologies to provide supplementary support, manage routine inquiries, and streamline processes. These technologies must be scalable and adaptable to manage surges in demand, complementing the primary phone-based services without replacing them.

1.18.2 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.

1.18.2.1 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.

1.18.2.2 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.

Offered Call

Volume for

Month

Monthly Nurse

ASA (Minutes)

Monthly Care

Coordinator (non-appointing) ASA

Monthly Care Coordinator

(appointing) ASA

(Minutes)

July 31, 2024

(Minutes)

1-62K 1.5 1.5 1.5

>62K -67K 3 3 3

>67K-72K 5 5 5

>72K-77K 7.5 7.5 7.5

>77K-82K 10 10 10

>82K-87K 12.5 12.5 12.5

>87K-92k 15 15 15

>92K-97K 17.5 17.5 17.5

>97K-102 20 20 20

>102K-107K 22.5 22.5 22.5

>107K-112K 25 25 25

>112K-117K 27.5 27.5 27.5

>117K-122K 30 30 30

>122K-127K 32.5 32.5 32.5

1.18.3 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.

1.18.4 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.

1.18.5 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.

1.18.6 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.

1.19.1.1 The IVR tree should be designed to reflect the specific needs of GNAL-NG, including healthcare-related options and the ability to handle various types of inquiries.

1.19.1.2 Ensure the IVR options are clear, concise, and easy to navigate, minimizing caller frustration.

1.19.1.3 The IVR tree should integrate with GNAL-NG's other systems, such as patient records and scheduling, to provide accurate and seamless service.

1.19.1.4 The IVR tree should be regularly updated to reflect changes in services, procedures, or contact information.

July 31, 2024

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 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.

2.1.6 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.

2.1.7 Contractor’s Technical Proposal: A detailed document submitted in response to an RFP or similar solicitation, outlining how the contractor plans to meet the technical requirements of a project or contract.

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

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

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 - Removed.

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: The contractor shall ensure that all services provided under the GNAL-NG are available 24 hours a day, 7 days a week, without interruption. This continuous availability is mandatory to meet the needs of the MHS beneficiaries, regardless of time zone or location. The contractor shall maintain sufficient staffing levels and system capabilities to deliver consistent and reliable service throughout the entire work week, including all weekends and federal holidays.

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 DEERS described in paragraph 2.3 and 5.2.13

2.1.20 Military Medical Treatment Facility (MTF): A military facility established for the purpose of furnishing medical or dental care to eligible individuals. MTFs range 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:

July 31, 2024

ACOR Alternate Contracting Officer's Representative

AIS Automated Information System

APL Approved Products List APL

AQL Acceptable Quality Level

ARRT Acquisition Requirements Roadmap Tool

ATO Authority to Operate

B2B Business-2-Business

CAC Common Access Card

CAP Cloud Access Point

CCEVS Common Criteria Cybersecurity Evaluation and Validation

Scheme

CDI Covered Defense Information

CDRL Contract Data Requirement List

CE Computer Environment

CFR Code of Federal Regulations

CIO Chief Information Officer

CJCSM Chairman of the Joint Chiefs of Staff Manual

CMMC Cybersecurity Maturity Model Certification

CMR Contractor Manpower Reporting

CNSSI Committee on National Security Systems Instruction

CO Contracting Officer(s)

CONUS Continental United States (excludes Alaska and Hawaii)

CONUS Continental United States (defined as the 50 United States

(U.S.) and the District of Columbia

COR Contracting Officer Representative

COTR Contracting Officer's Technical Representative

COTS Commercial-Off-the-Shelf

CSP Cloud Service Provider

CSSP Cyber Security Service Provider

CUI Controlled Unclassified Information

DAD-A Deputy Assistant Director for Acquisition

DB Design-Build

DBB Design-Bid-Build

DC3 DoD Cyber Crime Center

DD254 Department of Defense Contract Security Requirement List

DEERS Defense Eligibility and Enrollment System

DFARS Defense Federal Acquisition Regulation Supplement

DFD Digital Front Door

DHA Defense Health Agency

DISA Defense Information System Agency

DMDC Defense Manpower Data Center

DMIS ID Defense Medical Information System (DMIS) Identifier (ID)

DMZ Demilitarized Zone

DoD Department of Defense

DoDD Department of Defense Directive

DoDI Department of Defense Instruction

July 31, 2024

DoDM Department of Defense Manual

DPCLO DHA Privacy and Civil Liberties Office

DSAA Data Sharing Agreement Application

DSAs Data Sharing Agreements

DUA Data Use Agreement

ED Emergency Department

EULA End User License Agreement

EVM Earned Value Management

FAR Federal Acquisition Regulation

FCI Federal contract information

FE Facilities Enterprise

FedRAMP Federal Risk Authorization and Management Program

FISMA Federal Information Security Modernization Act

FRCS Facility Related Control Systems

FSO Facilities Security Officer

GFP Government Furnished Property

HA Health Affairs

HCA Head of the Contracting Activity

HIPAA Health Insurance Portability and Accountability Act of

HIT Health Information Technology

I/O In/Out Processing Portal

IA Information Assurance

IGCE Independent Government Cost Estimate

IO Initial Outfitting

IPv Internet Protocol Version

IS Information System

ISCM Information Security Continuous Monitoring

ISP Internet Service Provider

IT Information Technology

IV&V Independent Verification & Validation

MCSC Managed Care Support Contractor

MedCOI Medical Community of Interest

MHS Military Health System

MIL-STD Military Standard

MTFs Military Treatment Facilities

NAL Nurse Advice Line

NCR National Capitol Region

NDA Non-Disclosure Agreement

NIAP National Information Assurance Partnership

NIST National Institute of Standards and Technology

OCI Organizational Conflict of Interest

OCONUS Outside Continental United States (includes Alaska and Hawaii)

ODC Other Direct Costs

OPM Office of Personal Management

OSD Office of the Secretary of Defense

July 31, 2024

P&R Personnel and Readiness

P-ATO Personal Authorization to Operate

PCM Primary Care Manager

PDT Project Delivery Team

PGI Procedures, Guidance, and Information

PHI Protected Health Information

PII Personally Identifiable Information

PIPO Phase In/Phase Out

PIT Platform Information Technology

PK Public Key

PKI Public Key Infrastructure

PMO Program Management Office

POA&M Plan of Action and Milestones

POC Point of Contact

PoP Period of Performance

PP Personal Property

PPSM Ports, Protocols, and Services Management

PRS Performance Requirements Summary

PSP Personnel Security Program

PWS Performance Work Statement

QA Quality Assurance

QAP Quality Assurance Program

QASP Quality Assurance Surveillance Plan

QC Quality Control

QCP Quality Control Plan

RFP Request for Proposal

RFQ Request for Quotation

RMF Risk Management Framework

RN Registered Nurse

SP Special Publication

SPRS Supplier Performance Risk System

SRG Security Requirements Guides

SRM Sustainment, Restoration and Modernization

STIG Security Technical Implementation Guides

TE Technical Exhibit

TOS Terms of Service

UC Urgent Care

UCC Urgent Care Clinic

UFC Unified Facilities Criteria

URAC Utilization Review Accreditation Commission

US United States

VPN Virtual Private Network

XML Extensible Markup Language

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

July 31, 2024

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

1. TRICARE Program Manuals – 2021Edition; 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 amended

25. DoD 8570.01-M, “Information Assurance Workforce Improvement Program,” December

9, 2005, as amended

26. DoD 5200.08-R, “Security of DoD Installations and Resources and the DoD Physical

Security Review Board (PSRB,” November 20, 2015, as amended

27. DoD 5400.11-R, “Department of Defense Privacy Program,” May 14, 2007

28. Chairman of the Joint Chiefs of Staff 6510.01F, “Information Assurance (IA) and https://www.govinfo.gov/

July 31, 2024

Support to Computer Network Defense (CND),” 9 February 2011

29. Chairman of the Joint Chiefs of Staff Manual (CJCSM)…