12_Section_L_Instructions__4-5-13_clean_.doc

SECTION L, INSTRUCTIONS, CONDITIONS AND NOTICES TO OFFERORS

L.1. SOLICITATION PROVISIONS

L.1.1. FAR 52.204-6 DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER (APR 2008)

L.1.2. FAR 52.211-14 NOTICE OF PRIORITY RATING FOR NATIONAL DEFENSE EMERGENCY PREPAREDNESS, AND ENERGY PROGRAM USE (APR 2008)

Any contract awarded as a result of this solicitation with DO-C9 rated order certified for national defense, emergency preparedness, and energy program use under the Defense Priorities and Allocations System (DPAS) (15 CFR 700), and the Contractor will be required to follow all of the requirements of this regulation.

(End of Provision)

L.1.3. FAR 52.215-1 INSTRUCTIONS TO OFFERORS—COMPETITIVE ACQUISITION (JAN 2004)

L.1.4. FAR 52.215-16 Facilities Capital Cost of Money (Jun 2003)

L.1.5. FAR 52.215-20 REQUIREMENTS FOR CERTIFIED COST OR PRICING DATA AND DATA OTHER THAN CERTIFIED COST OR PRICING DATA (OCT 2010)

a. Submission of certified cost and pricing data is not required.

b. Offerors shall provide the information described in L.8. Volume IV, Price Proposal (Factor 3).

(End of Provision) L.1.6. FAR 52.215-22 LIMITATIONS ON PASS-THROUGH CHARGES –IDENTIFICATION OF SUBCONTRACT EFFORT (OCT 2009)

L.1.7. FAR 52.216-1 TYPE OF CONTRACT (APR 1984)

The Government contemplates award of a requirements contract with fixed unit prices resulting from this solicitation.

(End of Provision)

L.1.8. FAR 52.222-24 PREAWARD ON-SITE EQUAL OPPORTUNITY COMPLIANCE EVALUATION (FEB 1999)

L.1.9. FAR 52.233-2 SERVICE OF PROTEST (SEP 2006)

(a) Protests, as defined in section 33.101 of the Federal Acquisition Regulation, that are filed directly with an agency, and copies of any protests that are filed with the Government Accountability Office (GAO), shall be served on the CO by obtaining written and dated acknowledgment of receipt from the CO, address in Block 7 of the Standard Form 33.

(b) The copy of any protest shall be received in the office designated above within one day of filing a protest with the GAO.

(End of Provision)

L.1.10. FAR 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998) This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer (CO) will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. The full text of a solicitation provision may be accessed electronically at these addresses:

http://www.acquisition.gov/far, http://farsite.hill.af.mil/, http://www.acq.osd.mil/dpap/dars/dfarspgi/current/index.html.

(End of Provision)

L.1.11. FAR 52.252-5 Authorized Deviations in Provisions (APR 1984) The use in this solicitation of any Federal Acquisition Regulation (48 CFR Chapter 1) provision with an authorized deviation is indicated by the addition of “(DEVIATION)” after the date of the provision.

L.1.12. DFARS 252.209-7001 DISCLOSURE OF OWNERSHIP OR CONTROL BY THE GOVERNMENT OF A TERRORIST COUNTRY (JAN 2009)

L.1.13. DFARS 252.215-7008 ONLY ONE OFFER (JUN 2012)

L.1.14. DFARS 252.225-7003 REPORT OF INTENDED PERFORMANCE OUTSIDE THE UNITED STATES AND CANADA—SUBMISSION WITH OFFER (OCT 2010)

L.1.15. DFARS 252.225-7031 SECONDARY ARAB BOYCOTT OF ISRAEL (JUN 2005)

L.1.16. DFARS 252.226-7001 UTILIZATION OF INDIAN ORGANIZATIONS, INDIAN-OWNED ECONOMIC ENTERPRISES, AND NATIVE HAWAIIAN SMALL BUSINESS CONCERNS (SEP 2004)

TMA Procedures Guidance and Information (PGI) 233.103-90, Agency Level Protests NOTICE OF AVAILABILITY OF INDEPENDENT REVIEW (MAY 2012).

a. An interested party filing a protest with TRICARE Management Activity (TMA) has the option of requesting review by either the Contracting Officer (CO) or an independent review official (IRO), who is a TMA official at a level above the CO. Alternately, an interested party may request an IRO review as an appeal of the CO's protest decision.

b. Where applicable, an interested party must clearly state in the protest that IRO review is requested, and must specify the nature of the independent review sought whether as an alternative to CO review or as an appeal of the CO's decision. Regardless of which review is requested, all protests must be complete and submitted to the CO within the timeframes specified in FAR 33.1.

Note: In accordance with 4 CFR 21.3(a)(3), any protest filed with the Government Accountability Office (GAO) will be considered by TMA to be timely if it is filed within 10 days of actual or constructive knowledge of TMA’s adverse action on the initial agency–level protest, provided the agency–level protest was filed in accordance with 4 CFR 21.3(a)(1) and (2). Any subsequent TMA appellate review of the initial agency–level protest shall not provide an extension of time to file a protest with the GAO. TMA’s Agency Level Protest process gives a higher level appellate review of the CO’s decision on the initial protest challenge; therefore, this independent review does not extend the Government Accountability Office’s timeliness requirements for subsequent protest of the initial adverse agency action (FAR 33.103(d)(4) and 4 CFR 21.2(a)(3).

L.2. GENERAL INSTRUCTIONS

L.2.1. To assure timely and equitable evaluation of proposals, offerors must follow the instructions contained herein. Offerors are required to meet all solicitation requirements, including terms and conditions, representations and certifications. If an offeror fails to meet a requirement, the CO may reject the proposal as “non-responsive” and ineligible for award. The Government will not evaluate non-responsive proposals. Proposals must be complete, self-sufficient, and respond directly to the requirements of this solicitation. The Government will not accept alternate proposals.

a. NOTE TO OFFERORS: No corrections and/or changes are allowed after the deadline for submission of proposals.

b. Each offeror shall comply with the solicitation requirements and submit a clear, concise proposal that includes sufficient detail for the Government’s effective evaluation and validation of offeror’s stated claims. The Government has provided Section L Exhibit L-3, Solicitation Cross-Reference Table, to assist offerors in proposal preparation. Exhibit L-3 provides a general cross-reference between solicitation sections and is not intended to be a substitute for the offeror’s reading and complying with the solicitation requirements. Offerors are not required to submit Exhibit L-3 as part of the proposal.

L.2.1.1. The Contracting Officer (CO) will determine whether the apparent successful offeror is responsible in accordance with FAR 9.1. A determination of non-responsibility will result in the rejection of an offer and that offer may not be considered for award.

L.2.1.2. Award without Discussions: The Government intends to evaluate offers and award a contract without discussions with offerors. Therefore, the offeror’s initial proposal should contain the offeror’s best terms from a price and technical standpoint. If an offeror submits more than one proposal, the Government will not evaluate any proposal from that offeror.

L.2.1.3. The Government reserves the right to conduct discussions if the CO determines they are in the Government’s best interests. The Government may reject any or all offers if such action is in the public interest, accept other than the lowest price offer, and waive informalities and minor irregularities in offers received. The Government cautions offerors not to leave solicitation items blank, including the Standard Form (SF) 33 blocks, Section K, Representations, Certifications, and Other Statements of Offerors, or any item requiring the offeror’s response. If an item is not applicable to the offeror, the offeror shall state “not applicable” or “NA.” The CO may consider the offer to be unacceptable and ineligible for contract award if an offeror (1) fails or refuses to assent to any of the terms and conditions of the RFP; (2) proposes additional terms and conditions of this RFP (excluding those permitted under L.6.); or (3) fails to submit any of the information required by this RFP. The offeror is reminded the Government reserves the right to award this effort based on the initial proposal received without discussions.

L.2.1.4. The offeror should not simply rephrase or restate the Government’s requirements in the proposal. The offeror shall provide convincing rationale that addresses how the offeror intends to meet the requirements. Offerors shall assume that the Government has no prior knowledge of their facilities, capabilities or experience. The Government will base its evaluation on the information presented, plus any additional past performance information the Government obtains from other sources.

L.2.1.5. Discrepancies and Ambiguities: If an offeror believes the requirements in these instructions contain an error, omission, ambiguities, or are otherwise unsound, the offeror shall immediately notify the CO in writing with supporting rationale as well as the remedies the offeror is asking the CO to consider related to the omission or error .

L.2.1.6. Electronic Reference Documents: All solicitation documents for this requirement are available on the Federal Business Opportunities (FBO) website at http://www.fbo.gov unless noted otherwise. Potential offerors are encouraged to register on FBO to receive e-mails regarding Government notifications on the FBO.gov website.

L.2.1.7. Contract Document: Sections K, L and M apply to the solicitation phase only and will not be part of the resulting contract.

L.2.1.8. The contract will be updated to reflect the actual Period of Performance dates prior to award.

L.2.2. ORGANIZATIONAL CONFLICTS OF INTEREST (OCI)

L.2.2.1. The Government directs offerors’ attention to FAR 9.5, Organizational and Consultant Conflicts of Interest. TMA hereby notifies all interested offerors that actual and potential OCIs may exist.

L.2.2.2. For the purpose of these provisions, the term "offeror" means the offeror, its subsidiaries, affiliates, partners, and marketing consultants or any of its successors or assignees.

L.2.2.3. In accordance with FAR 9.505, General Rules, TMA is advising all interested offerors that “actual” and “potential” OCIs may exist. This information is provided to assist prospective offerors in developing their own business strategies regarding TMA requirements so offerors may avoid, mitigate, and neutralize any “actual” and “potential” OCIs. The following is provided for the purpose of identifying, avoiding, and mitigating against OCIs of this solicitation/award process:

L.2.2.3.1. In the Government’s opinion, the following companies represent an “actual” conflict of interest and, unless demonstrated otherwise, may not serve as a prime contractor, subcontractor, or in any advisory capacity to any offeror of this solicitation and the resulting contract: Axiom, Kennell and Associates, Keystone Peer Review Organization (KePRO), Lockheed-Martin, National Government Services (NGS), SofTec Solutions, Cherokee Information Services, ThinkQ and OST Global Solutions, Inc.

L.2.2.3.2. “Potential” or “actual” OCIs may exist with TMA contractors who currently perform logistical, program, operational, data management support for TMA Aurora, CO; TMA Falls Church, VA; and Defense Manpower Data Center. It is incumbent on all offerors to use sound business judgment and determine the significance of any conflict of interest. In TMA’s opinion, by the nature of their performance with TMA, some contractors, including, but not limited to the following, may fall into the “potential” or “actual” category: HP Enterprise Services (formerly EDS), NGS, KePRO, IntelliDyne LLC, CTA Inc., E.R. Williams, Bearing Point, the Lewin Group, Ingenix, Delmarva Foundation, Quintiles Pharma Inc., and Quintiles Transnational Group.

L.2.2.4. “Potential” or “actual” OCIs may exist with former DoD officials/employees that have served in positions such as TRICARE acquisitions, program management, finance, in an executive position or participated in a TRICARE source selection evaluation board as the source selection authority, an advisor or an evaluator. (See DFARS 252.203-7000 (Ref 203.171-4)).

L.2.2.5. In the event an offeror for this procurement intends to use any of the above entities referenced in paragraph L.2.2.3 above, as a subcontractor or in any advisory capacity to this solicitation or the resulting contract, or to use a former DoD official/employee, as referenced in paragraph L.2.2.4 above, when developing a proposal in response to this solicitation, or as a member of the offeror’s organization structure, the offeror shall provide a mitigation plan to the Government that effectively demonstrates how the offeror will avoid, neutralize or mitigate any potential or actual OCI in its business arrangement for supporting this contract and any other TMA contract. The mitigation plan shall be forwarded to the Contracting Officer no later than 15 calendar days prior to the proposal due date.

L.2.2.6. If the offeror believes no OCI exists, the offeror shall represent in writing in Volume I of the proposal that, to the best of the offeror's knowledge, there are no relevant facts or circumstances concerning any past, present, or potential contracts or financial interest relating to the work to be performed, which could give rise to an OCI as described in FAR, Subpart 9.5. Each offeror shall use sound business judgment to identify and determine the significance of any conflict of interest.

L.2.2.7. The above restrictions shall be included in all subcontracts, teaming arrangements, and other agreements calling for the performance of work subject to the OCI restrictions identified in these provisions.

L.2.2.8. The offeror acknowledges the full force and effect of these provisions. The Government reserves the right, in case of a breach, misrepresentation or nondisclosure, to terminate the resultant contract, disqualify the offeror from subsequent related contractual efforts, or pursues any remedy permitted by law, regulation or the terms and conditions of this solicitation.

L.2.2.9. The CO will review all mitigation plans to determine whether award to the offeror is consistent with FAR 9.5. If the CO determines that no conflict would arise or that the mitigation plan adequately protects the interests of the Government, the offeror will be eligible for award. If the CO determines that the mitigation plan is inadequate, remedial actions will be considered, including elimination from the solicitation process, termination of related contract efforts already awarded, or negotiation of the mitigation plan.

L.2.3. Offerors shall use their legal name and not a shortened version that could be confused with a parent company or other corporation. Use of an acronym is permissible after the first usage of the full legal name in each of the proposal volumes. The offeror shall clearly distinguish information in its proposal that it attributes to itself (the offeror) its parent company, affiliate or subsidiary.

L.2.4. Offerors shall submit proposals to the CO at the address indicated below. The proposals are to be in electronic and hard copy format (see paragraph L.4.) in the quantities indicated in Table 1. Hardcopies and CDs shall be submitted to:

Mr. Scott Lamond, Contracting Officer

TDEFIC, HT9402-12-R-0005

TRICARE Management Activity/COD-A 16401 East Centretech Parkway Aurora, CO 80011-9066

L.2.4.1. Each CD and hardcopy volume shall be marked as follows:

OFFEROR’S COMPANY NAME, e.g., XYZ Corporation

HT9402-12-R-0005

TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC) Volume Number CD number (e.g., 1 of 3) Date the CD was created Software and version used (See paragraph L.4.2.)

L.2.4.2. Offerors shall apply all appropriate markings including those prescribed in accordance with FAR Clause 52.215-1(e), Restriction on Disclosure and Use of Data; and FAR 3.104-4, Disclosure, Protection, and Marking of Contractor Bid or Proposal Information and Source Selection Information. Offeror shall also identify any proprietary data that is to be protected in accordance with FAR 2.101.

L.2.5. Personal Deliveries: If an offeror plans to have a representative deliver its proposal, the offeror shall coordinate the delivery with the Contract Specialist (See Block 10 of the SF 33) at least 1 business day prior to the due date/time to ensure timely submission. Proposals must be received no later than the date/time and at the address stated on the SF 33.

L.3. GENERAL INFORMATION

L.3.1. Communications: The CO and the Contract Specialist are the sole points of contact for this procurement. Offerors shall submit any questions regarding the solicitation or other concerns via email to the Contract Specialist with a courtesy copy to the CO.

L.3.1.1 The CO encourages offerors to submit questions regarding the solicitation or other concerns via email to the Contract Specialist at Margaret.Zancanella@tma.osd.mil no later than 10 business days after issuance of solicitation. The CO will provide answers to questions to all prospective offerors via the Federal Business Opportunities website at https://www.fbo.gov.

L.3.2. Pre-proposal Conference: TMA anticipates holding a pre-proposal conference. TMA will provide the specifics about the pre-proposal conference on Federal Business Opportunities website at a later date.

L.3.3. The remarks, explanations, and answers provided by Government representatives whether orally, or in writing, shall not change any of the terms or conditions of the solicitation. The solicitation can only be changed by a formal written amendment issued by the CO.

L.3.4. Data on eligible beneficiaries, electronic and paper claims quantities, and administrative support services workload volumes are located in Section L Exhibits L-1 and L-2.

L.3.5. Offerors may access the TRICARE Manuals on the TMA website at http://manuals.tricare.osd.mil.

L.4. PROPOSAL PREPARATION

L.4.1. The offeror’s proposal shall consist of five (5) physically separated volumes, individually titled as indicated below. Each copy of each volume shall be in separate three-ring binders in the appropriate quantity. The total number of copies includes the original (e.g., 4 copies = original + 3 copies).

Table 1, Proposal Volumes

Completed, signed SF 33, with Sections B, K and G.1, Small Business Subcontracting Plan if applicable, OCI Representation and Mitigation Plan if applicable Cost Accounting Standards Board (CASB) Disclosure Statement(s)

Narrative for Subfactors 1-4

Proposed Enhancements List

Past Performance Summary Past Performance Summary Description for Each of 5 Largest Clients for Prime and each 1st-tier Subcontractor Organizational Change Roadmap

Completed Client Authorization Letter for Each Client Point of Contact

Each Subcontractor and Teaming Partner’s Key Personnel Information

Copy of Section B, Supplies or Services and Prices/Costs Supporting Spreadsheets, and any additional support

Wage determination(s) and/or Collective Bargaining Agreements (CBAs) for the offeror’s place(s) of performance.

Dun and Bradstreet (D&B) Comprehensive Report(s), Financial Statements

DCMA Form 1620 04-04 Guaranty Agreement for Corporate Guarantor

L.4.2. Electronic Copies. The electronic portion of the proposal shall be submitted on virus-free CD-ROMs that are compatible with Microsoft Office 2003 or later applications. For the original and copies listed above, the documents shall be either in Word or Excel format. If this is not possible, then a PDF document in Optical Character Recognition (OCR) format is acceptable for all volumes except for Volume IV, Price Proposal, which shall only be submitted in Word and Excel format (See paragraph L.8 for additional requirements). Each CD shall be labeled as stated in paragraph L.2.4. In addition, each CD must be made “final.” “Final” is a recording option that renders the CD totally used so no other data tracks can be added. Do not use compressed file formats. Use separate files to permit rapid location of all portions, including exhibits, annexes, and attachments, if any. All portions of the electronic documents, including the body of text, tables, charts, and graphs shall be in a format that enables the Government to perform electronic searches of the documents. Electronic versions shall be exact duplicates of the paper copy proposals in both content and format.

L.4.3. Paper Copies. Paper copy proposals shall be exact duplicates of the electronic versions in both content and format. Offerors shall submit each copy of each volume in a separate 3-ring binder with the offeror’s name, volume number, volume title, proposal date and solicitation number on the outside front cover and spine. Offerors shall also indicate which set of the volumes is the original and indicate the number of each set of copies (COPY 1 of 3). All paper proposal material shall be submitted on white paper with one-inch (1”) margins on all sides. The font for both CD ROM and paper submissions shall be Times New Roman, and at least 12 points with normal spacing and kerning. However, offerors may use 8-point Times New Roman for illustrations, organization charts, supporting data exhibits, report listings, or levels on process flows. Elaborate brochures or documentation, binding, detailed artwork, or other embellishments shall not be submitted. Proposal Volumes I-III shall be printed single-spaced, double-sided only with non-duplicative, sequential page numbers at the bottom of each page. Offerors shall include the offeror’s name and solicitation number at the bottom of each page. Volumes IV-V shall be printed single-sided. In instances where the paper copy differs from the electronic copy, the original paper volumes prevail.

L.4.4. Page Limitations. Page limitations shall be treated as maximums. If exceeded, the excess pages will not be considered in the evaluation of the proposal. The excess hard copy pages will be destroyed without review, and excess electronic pages will not be reviewed. Table 2 below shows the required documents with page limits and the corresponding paragraph in Section L. If a required document is not listed in Table 2, then it has no page limit.

Table 2, Proposal Page Limits

L.4.5. If the CO issues an Evaluation Notice (EN) (i.e., clarification questions), the offeror shall follow the instructions in the EN.

L.4.6. If the CO requests final proposal revisions, the offeror shall follow the revision instructions in the request for final proposal revision.

L.4.7. An offeror’s proposal will not be incorporated into the awarded contract as a whole. However, the Government may incorporate portions of the proposal into the resulting contract.

L.4.8. In accordance with FAR 4.803, Contents of Contract Files, the agency’s contracting office will retain one copy of all unsuccessful proposals. TMA’s Office of General Counsel (OGC) may retain their copies of proposals. Unless the offeror requests otherwise in writing, the contracting office will destroy the remaining copies of unsuccessful proposals.

L.4.9. Organization Chart. The offeror shall submit their proposed organizational structure and must include the prime contractor, the parent entity, affiliates, subsidiaries, teaming partners, and first-tier subcontractors. A first-tier subcontractor is a company with a direct contractual relationship with the offeror to perform TDEFIC requirements, and whose contract price exceeds $25,000,000 in any one year for Option Periods 1-6.

L.4.9.1. The offeror shall include addresses and telephone numbers in the organizational chart. In the case of a joint venture or other business structure (e.g., subsidiary relying upon its parent corporation and/or relying on other corporate subsidiaries of its parent), the offeror shall disclose a clear description of the organizational relationships. The offeror shall place a copy of the organization chart in the front of each volume. The organization chart shall not exceed 3 pages and will not count against any of the other page limitations indicated in paragraph L.4.4.

L.5. VOLUME I, EXECUTED OFFER

L.5.1. Volume I shall contain the signed original of all documents requiring the offeror’s signature, including the SF 33 and the acknowledgement of any issued amendments to this solicitation. Use of reproduction of the signed original is authorized in the copies. The offeror shall complete and provide Section K, Representations, Certifications, and Other Statements of Offerors, with all representations and certifications, including FAR Provision 52.204-8, Annual Representations and Certifications, in Volume I. An electronic Representations and Certifications Application is available at the System for Award Management (SAM) website (https://www.sam.gov/portal/public/SAM).

L.5.2. Offerors shall submit a completed original Section B, Supplies or Services and Prices/Costs, in Volumes I and IV. Offerors shall not include price information anywhere else in their proposal. Offerors are instructed to price the appropriate CLINs and subline items numbers (SLINs) in Section B, Section B, Supplies or Services and Prices/Costs, as described in paragraph 8.0, Volume IV, Price Proposal, (Factor 3, Price).

L.5.3. Offerors must complete, sign, and date Blocks 12 through 18 of the SF 33. The Government estimates it will require a minimum of 180 calendar days to evaluate the TDEFIC offers and select the successful offeror. Therefore, offerors shall provide at least 180 days in Block 12, Minimum Acceptance Period.

L.5.4. Offeror’s Point of Contact (POC): An offeror shall include a cover page in Volume I identifying offeror’s POC(s) authorized to respond to evaluation notices (ENs) and/or hold discussions/negotiations with the Government with the full authority to bind the company. The following POC information is required: Full name, title, e-mail address, phone number, fax number, and level of authority.

L. 5.5. Section G, Contract Administration Data: As required in paragraph G.1.1.1, the offeror shall provide the POC’s name and contact information for contract administration in Volume I.

L.6. VOLUME II, TECHNICAL PROPOSAL (FACTOR 1, TECHNICAL APPROACH)

L.6.1. The offeror shall submit a written technical proposal that demonstrates the offeror’s understanding of the solicitation requirements and provides an effective and efficient technical approach for the prospective contract. The technical proposal shall also include a Proposed Enhancement List. The Proposed Enhancement List shall cite the proposal reference where each offered element is located in the technical proposal.

L.6.1.1. The technical proposal shall clearly describe each element offered and demonstrate how the offeror will meet or exceed the TDEFIC requirements and explain why any proposed enhancements are advantageous to the Government.

L.6.1.2. If a proposed enhancement is not a requirement, then the offeror shall so state and explain how the enhancement benefits the Government. The Government may incorporate the proposed enhancements into the contract if the Government also determines they exceed requirements/standards and/or are advantageous to the Government.

L.6.1.3. For each proposed enhancement, the offeror shall include adequate language that may be incorporated into the contract as an enforceable provision. The Government, at its sole discretion, may or may not incorporate proposed enhancements into the contract.

L.6.1.4. The Government will not assess a strength as defined in Section M, Evaluation Factors for Award, to any enhancement to the following Government standards or requirements (TRICARE Operations Manual (TOM) 6010.56-M, February 1, 2008, Chapter 1, Section 3):

a.

Claims Processing Cycle, paragraph 1.6.

b.

TEDS Timeliness: 100% of initial submission vouchers transmitted to TMA within five calendar days, paragraph 1.8.

c.

Filing, paragraph 2.1.

d.

Availability of Information, paragraph 2.2.

e.

Walk-ins, paragraph 3.3.

f.

Telephone Blockage Rates, paragraph 3.4.

g.

Telephones answered within 2 rings by Automated Response Unit (ARU), paragraph 3.4.

h.

Telephones transferred to ARU within 20 seconds, paragraph 3.4.

i.

Expedited Preadmission/Pre-procedure Reconsiderations, paragraph 4.1.

g.

Grievances, paragraph 5.0.

L.6.1.5. The proposal shall not reflect a marketing or sales presentation. Unnecessarily elaborate proposals beyond those sufficient to present a complete and effective response to this solicitation are not desired. The proposal should illustrate the offeror’s capability and clearly demonstrate the organization and methodology that will satisfy the solicitation requirements.

L.6.1.5.1. The proposal shall clearly describe the technical approach to the solicitation requirements. The proposal shall address all of the subfactors identified in paragraphs L.6.2. through L.6.6. The Government will evaluate the proposal using the criteria in Section M, Evaluation Factors for Award.

L.6.1.5.2. The proposal may state information on the offeror’s experience (for this purpose, experience refers to what an offeror has done, not how well it was accomplished) in performing the proposed processes and procedures. This information may be considered in the evaluation of specific technical approaches and related technical proposal risk. However, any such information in the technical proposal will not be considered for the purposes of evaluating past performance as described in paragraph M.5.

L.6.1.5.3. The price proposal, past performance information, and financial information shall not be addressed in the technical proposal volume, and no part of the technical proposal shall be incorporated by reference in any other proposal volume.

L.6.1.6. The technical proposal shall not exceed 150 pages inclusive of the exhibits, illustrations attachments, flow diagrams, data dictionaries, figures, charts, and any other non-narrative documents. The table of contents, index, and tabs separating sections of the volume will not be counted as long as they do not contain proposal content. The offeror may cross-reference information within the technical proposal rather than repeating the information (i.e., a cross-reference to another paragraph within the technical volume; a cross-reference to another volume is not allowed).

L.6.2. SUBFACTOR 1, CLAIMS PROCESSING

L.6.2.1. The offeror shall describe how it will establish, maintain, and monitor an automated claims processing system to include the receipt and transmission of HIPAA compliant transactions through claims history retention. At a minimum, the Claims Processing description shall include the offeror’s method and/or process to:

· Verify patient eligibility

· Ensure a service is medically necessary and a covered TRICARE benefit

· Authorize/pre-authorize services (including skilled nursing facility services when TRICARE becomes primary payer)

· Determine the appropriate allowable payment amount

· Coordinate and apply Medicare and Other Health Insurance (OHI) benefits

· Correctly apply deductible, co-pay/cost-share and catastrophic cap provisions

· Create and disburse the explanation of benefits and release of payment

· Complete provider certification, jurisdiction determinations

· Receipt and control of both paper and electronic claims, missing claim information/claim development and data entry.

L.6.2.2. Timeliness: The offeror shall describe how it will monitor and achieve claims processing timeliness standards:

· 98% of retained claims and adjustment claims shall be processed to completion within 30 calendar days from the date of receipt; and

· 100% of all claims (both retained and excluded, including adjustments) shall be processed to completion within 90 calendar days unless the Government specifically directs the contractor to continue pending a claim or group of claims.

L.6.2.3. Accuracy: The offeror shall describe how it will monitor and achieve the claims processing accuracy standards:

· The absolute value of the payment errors shall not exceed 2% of the total billed charges for Option Periods 1 and 2, and shall not exceed 1.75% for the remaining option periods.

· The claim occurrence error rate shall not exceed 3% for all types of TED records.

L.6.3. SUBFACTOR 2, BENEFICIARY AND PROVIDER CUSTOMER SERVICE AND SATISFACTION /

L.6.3.1. The offeror shall comprehensively describe its customer service program for achieving satisfied beneficiaries and providers at the highest level possible to include the types of customer services offered; the manner in which services can be accessed; and how the offeror will ensure provider and beneficiary satisfaction for all customer service activities.

L.6.3.2. The offeror shall describe how it will ensure and measure customer service functions are performed with knowledgeable, courteous and responsive staff to include a description of how the offeror will ensure the quality and accuracy of responses to provider and beneficiary inquiries. The offeror shall not propose its own beneficiary and provider surveys. The offeror may use Government survey results in the offeror’s approach.

L.6.3.3. The offeror shall describe how it will identify and respond to beneficiary and provider education needs consistent with the solicitation and coordinate with the Beneficiary Education and Support (BE&S) Division to develop and disseminate education materials, including mode and frequency.

L.6.4. SUBFACTOR 3, MANAGEMENT FUNCTIONS

L.6.4.1. The offeror shall describe the proposed management approach for establishing and maintaining staff , facilities, systems, and infrastructure to achieve the solicitation requirements, incorporating best business practices when practicable. The management approach shall describe the necessary administrative, management, oversight, customer service, staffing, quality and risk management processes the offeror will use to achieve the solicitation requirements.

L.6.4.1.1. The offeror shall describe how it will establish and maintain experienced and qualified personnel with appropriate skill sets, including management positions, to meet the requirements of this contract and support the offeror’s technical approach. The offeror shall also describe how they will retain and train employees.

L.6.4.1.2. The offeror shall describe its ability to manage contractor operations to meet the solicitation requirements and integrate all contractor activities. The description shall include flow integration, organizational structure, lines of authority, decision points/persons, availability and maintenance of documented process, procedures, instructions, subcontractor management, and performance monitoring and reporting.

L.6.4.1.3. The offeror shall describe its approach for quality management/quality improvement and how quality problems will be managed to ensure the solicitation requirements are met.

L.6.5. SUBFACTOR 4, TRANSITION-IN ACTIVITIES

L.6.5.1. The offeror shall provide how it will ensure services and systems are fully operational prior to the beginning of Option Year 1. The offeror shall provide a description of and timeline for all major start-up activities that comply with the TOM, Chapter 20, Section 5. The description shall specifically address how the offeror will minimize disruption of services to beneficiaries and providers and meet the timeline for commencing claims processing/customer service. This description shall include the timeline for establishing crossover agreements with the Medicare Coordination of Benefits Contractor (COBC).

L.6.6. SUBFACTOR 5, SMALL BUSINESS PARTICIPATION

L.6.6.1. Large Businesses: Large business offerors shall include their small business subcontracting plan in Volume I pursuant to FAR 19.702, FAR 19.704, FAR Clauses 52.219-8, Utilization of Small Business Concerns; FAR 52.219-9, Small Business Subcontracting Plan; and DFARS 252.219-7003, Small Business Subcontracting Plan (DoD Contracts). Offeror's small business subcontracting plan shall include offeror’s good faith efforts to subcontract a minimum of 36.7% of the total annual planned subcontracting dollars to small businesses. The level of participation can be obtained in any combination of vendor subcontracts, purchases, or other business arrangements. The TMA subcontracting program goals are stated below.

L.6.6.1.1. Additionally, in accordance with 10 U.S. Code 2410d, large business offerors are advised they may use the services and/or products of the AbilityOne program (National Industry for the Blind/National Industry for the Severely Handicapped) in meeting their small business subcontracting goals. Offerors are also strongly encouraged to consider using the products and/or services offered through the Wounded Warrior to Work Program.

L.6.6.1.2. TMA Small Business Subcontracting Goals, Fiscal Year 2013 Small Business Category

GOAL % of Total Planned Subcontracting Dollars

Small Business (SB)

36.7%

Small Disadvantaged Businesses (SDB)

5.0%

Woman-Owned Small Business (WOSB)

5.0%

Service-Disabled Veteran-Owned Small Business (SDVOSB)

3.0%

HUBZone Small Business

3.0%

L.6.6.1.3. The offeror shall identify the entity/entities they intend to employ and the type of work the entity/entities will perform. The offeror shall provide evidence of its commitment to implementing these proposed opportunities by providing signed subcontracting agreements and/or other letters of intent.

L.6.6.1.4. The successful offeror’s small business subcontracting plan will be incorporated into the contract if the successful offeror is a large business.

L.6.6.2. Small Business Exception to Subcontracting Plan: In lieu of submitting a subcontracting plan, a small business offeror shall make an affirmative statement of their small business status, identify the specific small business category(ies), and describe any teaming arrangements the offeror intends to use in support of the offeror’s technical proposal.

L.7. VOLUME III, PAST PERFORMANCE INFORMATION (FACTOR 2, PAST PERFORMANCE)

L.7.1. Past Performance applies to the prime contractor (offeror) and its first-tier subcontractors (as described in paragraph L.4.9). As used in this paragraph, “offeror” is inclusive of the prime contractor, teaming partners, and first-tier subcontractors. For the purpose of submitting past performance information, the prime contractor may be an individual company or an entity that is a consortium of entities.

L.7.1.1. Recency: The Government will only consider relevant past performance information for ongoing contracts and contracts that concluded within the last three years. The last three years is defined as three years prior to the proposal due date in Block 9 of the SF 33. The Government will consider the entire period of performance of the contract to include the transition-in and transition-out periods.

L.7.1.2. The Government may obtain past performance data from any source, including, but not limited to, the references listed in the proposal, other customers known to the Government, consumer protection organizations, business news sources, and persons inside or outside the Government who may have useful and relevant information.

L.7.2. Past Performance Narrative: The offeror shall provide a narrative summarizing the past performance that is relevant to this solicitation as defined in M.5. Evaluation of Factor 2, Past Performance, for the prime contractor and each proposed first-tier subcontractor The Past Performance Narrative shall not exceed 15 pages. The offeror is required to explain what aspects of their past performance are deemed relevant in scope of services and magnitude as they relate to the solicitation requirements and Section C, Description/Specifications/Work Statement.

L.7.2.1. The offeror shall specifically indicate whether or not such performance was as the prime contractor. The offeror shall provide the total number of covered lives and total annual number of claims processed for the most recent 12-month period available. If this is a newly formed company, the totals shall be that of the entity in which they report. If the newly formed company reports directly to the parent company, then the offeror shall report the parent’s totals. The table of contents and tabs separating sections of the volume will not be included in the page count as long as they do not contain proposal content. All relevant past performance shall be addressed in the Past Performance Narrative.

L.7.3. The offeror shall identify its five largest contracts that are relevant to the services of this solicitation, based on the number of covered lives and the total number of claims processed for itself and each of its first-tier subcontractors with contracts that are currently ongoing or have concluded in the last three years. The offeror and each of its first-tier subcontractors shall state if they have fewer than three relevant contracts. The offeror shall not include contracts from its own subsidiaries, subcontractors, or other team members. The offeror shall provide a separate description for each contract not to exceed four pages per contract. For each contract, the offeror shall provide the following information regarding the contract:

a. Name of the client that will provide the past performance reference and relation to offeror. The offeror shall include a completed Client Authorization Letter (See Exhibit L-6 Sample Client Authorization Letter) for each contract.

b. Contract number, contract type, and offeror’s/first-tier subcontractor’s role (prime, subcontractor, other lower-tier participant).

c. A verified POC for the client who can discuss the offeror’s or first-tier subcontractor’s performance and contract standards/requirements and functions with the Government. The POC should be the same person who completes the Past Performance Questionnaire (See paragraph L.7.5) for the offeror. The POC information shall include POC’s name, title, role on contract, phone number, and mailing and email addresses.

d. Start and end dates of the contract.

e. Total dollar value of the contract.

f. Number of covered lives.

g. Number of claims processed annually (state if this is not applicable to the contract).

h. Scope of Work: A clear explanation of the functions performed and what aspects of the contract are deemed relevant to the solicitation requirements and Section C, Description/ Specifications/Work Statement.

i. A clear description of management actions employed in resolving problems, ability to promptly correct performance problems and the effects of those actions, in terms of improvements achieved or problems rectified.

L.7.3.1. The offeror shall explain the circumstance if any of the following occur during the contract period of performance:

• Failure to meet the minimum performance standards in the referenced contract and actions taken to restore performance to an acceptable level.

• Contract option period was not exercised.

• Assessment of Liquidated Damages or other reduction against offeror.

• Termination of a contract.

• Withheld payments.

• A notice to cure, claim or lien against the offeror, or suspension of work due to offeror’s quality issues.

L.7.3.2. Small Business Participation: If the past performance contract had small business subcontracting participation goals, the offeror shall include the participation percent and dollar targets as required by FAR 19.202-1. The offeror shall state the actual performance percent and dollars in reaching the contract’s Small Business participation targets. If the goals were not met, the offeror shall explain why and the actions the offeror took to meet the small business subcontracting goals.

L.7.3.3. If the offeror or any of its first-tier subcontractors and teaming partners has had any contract terminated for default or cause within the last three years preceding submission of the proposal, the offeror shall provide documentation detailing the reason for the termination. The documentation shall identify the client, its address, the cognizant contracting official, and his/her telephone number and e-mail address. For any contract terminated for default or cause, the offeror shall identify the actions it took to prevent similar failures from recurring.

L.7.4. If the offeror or its first-tier subcontractor(s) was formed or is being organized solely for the purpose of proposing on this solicitation, and the parent corporation or consortium has relevant past performance and will be involved in the management and/or operations of the offeror; then the offeror shall submit the five largest contracts for its parent organization or each member of the consortium and provide the same information that is required in paragraphs L.7.3 and L.7.5.

L.7.4.1. The offeror shall document in the Past Performance Narrative (see paragraph L.7.2) how the past performance of the parent corporation or consortium is relevant to this solicitation and the amount of involvement the parent or consortium member will have in the operations of the offeror. When describing the parent or consortium member’s involvement, the offeror shall describe in detail what division/entity the five largest contracts report to and what involvement and commitment of resources these divisions/entities will have in the operation of the offeror.

L.7.4.2. The offeror shall describe what if any resources from the parent entity or consortium members will be shared with the offeror (e.g., claims processing, customer service, systems, personnel, facilities). The Government may downgrade past performance relevancy if offeror does not provide clear evidence of the connection or commitment of resources from the entity with relevant past performance to the entity that will perform the solicitation requirements.

L.7.5. Past Performance Questionnaire (PPQ): The offeror and each of its first-tier subcontractors as defined in paragraph L.4.9. shall provide the PPQ (Section L Exhibits L-4, Sample Cover Letter, and L-5, Past Performance Questionnaire) to the contract POCs to complete for each of the contracts identified in accordance with L.7.3. The offeror is solely responsible for adding adequate specifics to its cover letter and the PPQ, so the Government can easily identify to which offeror the past performance refers and the specific contract referenced. If the Government cannot determine whose past performance or the offeror team to which the past performance belongs, the past performance questionnaire will not be considered.

L.7.5.1. TMA will not accept or evaluate any PPQs sent directly to TMA from a proposing offeror or its subcontractors. For expediency of evaluation, offerors shall instruct past performance POCs to email the PPQ to Margaret.Zancanella@tma.osd.mil AND Scott.Lamond@tma.osd.mil as soon as possible but not later than the date specified in Block 9 of the SF 33.

L.7.5.2. It is the offeror’s sole responsibility to ensure questionnaires are submitted to the Contract Specialist by the date specified in Block 9 of the SF 33. The Government encourages offerors to follow-up with respondents to ensure questionnaires are completed and forwarded to the Contract Specialist by the date specified in the solicitation.

L.7.5.3. POCs: The questionnaire shall be completed by the client’s representative who is most cognizant of the contract. If it is a Government contract, the POC should be the Procuring Contracting Officer, Administrative Contracting Officer, or Contracting Officer’s Representative. The submitted questionnaires must include the name, title, and contact information of the person completing the questionnaire. The Government may contact the offeror’s references to discuss the offeror’s past performance. Client authorization letters are also required for each identified past performance effort (Section L Exhibit L-6, Sample Client Authorization Letter). This letter will authorize the POC to discuss the offeror's (or subcontractor or teaming partner) performance with the Government. The offeror is solely responsible for adding adequate specifics to the client authorization letter, so the Government can easily identify to which offeror the client authorization letter and the specific contract refers. Offeror shall ensure the contact information for designated POCs is accurate and up to date.

L.7.5.4. Once the Government receives the PPQ, the information contained therein shall be Source Selection Information and For Official Use Only (FAR 2.101 & 3.104). The Government shall not release such information to the offeror or any of its subcontractors or teaming partners.

L.7.5.5. Information provided by or for POCs who work directly for the offeror’s company will NOT be considered.

L.7.5.6. Subcontractor’s Consent: If a subcontracting or other teaming relationship is proposed, the offeror shall submit the consent of its proposed first-tier subcontractor(s) and teaming partners, as applicable, to disclose their past performance information to the offeror along with the offeror's proposal submission (see Section L Exhibit L-7, Sample Teaming Partner/ Subcontractor’s Consent). If the proposed subcontractor or teaming partner’s consent is not provided with the offeror's proposal, the Government will not consider the subcontractor’s past performance in assessing the offeror's past performance and may determine the proposal is non-responsive.

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