RFP_Att_F_QandA_ATAMMC ACC_12.11.23 (Attachment F).pdf

Instructions for Providing Specific Feedback on AT Augusta Military Medical Center (ATAMMC) Ambulatory Care Center (ACC) Draft RFP Feedback Form The Defense Health Agency (DHA) is releasing the ATAMMC ACC RFP for the purpose of obtaining feedback from industry. All questions or comments related to this ATAMMC ACC RFP must be submitted on this Excel feedback form. Questions or comments submitted via a narrative email or in any other format will not be accepted.

All comments, questions, and feedback for your company will be submitted using this Excel Form to DHA no later than 12PM(San Antonio, TX Time) December 11, 2023. Specific comments contained in the Excel tool may be considered in revisions to the ATAMMC ACC RFP.

Feedback will be SENT by email to the ATAMMC ACC mailbox at dha.ncr.acq-sustainment.mbx.atammc-acc@health.mil

Please ensure the Excel file is clearly LABELED with your Organization's Name (for example: XYZCompany_Comments on Draft ATAMMC ACC RFP)

Instructions for completing the Excel Worksheet:

- Type in the specific Topic.

- Type in the specific documnet page number, section, and subsection reference for your comment.

- Type in your comment or question.

- Save the file and email to the ATAMMC ACC mailbox as indicated above.

Offerors Number Topic Comment/Feedback PM comments

1 PWS

PWS 5.16. Facility Requirements, page 40: In the event that an offeror operates other ACCs will the government confirm that enrolled and non-enrolled beneficiary access would be limited to the ACC locations explicitly designated for in the contract proposal.

Alternatively, would DHA expect the contractor to send the beneficiary to the network if the contractor is not allowed to utilize another facility within their system that is not previously identified to the DHA?

Yes, enrolled and non-enrolled beneficiary access to care will be limited to the ACC locations explicitly designated for in the contract proposal.

2 PWS

PWS Section 1.7. Transition, page 3:Please provide clarification as to if the SHCD is nine months from the contract award date, regardless of when this date is? Currently, the SCHD would be 5/1/2025 per the timeline in the RFP, is there significance to this date that would cause the government to shorten the 9-month transition period?

Pursuant to para 1.7.1 of the PWS, If a transition from the incumbent contractor is required, then the one-year base period (first period of performance) of this contract, will include the phase-in transition period, which may not exceed nine (9) months, with the exact length of the phase-in transition depending on the incoming contractor’s proposed transition schedule. The transition may be less than nine (9) months.

3 PWS

PWS Section 1.9. Unplanned Closures, page 4: Please provide clarification on the government's stipulation for unplanned closures, wherein if the contractor deems an ACC facility temporarily unsafe for occupants, they must seek prior authorization from the ATAMMC Commander before closing. Is it the government's intention that a facility should not be closed, even if an unsafe circumstance arises and the need is imminent to close the facility, that a facility may not close unless the ATAMMC Commander allows it?

Per PWS para 1.9 1.9. Unplanned Closures: The Contractor shall receive approval from the ATAMMC Director before closing the facility on any days other than those specified in PWS para 1.8.

4 PWS

PWS Section 1.19. Record Contractor Employee Time. page 7:

Please provide guidance on how the government foresees the accounting of hours for TRICARE beneficiaries that may "walk-in unscheduled or F2F visit" for care vs appointments that are scheduled for the purposes of timekeeping?

Per DHA Procedures Manual 6010.13 Vol 1 and Vol 2, DHA captures outpatient care data using the "B" Medical Expense and Performance Reporting System (MEPRS) code. MEPRS is a Military Health System managerial cost accounting system. DMHRSi is a MEPRS data source.

The Government will provide DMHRSi Training as it is a Government owned human resources system, but is not an accounting system for the Contractor. Military, Civilian, and Contractor personnel within the MTF are required to input their time into DMHRSi.

5 PWS

PWS Section 5.14. Access Standards, page 39: Regarding access to care for non-enrolled beneficiaries for services beyond those specified in the agreement (e.g., urgent care, laboratory testing, and radiology), please provide clarification on the government's expectations for processing MTF referrals and beneficiary requests for services when the contractor is at capacity limits, as defined by the government projected utilization. How would the MTF referrals and beneficiary requests be redirected?

All specialty care referrals are managed by the IRMAC.

ATAMMC ACC Feedback Form

ATAMMC ACC Feedback Form

6 PWS

PWS Section 3.2. Medical Equipment, page 18:

The allowance of the use of a contractors pre-existing GFE could potentially result in reduced administrative costs, particularly if the contractor has pre-existing equipment at a particular location. Furthermore, the integration of the contractor's existing equipment into well-established institutions facilitates a more seamless transition phase, thereby promoting improved coordination of care for beneficiaries and establishing a secure clinical environment through the elimination of equipment relocation requirements. Please provide clarification as to whether the government will permit a contractor to utilize its own equipment (in lieu of GFE) if it is already present on-site?

Because the ACCs are part of the Alexander T. Augusta Military Medical Center (ATAMMC) and operate as extensions of ATAMMC (see PWS para 1.3), the Government must supply the required medical equipment to ensure compliance with Government network and cyber security requirements and for other reasons. Per PWS para 3.2, Medical Equipment, the government will provide all medical equipment identified in Exhibit J, GFE (including dispensing/automation and storage equipment) required to support the scope of services at each ACC. (Except per PWS para 4.1.2 under which the Contractor shall provide a Magnetic Resonance Imaging (MRI) machine, and all equipment to operate it that are not included in Exhibit J.)

7 PWS

PWS Section 3.8.2. IT Training, page 19: At what point following the award of the contract will DHA commence delivering the requisite training sessions for providers at every ACC location regarding the GENESIS system?

The Government offers MHS GENESIS training sessions on a recurring basis at ATAMMC, and can provide training upon request. Per PWS para 1.7.1.2, the Contractor is required to ensure it has sufficient staff (both providers and non-providers) in place, and functionally trained and qualified, by the healthcare delivery performance start date.

8 PWS

PWS Section 3.8.3. page 20: The Government will provide onsite IT manpower and IT support:

Please provide information as to whether each ACC will have dedicated technicians or "on-call" IT support that is supplied onsite? Additionally, how many human resources are anticipated to be assigned to each ACC if onsite support is dedicated?

Per PWS para 3.8.3, the Government will provide onsite IT manpower and IT support. The number of technicians and skillset required will be determined and provided by the government post contract award.

Currently there is one IT support person at each ACC, with additional support available 24/7 from the DHA Global Service Center.

9 PWS

PWS Section 4.1.1. Contractor GFE, page 21: The Contractor shall be responsible for the initial installation of all inside cable plant infrastructure: Does the government intend that the Contractor shall be responsible for establishing, configuring, maintaining, and sustaining IT infrastructure to support required capabilities at no cost to the Government?

Per PWS para 1.3.2, the Government will provide all required IT support and maintenance for everything the Government installs. The Contractor is responsible to maintain any IT equipment that it provides/installs. If the contractor's IT will be connected to the Government network, it must have a service agreement in case of failure in order to be certified on the network.

10 PWS

PWS Section 5.13.2.15.1. Specialty Care: Obstetrics, page 35 Assuming that the obstetric care for eligible beneficiaries enrolled to surrounding MTFs be driven by referrals as stated in the RFP, should an OB provider be at capacity (Capacity is defined as the max number of allowable hours as stated in the RFP pricing matrix) serving ACC enrolled beneficiaries, does the government intend for the contractor to re-direct those referrals to the network? If not, please clarify the government's expectation.

see response to #5

11 PWS

PWS Section 5.13.2.11. Specialty Care: Physical Therapy, page 34:

Does the government require a fully separate PT clinic be established or is it acceptable for PT programs and/or services to be offered by contractors at pre-existing ACCs where they may be already be integrated? If allowed, what building and security requirements would apply to the designated PT/OT locations?

see response to #1

ATAMMC ACC Feedback Form

12 PWS

PWS Section 5.13.2.14.1. Orthopedic Services. page 35: the government stated the Contract PA shall not be involved in complex cases. How does the government define "complex cases"?

Per PWS para 5.13.2.14.2, the Contractor shall deliver routine and emergent care in an outpatient clinic setting to include treatment of sports injuries, overuse syndromes, mild to moderate trauma, and musculoskeletal medicine. The Contractor shall not perform treatments requiring conscious sedation. (i.e. complex cases)

13 PWS

PWS Sections 5.13.2.14.3. through 5.13.2.14.3.9. Orthopedic Services, page 35: Please clarify if the only services the ACC offeror may provide are those stated in these sections. If limited to PA services, how will physician oversite for the PA services be provided?

Yes, the services are listed in PWS para 5.13.2.14.3. Currently, the Physician oversight of the PA is provided by the Sports Medicine Provider.

14 PWS

PWS Section 5.14. Access Standards. Page 39: Is the government's intent that ACC enrolled beneficiaries have priority access over non-enrolled beneficiaries?

Non-enrollees generally will not have access to Primary Care services, except in exigent circumstances. All specialty care referrals are managed by the IRMAC.

15 PWS

PWS Section 5.14. Access Standards. Page 39:

Assuming the industry operates under the belief that beneficiaries enrolled in the ACC are granted priority access, and assuming the contracted allotted capacity has been fully utilized by the projected volume of enrolled members, does the government instruct the contractor to refer the beneficiary to the MCSC network?

see response to #14

16 PWS

PWS Section 5.14. Access Standards, page 39:

Does the absence of differentiation between enrolled and non-enrolled patients in the CLINs for specialty care mean that non-enrolled individuals might not be eligible for unspecified specialty services like Orthopedic, Dermatology, Podiatry, or Sports Medicine?

Is the government's intention to potentially create separate CLIN categories for these services or is it the government's intent that any healthcare provided to non-enrolled beneficiaries would need to fall within the allowable number of provider hours specified in the pricing matrix?

(1) Non-enrolled beneficiaries are eligible for specialty care services at the ACCs but referrals are managed by the IRMAC. (2) All specialty care offered to enrolled and non-enrolled beneficiaries must fall within the number of providers hours specified in the Pricing Matrix. PWS para

5.14 Access Standards will be updated to reflect Priority of care determination. PWS para 5.14.1.3 has been deleted (Referred/Specialty Care).

17 Exhibits

PWS Exhibit AA-2 Historical Workload data sheet:

Please provide clarification on if the term "enrolled elsewhere" refers to the population considered as non-enrolled? Are these terms, "non-enrolled" and "enrolled elsewhere" one in the same?

Yes, "enrolled elsewhere" (not at the current DMIS ID referenced in AA-

2) and "non-enrolled to the current MTF" are the same. (See PWS para 2.1.21.) A A beneficiary can be enrolled to only one facility at a time.

18 PWS

PWS Section 5.14.2, page 39: Please provide clarification as to whether there is DHA provided training on the written/electronic documentation requirements and Active Duty-specific examination requirements pertaining to temporary or permanent profiles, limited duty boards, medical boards, and medical evaluation profiles?

The Government will provide training on utilization of service specific requirements for documentation of medical conditions that impacts a service members fitness. Contract providers are made aware of the full military process but are only active participants in the initial phase of generating tempory/permanent profiles, limited duty documents, etc.

The contract provider is not involved in the formal medical boards.

ATAMMC ACC Feedback Form

19 PWS

PWS Section 1.3.1.6. Clinical Care, page 2: To accurately calculate the PMPM rate for Primary Care, age and gender data of the population are minimum requirements. To ensure that all proposals from the industry accurately reflect the needs of the beneficiaries, would the government furnish this essential demographic information?

In contrast, in order to facilitate a true comparison of PMPM rates by the government, kindly furnish an elucidation of the government's justification for not providing age and gender information. Furthermore, kindly offer instructions on how to compute the PMPM for Primary Care in the absence of population demographics?

The Government will provide Exhibit T: Enrollment data by age.

Breakdown of beneficiary data by gender is not required and will not be provided.

20 Other

PWS Section 5.17.1. Physical Security, page 40: Would the government provide clarification on whether the physical security and security requirements detailed in the PWS, Exhibit G, and Exhibit H are applicable to the entire the ACC facilities provided by the Contractor? If it is not to include the entire facility, please provide the areas this does include.

Per PWS para 5.17.1, the Contractor shall incorporate the requirements in Exhibit G, Site Security Criteria, and Exhibit H, DHA Physical Security Checklist, for the physical design and security of the ACCs. The Contractor shall meet any security requirements for ambulatory care centers that exist under Virginia law, to the extent any such state requirements exceed those described in the PWS and its attachments. --this is for all ACCs.

21 PWS

PWS Section 1.3. Scope, page 2: Please provide clarification for ACC enrolled beneficiaries that may be willing to waive drive time access standards to access additional contracted specialty services at facilities not included within the contract but having the ability to still operate within the confines of the requirements. Will enrollees be allowed access specialty services physically located outside of the proposed Contractor ACC facilities?

No. Because the contract requirement is for the contractor to deliver ACCs that operate as extensions of ATAMMC (i.e., part of the MHS direct care system), the Government must maintain meaningful oversight of the care provided under the contract. Therefore, all care for ACC enrolled (or non-enrolled) beneficiaries must be provided in ACC facilities.

instructions to

Offerors

The government's assessment of these adjustments in beneficiary care is regarded as an important step in ensuring a sustainable route forward.

While the government's tight procurement timetable is recognized, it is respectfully asked that the proposal submission period be extended to January 31, 2024. There are several areas that require clarity that will have an influence on offerors' suggested solutions for this opportunity.

Additional time is requested to ensure that offerors may adequately reply to the government's

RFP.

All proposals must be received by Noon local time for Fort Sam Houston, TX on 5 Jan 2024.

23 PWS

PWS Section 1.3.1.6. Clinical Care, page 2: please provide clarification on the governments definition of the "level of service existing at the time of contract award".

The Government will remove the following language from PWS para 1.3.1.6: "At a minimum, the Contractor shall support the level of service existing at the time of contract award."

24 PWS

PWS Section 5.13.2.9.1. Specialty Care: Sports Medicine Services, page 33: Please provide clarification on the definition of 'procedural cases' and their respective complexity.

Procedures that are not supported at the ACCs, such as Platelet Rich Plasma, may be coordinated for completion at ATAMMC. No procedure requiring conscious sedation is supported at the ACCs.

25 PWS

PWS Section 5.13.2.19.2. Behavioral Health, page 38 : Please provide clarification as to if there is a separate IT system and process for managing BH cases, appointments, etc. or is this part of

GENESIS?

The IT system reference is part of MHS GENESIS.

ATAMMC ACC Feedback Form

26 Exhibits

PWS Section 5.17.1. Physical Security, page 40 & Exhibit G & H: Should the offeror have the capability to provide co-located facilities, are all spaces within Contractor provided ACC facilities that are not required to comply with physical security and security requirements outlined within the PWS, Exhibit G, and Exhibit H? For example, may TRICARE members within Contract ACCs access shared spaces with non-TRICARE beneficiaries for services such as ancillary or specialty care services?

see response to #21

27 Exhibits

PWS Exhibit G Section 2.4.1 Blast resistant windows, page 1- Would the government please provide clarification on what protection level the government requires to satisfy this requirement? Specifically, please provide clarification at to the commercial standards that may be utilized.

No additional details will be provided. All information is listed in Exhibit G.

28 PWS

PWS Section 1.7.1.2. Administrative and Personal Transition Requirements, page 3: Please provide clarification as to how is Sufficient Staffing defined for both Provider and Non-providers?

Offerors are required to propose administrative and clinical operations approaches, and a staffing model, detailing how it will fulfill all contractual requirements beginning at the healthcare delivery performance start date. Accordingly, an offeror's efforts to develop 'sufficient staffing' during the transition phase should correlate to its proposed administrative, clinical, and overall staffing approaches.

29 Exhibits

PWS Exhibit G Section 2.3. Authorized Parking, page 1: Requires that the contractor exceed staff and patient parking requirement by at least 10%. Please provide clarification as to what is the government expectation if jurisdictional parking ratio limits are below the government requirement?

Contractor must meet PWS standards for the life of the contract.

30 Exhibits

PWS Exhibit G Section 2.4.1. Blast resistant windows, page 1: Please provide clarification on the blast resistant windows requirement regarding ‘clinic windows’. As this discusses clinic windows, does this imply that exterior facing windows that are not an exam room do not need blast resistant glass?

The ACCs are defined as the Ambulatory Care Centers. Window glazing shall be applied at all ACC windows.

31 PWS

PWS Section 5.13.2.19.4.1. BH Facility, page 38: Please provide clarification on if DHA will provide the BH kiosks (Furniture associated with BHDP)? What other aspects of the kiosk infrastructure or use would the contractor need to plan for from the facility or system standpoint?

Per PWS para 5.13.2.19.4.1, the Contractor’s BH clinic design must include a reception area with no fewer than 12 working and maintained kiosks at each location where BH services are provided in which patients can privately complete DoD-mandated Behavioral Health Data Portal (BHDP) intakes. "Working and maintained" includes providing necessary furniture.

32 PWS

PWS Section 5.13.2.19.4.1. BH Facility, page 38: Does each ACC location require 15 kiosks or are the kiosks to be divided proportionately between BH clinic locations?

If the ACC has a BH clinic, then 12 kiosks are needed at that clinic.

33 PWS

PWS Section 5.13.2.19.4.1. BH Facility, page 38: Please provide more specific office space requirements (e.g., size and types of space, etc.) for the 25 BH Offices.

The offerors should determine the size of the rooms, applying commercial standards/practices.

34 PWS

PWS Section 5.16.2 Please provide clarification on the facility requirements to accommodate the government provided primary care providers (room size, etc.).

see response #33

35 PWS

PWS Section 5.16.2 Facility requirements, page 40. Dedicated GOV office space: Please provide clarification as to if the space has to be in or contiguous to clinic space, or just in the same building? Please provide more specific office space requirements (room size, etc.).

see response #33

ATAMMC ACC Feedback Form

36 PWS

PWS Section 5.13.2.1.5.7. Referral Management, page 29: Please provide clarification as to when the government will provide NCR Referral Management Guidelines to ensure adherence with NCR Referral Management Guidelines for Contractor referral management processes and workflows, including documentation of medical necessity and education of TRICARE PLUS beneficiaries?

The Government will add Exhibit U_MHS Genesis RM 2.0 Referral Management Guide.pdf

37 PWS

PWS Section 5.13.2.1.5.7. Referral Management, page 29: The contractor shall support and integrate referral management programs utilized by the ATAMMC and the DTN NCR. Please provide clarification for ACC enrolled beneficiary referrals deferred to MCSC Network, what are the governments expectations around the Contractor's referral coordination for specialty care referrals? Will ATAMMC serve as primary interface with MCSC for network referrals?

All specialty care referrals are managed by the IRMAC.

38 PWS

PWS Section 1.3 Scope, page 29 states “The Contractor’s ACC facility locations should be such that there is limited enrollment overlap with the Government footprint at ATAMMC and DiLorenzo Pentagon Health Clinic.” Please provide clarification as to the definition of “limited enrollment overlap” (i.e. physical distance, drive times, etc.)?

Based on TRICARE standards, drive time for beneficiaries seeking Primary Care at an MTF (or MTF extension - such as the ACCs) should not exceed 30 minutes. Using the zip code information provided in Exhibit A, offerors should site their ACC facilities to maximize beneficiary access to the facilities (applying the 30 minute drive time standard). The Government will revise the language in PWS para 1.3 regarding facility locations and enrollment overlap. The Government will add Exhibit V_ATAMMC Drive Time.

39 PWS

RFP Section 2, Tab 3 Subfactor (TRS3) number 2, page 84 - Please provide clarification as to when the government will provide NCR Business Rules to ensure the Contractor's Access to Care approach aligns with local requirements.

NCR Business Rules are described within the PWS and the Exhibits, including the added Exhibit U (see response #36). The Government has also revised PWS para 5.14.

40 PWS

PWS Section 5.13.2.19. BEHAVIORAL HEALTH, Page 38. For BH support staff planning to support government provided BH staff, please provide clarification what BH services are in scope for delivery at ACC locations (i.e., substance use conditions, etc.).

BH providers provide psychotherapy, medication evaluation and management, and psychological testing.

41 PWS

PWS Section 5.13.2.19.2. BEHAVIORAL HEALTH, page 38. Provide additional clarity relating to this requirement so that offerors understand the government's expectations for performance is that two designated BH RN CM per location are to support and participate in the full continuum of services for Behavioral Health members. This includes coordination of individual outpatient care only, intensive outpatient (IOP), psychiatry medication management, long-acting injections, substance abuse/suboxone induction, group therapy, specialty programs, etc.

That is the Government's expectation.

42 PWS

PWS Section 5.13.2.19. BEHAVIORAL HEALTH, Page, 38. The State of Virginia mandates patients are cared for under the Virginia State DBHDS program license. Please provide clarification as to if DHA psychotherapists & patients participate in these regulatory guidelines; or are they carved out?

As the government BH providers work at an MTF (the ACCs are an MTF extension), they can be licensed to practice in any U.S. jurisdiction.

Providers are required to follow the guidelines for their state of licensure to maintain their licenses but they don't have to be licensed in Virginia.

43 PWS

PWS Section 1.3.1.4, Page 2: Please provide clarification on the contractors role in implementing the JOES survey process.

JOES surveys will be sent from a third party source, the contractor is only required to understand surveys exist and there are measurements to success as detailed in PWS paras 5.13.2.1.5.6.4 and 5.13.2.1.5.2.1.

The Contractor will have access to the JOES survey results.

ATAMMC ACC Feedback Form

44 PWS

PWS Section 6.3. Information Assurance, page 42. Given that the Government is supplying all IT support/service, can DHA please provide details into which Contractor IA/IT functions would require compliance with DoDD 5144.02.01, DoD 8570.01-M?

The contractor will only be responsible for IT support of contractor provided equipment. DoD 8570.01-M is rescinded and replaced with DoDM 8140.03 in PWS Para 6.3.

45 Pricing

RFP Attachment B Compensation: Would the Government please provide detailed labor category descriptions to map to the required Compensation Plan to allow for multiple levels for each Labor Category to demonstrate cost difference between professionals with varying years of experience?

All positions are referenced in PWS.

46 Pricing

RFP Attachment A. Pricing Matrix & Attachment B Compensation: The Compensation Plan requires information for “Obstetrician”, “Certified Nurse Midwife” and “Nurse Practitioner (GYN)”. However, the pricing only asks for “Obstetrics- Provider”, “Obstetrics- Support Staff”, “OB On-Call”, and “OB In-House.” Please provide clarification as to how pricing should reflect the blended delivery of these different providers.

The pricing provided per CLIN should reflect a blended approach as needed to meet the requirements in the PWS.

47 Other Please provide clarification how the ATAMMC and ACC providers and support staff will work congruently to implement ACC programs services (e.g., population health and case management services). Will the government provide a reporting structure for personnel?

The staff at the ACCs work in close coordination with their counterparts at ATAMMC in regards to ACC programs. Additional the Medical Directors will serve as a liaison for specific questions and directives to ensure each ACC is following ATAMMC guidance.

48 PWS

PWS Section 5.17.4. Facility Access, page 40: For co-located building spaces, please confirm that the "entrance" where patient/visitor identification checks will occur is at the secure entrance into the space where TRICARE members will be serviced.

Yes.

49 PWS

PWS Exhibit G Section 2.41: Please provide clarification as to if this requirement be met by installing blast resistant windows only in areas most susceptible to blast damage (e.g. lower floors)?

see response #30

50 PWS

PWS Exhibit G Section 2.7.3 & 2.7.4: Please provide clarification as to how are "Enforcement Upon Request" requirements factored into the current pricing matrix (e.g. armed security)?

In Exhibit G, the words "Enforcement upon request" are part of a sentence carrying over from the prior page. The requirement reads that the contractor must be prepared to present video surveillance footage "to the COR, the ATAMMC Security Office, or Law Enforcement upon request." The contractor should capture costs associated with providing building security (Exhibit G, para 2.7.3) in its PMPM price.

51 Exhibits PWS Exhibit G and Exhibit H- Compliance: Please provide additional details or reference documents on the security criteria and checklist outlined in Exhibit G and H, specifically regarding the level of security and technology required.

No other details to provide.

52 PWS

PWS 1.7.1.3. Facility Transition Requirements: Please provide specific details on Contractor expectations related to preparing facility and physical infrastructure requirements that enable government to install IT/network infrastructure requirements.

see response #44

53 PWS

PWS Section 5.17.1 State and Federal Security Standards, page 40: Please delineate the manner in which security regulations of ambulatory care centers are governed by state and federal laws in Virginia. Furthermore, are there any supplementary state-specific regulations that pertain to this law? Would the government please specify whether these requirements surpass or deviate from the DHA Physical Security Checklist and other federal mandates?

It is the offeror's responsiblity to determine whether any state-specific laws or regulations impose security requirements on ambulatory care centers that exceed those specified in the solicitation and its exhibits.

ATAMMC ACC Feedback Form

54 PWS

PWS Parts 1 & 5 sections 1.25.1, 5.13.2.1.5.8, and 5.13.2.18.8: Please clarify when the government will provide all ATAMMC administrative and clinical operation policies referenced throughout the PWS to ensure all Offerors can take those policies into consideration in developing the implementation plan and adherence with ATAMMC guidance, including ATAMMC policies governing immunizations, quality management and/or performance improvement.

Policies applicable to proposal submission are detailed in the PWS and Exhibits. The government will add DHA-IPM 19-004, Utilization of the Case Management to the list of policies in Part 7 of the PWS.

Evaluation

Factors

Volume III, Technical (Factor 4) pg. 83., #2 - Please provide further elucidation regarding the provisional timeframe for the establishment of healthcare facilities. 1.7.1. Phase-in Transition Period - specifies that SHCD will commence within nine months of the contract award, whereas the RFP stipulates that the Offeror will execute transition-in activities and establish a timeline for opening the facility for healthcare delivery no later than one year after.

The Government will amend the evaluation criteria to be consistent with PWS paragraph 1.7.1 (phase-in transition period may not exceed 9 months) instructions to

Offerors

HT001523R0030 Table 1 Proposal Instructions, Page 77 Tab 3 Identifies 20 pages of Key Personnel Qualifications with supporting documentation list Page 82 Part 5 Tab 3: The Offeror shall submit a listing of Key Personnel and demonstrate how each meets the minimum qualifications.

PWS Page 6 1.18 Contractor Key Personnel: The Contractor shall submit names and resumes of all key personnel and contact information (email addresses and phone numbers) to the COR for Government review no later than five (5) business days after contract award Will the Government please clarify if Key Personnel names and qualifications are due after award, rather than included in the proposal?

Two separate requirements. Tab 3: Key Personnel Qualifications (Factor

3) The Offeror shall submit a listing of Key Personnel and demonstrate how each meets the minimum qualifications (either by submission of resumes or by other means) for their positions, as described in the PWS. Key personnel for each clinic are the Clinic Administrator, Alternate Clinic Administrator, and Nursing Supervisor. Key personnel at the contract level are the Contract Program Manager, Alternate Contract Program Manager, and Lead Physician (PWS paras 1.18, 5.13.2.1.1, 5.13.2.1.2, 5.13.2.1.3, 5.13.2.1.4). Per PWS para 1.18, Key Personnel names and resumes with contact information is due NLT 5 business days after contract award.

instructions to

Offerors

RFP HT001523R0030 Proposal Instructions, Tab 1 Subfactor TRS1, Page 83 Paragraph 2 Offeror’s proposal shall include a detailed transition plan/schedule explaining its approach (and identifying major milestones) for preparing its proposed facilities for full operational capability at the date specified for the start of healthcare delivery. (PWS 1.3.1, 1.7, 5.13, 5.16)

PWS Section 1.7.2 Incoming Transition Plan, Page 3: The Contractor shall provide a detailed Incoming Transition Plan. This plan will show the activities that will be carried out to ensure smooth transition of all aspects of service and support covered in this PWS: Will the Government confirm that the transition plan for facilities is to be included in the proposal and the detailed incoming transition plan is to be provided after award?

Per Evaluation criteria: How the Offeror will carry out transition-in activities and schedule for opening the facilities for healthcare delivery not later than 9 months (amended from original RFP) from award to include evidence from the facility owner of availability. The Offeror’s proposal shall include a detailed transition plan/schedule explaining its approach (and identifying major milestones) for preparing its proposed facilities for full operational capability at the date specified for the start of healthcare delivery. (PWS 1.3.1, 1.7, 5.13, 5.16) and Per Part 9 Incoming Transition Plan; As described in PWS; Due with Offeror’s Proposal; Updated as Required

58 Other

RFP_Att_A_ATAMMC_ACC_Pricing+Matrix+(Attachment+A): Concerning "urgent" and same-day visits, please provide additional clarification- For urgent and primary care visits for non-enrollees, a single CLIN line is included in the pricing matrix. For non-enrolled beneficiaries, does the government equate one-time primary care visits to urgent care visits?

Yes, for non-enrolled beneficiaries, a one-time primary care visit is equivalent to an urgent care visit. Generally speaking, however, non-enrollees will not have access to primary care services, except in exigent circumstances.

ATAMMC ACC Feedback Form

RFP_Att_A_ATAMMC_ACC_Pricing+Matrix+(Attachment+A): Please confirm the governments intent that non-enrollees do not have access to the full scope of primary care services (ongoing, routine care services). If this is not the governments intent, please provide the specific scope of primary care services to the Contractor must provide to non-ACC enrollees.

See Response #14.

60 PWS

PWS Section 2.1.38. Non-Enrollee Patient Visit, page 12 & 5.14 Access Standards 5.14. page 39:

Please provide clarification to whether non-enrolled beneficiaries' access is limited to in-person UC and PC office visits only. Is the government's goal that beneficiaries be barred from participating in any specialized virtual services provided by the contractor?

See Response #14.

61 PWS

PWS Section 5.13.2.1.5.7. Referral Management, page 21: Please provide clarification whether the Contractor should anticipate the IRMAC appointing agents will book into open appointments for providers assigned to the ACCs?

Yes, IRMAC appointing agents may book into open appointments for the ACCs.

62 PWS

5.14. ACCESS STANDARDS: Please provide direction on how the contractor would manage requests for primary care services to non-enrolled beneficiaries when primary care has reached capacity.

Capacity should not be impacted by non-enrolled beneficiaries for primary care. Primary Care generally is reserved only for beneficiaries enrolled to the ACC with rare exceptions based on exigent circumstances -- usually for AD service members.

63 Pricing

RFP_Att_A_ATAMMC_ACC_Pricing+Matrix+(Attachment+A): The Pricing Matrix provides a quantity of prescriptions per year. Please provide clarification that if the quantity provided represents the total quantity of prescriptions for both enrolled and non-enrolled beneficiaries or, the projected prescriptions for just the non-enrolled beneficiaries.

Per the CLIN descriptions, this projected amount is for both enrolled and non-enrolled combined.

64 PWS

PWS. Section 1.3. Scope, page 2: Please provide clarification that the contract does not require the two ACC facilities to be similar in size/capacity.

The solicitation calls on offerors to propose an approach/solution for providing strategically located ACCs, delivering community-based health care services (as described in the PWS), for eligible military beneficiaries residing predominately in the southern (I-95) and western (I-66) corridors of the NCR and satisfying the 30-min drive time standard for Primary Care for eligible beneficiaries. There is no requirement that offerors propose precisely 2 ACC facilities or that all ACC facilities be similar in size and capacity.

65 PWS

PWS Section 1.3. Scope. page 2 & 5.13.2.1.5.6.3, page 29: According to Exhibit D Radiology, CT, PET, and some MRI services are out of scope for this contract. For patients reporting to ACC urgent cares who require advanced imaging, please provide the process for referring these beneficiaries to a higher level of care.

see response #5

66 PWS

PWS Section 3.8. page 19: Please provide clarification for offerors regarding the potential utilization of their existing IT infrastructure and systems to meet the identified program objectives of access, quality, and patient satisfaction more efficiently? Specifically, please provide clarification as to if the government will permit the use of existing infrastructure and systems if the Offeror provides the necessary data bridge to transfer all required government data and clinical documentation into MHS GENESIS as outlined in the Related Requirement, PWS 3.8?

Would the government consider covering the expenses for necessary IT enhancements aimed at supporting interoperability and clinical data exchange if organizations opt to provide and maintain their own IT infrastructure?

Because the contract requirement is for the contractor to deliver ACCs that operate as extensions of ATAMMC (i.e., part of the MHS direct care system), offerors must use the Government provided medical equipment and Government IT systems, to include MHS GENESIS.

ATAMMC ACC Feedback Form

67 PWS

PWS Section 3.8.5. page 20: The Government will provide Avaya licenses to use the Avaya appointing system (Call Center) - An integrated IT system that duplicates information from the Offeror's E.M.R. into MHS GENESIS could improve care coordination, meeting productivity standards. If an Offeror's appointing system integrates with the government's IT and achieves access, quality, and patient satisfaction goals, would the government permit its use?

IRMAC uses Avaya; therefore the Contractor must use Avaya.

68 PWS

PWS Section 3.8.1. IT Automation Systems, page 19 and Section 4.1.3, page 21: Can the government please update the requirement to allow the utilization of existing E.M.R.? E.M.Rs are routinely used and ubiquitous in the commercial clinical setting. The government will receive greater competition with more innovative proposals if it allows the inclusion of the offeror's existing EMR, provided that it interfaces with MHS GENESIS.

No. Pursuant to PWS paragraph 4.13, the Contractor must use MHS

GENESIS.

69 PMPM

1.3.1.6. To accurately calculate the PMPM rate for Primary Care, age and gender data of the population are minimum requirements. To ensure that all proposals from the industry accurately reflect the needs of the beneficiaries, would the government furnish this essential demographic information?

In contrast, in order to facilitate a true comparison of PMPM rates by the government, kindly furnish an elucidation of the government's justification for not providing age and gender information. Furthermore, kindly offer instructions on how to compute the PMPM for Primary Care in the absence of population demographics?

The Government will add Exhibit T, Enrollment By Age, to the RFP.

instructions to

Offerors

The government's assessment of these adjustments in beneficiary care is regarded as an important step in ensuring a sustainable route forward.

While the government's tight procurement timetable is recognized, it is respectfully asked that the proposal submission period be extended to January 31, 2024. There are several areas that require clarity that will have an influence on offerors' suggested solutions for this opportunity.

Additional time is requested to ensure that offerors may adequately reply to the government's

RFP.

The government maintains the due date as published of 5 Jan 24 for all responses.

ATAMMC ACC Feedback Form

71 Pricing

PWS 1.7.1.3. Facility Transition Requirements. Clarification needed: The Pricing Template states, "4. Admin transition costs (Base Year Only) are only for non-incumbent offerors and will NOT include Facility acquisition/leasing, designing, updating, remodeling, refurbishing costs, etc. See PWS 1.7.1.3. Non-incumbent offerors should amortize such facility costs into their base year and option year PMPM rates, recognizing that the base year will include up to a 9-month transition period before health care delivery (and application of base year PMPM rates) begins.

These two statements seem in conflict: 1) The Pricing Template uses the terminology "Admin Transition Costs." The PWS at 1.7.1.3 uses the terminology "Facility Transition Requirements."

Are these two terms and the associated price/costs synonynmous with one another? 2) The Pricing Template states, "Admin transition costs (Base Year Only) are only for non-incumbent offerors and will NOT include Facility acquisition/leasing, designing, updating, remodeling, refurbishing costs, etc. See PWS 1.7.1.3. " However, following that statement, the Pricing Template states, " Non-incumbent offerors should amortize such facility costs into their base year and option year PMPM rates, recognizing that the base year will include up to a 9-month transition period before health care delivery (and application of base year PMPM rates) begins."

It appears that the Base Year does, in fact, require such facilty costs in the Base Year---just not ALL facility costs in the Base Year as facility costs are to be spread out in the PMPM CLINs for the Base Year and the Option Year CLINs.

The term 'Admin Transition Costs' in the pricing template correlates to PWS paragrapn 1.7.1.2 'Administrative and Personnel Transition Requirements' and CLIN 0031. The CLIN 0031 description provides that 'the Contractor shall provide admin transition services IAW the attached PWS (para. 1.7.1.2).' The 'Facility Transition Requirements' described in PWS para 1.7.1.3 are distinct from the Administrative and Personnel Transition Requirements. As indicated in the pricing template, offerors must account for Facility Transition Requirement costs in their PMPM pricing. The Government is modifying Pricing Matrix note 4 and PWS paragraph 1.7.1 to provide clarity.

72 Pricing

On page 3 of the RFP at Item 0001, the Item indicates a Quantity of 540,000 each, and that the contractor may invoice each month for up to 45,000 Enrolled Beneficiaries. The Quantity increases to 612,000 for Items 1001, 2001, 3001, and 4001, though, the number of enrolled beneficiaries remains at 45,000 with a statement in each Item that, "The Contractor may invoice each month for up to 45,000 Enrolled Beneficiaries IAW the PMPM clause and the PWS." The Pricing Template for OP1 through OP 4 makes a beneficiary enrollment adjustment to 51,000 enrollees, which is in conflict with the RFP at Items 1001 through 4001 which still uses a beneficiary enrollment of 45,000.

Comment: It is not clear what happens in the event the number of enrolled beneficiaries exceeds 45,000. Does the PMPM clause take precedence over the 45,000 maximum cited in the Items 0001 through 4001?

The Base year of the contract requires a total of 45,000 enrolled beneficiaries to be seen under PMPM. Each Option Year should indicate a total of 51,000 enrolled beneficiaries to be seen under PMPM. The RFP will be updated to reflect these totals for the base year and each option year.

73 Pricing RFP Instructions, Volume I, Tab (page 80 of 161) says "The offeror is not required to submit the entire SF 1449." Will the government confirm that offerors are not required to complete and submit the SF 1449 Continuation Pages located on pages 3 thru 63?

Correct. the Offeror is required to sign the front page of the 1449 and any amendments. the Offeror is also required to fill out any clauses and provisions that pertain to the offeror as indicated in the instruction to Offeror's. the Offeror is not required to fill in CLIN pricing on the 1449 as that will be provided on Attachment A.

74 Other Please clarify the contract type for this contract is (FFP, IDIQ). The contract type is FFP. It will be a 'C' type contract and not an IDIQ.

Evaluation

Factors

Factor 4 includes a requirement to provide a staffing model. To allow offerors to be equitably evaluated, we recommend the Government require Offerors submit hours or FTEs for each position on the non-PMPM CLINS for the base and each option period. Additionally, the request for the staffing model would be excluded from the page limitations of Factor 4 as models will vary by offeror.

The Government will leave the Factor 4 (SF 3) staffing model submission requirements as is. (See answer # 76 for additional information.) The staffing model submission is part of the page limitation requirements set forth in the RFP, no and there will be no exclusions from the page limitation.

ATAMMC ACC Feedback Form instructions to

Offerors For the price proposal, please confirm the detail required staffing model submission should reflect the hours identified in RFP Attachment A.

The staffing model is proposed by the Offeror to meet the PWS requirements and should include the details the Offeror deems appropriate. The hours may be included in the staffing model if the Offeror deems it necessary for evaluation.

Evaluation

Factors

Will offerors who propose professional compensation be evaluated as unrealistic pursuant to FAR 52.222-46 and therefore be given an Unacceptable rating for Factor 1? If this is not the case, please provide additional detail to describe the basis for evaluating an offeror as unacceptable.

An Offeror's proposal for Factor 1 will be evaluated as "acceptable" or "unacceptable" only. As identified in Addendum 52.212-2, the rating of "unacceptable" is described as "The Professional Employee Compensation is insufficient to recruit and retain qualified candidates to support this requirement."

Evaluation

Factors

Will any offeror that proposed professional compensation evaluated as unrealistic pursuant to FAR 52.222-46 evaluated as Unacceptable for Factor 1? If not, please explain the bases for evaluating an offeror as unacceptable.

See response #77 instructions to

Offerors

We recommend the Government revise Factor 3 to submit resumes and letters of commitment for all proposed key personnel to ensure that the Government has sufficient information to evaluate the acceptability of all proposed personnel.

The government will not modify the Key Personnel submittal requirements.

Evaluation

Factors

Will any offeror that proposes small business participation for any category lower than those identified in the RFP be evaluated as Unacceptable for Factor 2? Please identify the bases for an Unacceptable rating under Factor 2.

Yes. The Government will consider how the Offeror’s proposed Small Business Participation Commitment Document compares with the small business goals listed in the solicitation. The Government will consider the extent to which the Offeror identifies intended small business partners in its commitment document and the extent to which the document explains the good faith efforts the Offeror will make to meet the specified goals by using small business, SDVOSB, HUBZone small business, SDB, and WOSB subcontractors to the maximum extent practicable. The small business goals for this solicitation have been established using SBA and DoD goals for subcontracting. The RFP will be updated to clearly reflect the small business goals as they pertain to the SBPCD for this requirement.

81 CLINs Will the offeror's have the opportunity to price each of the CLINS, outside of the PMPM, based on labor categories proposed in our staffing models? This would match the total number of hours by CLIN and eliminate the average rate per Support CLIN.

No modifications may be made to Attachment A except those items highlighted in yellow.

82 Pricing Please define specifically what costs may be included in “Admin transition costs” for the base year as identified in the Instructions Tab of RFP Attachment A.

See response #71

83 PMPM

Please confirm that any other transition costs aside from those the Government identifies in defining “Admin transition costs” are to be included in the PMPM rates for the base and each option year.

See response #71

84 Other

As the RFP incorporates new and/or different requirements from the incumbent contract, and the incumbent contractor is not required to propose its existing facilities, please revise the RFP (including but not limited to PWS Section 1.7 and RFP Attachment A) to apply equally to all offerors regardless of incumbent status. Such revisions are necessary to ensure offerors are competing on a level playing field.

See response #71. The Government will revise PWS paragraph 1.7.1.

ATAMMC ACC Feedback Form

85 PMPM

Please confirm that all offerors’ PMPM pricing must include facility acquisition/leasing, designing, updating, remodeling, refurbishing costs for the Base Period for a full 12 months.

Note that to the extent offerors are NOT required to propose facility-related costs for the same period of performance, offerors would not be competing on a level playing field.

See response #71

86 PWS Please update the PWS to clarify if OB & Ortho specialties are required at each ACC location?

The offerors should propose an approach for offering OB and Ortho services based upon where their facilities are located, the historical Workload (Exhibit AA-2), and the zip code by…