21_Section_M_Evaluation_4-5-13_clean.doc

SECTION M, EVALUATION FACTORS FOR AWARD

M.1. FAR 52.217-5 EVALUATION OF OPTIONS (JUL 1990)

Except when it is determined in accordance with FAR 17.206(b) not to be in the Government’s best interests, the Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. Evaluation of options will not obligate the Government to exercise the options(s).

(End of Provision)

M.2. BASIS OF EVALUATION

M.2.1. General. This is a full and open competitive source selection and will be conducted in accordance with the FAR 15 and applicable supplements. The Government has established a Source Selection Evaluation Board (SSEB) to evaluate proposals submitted in response to this solicitation. The SSEB will evaluate proposals using the tradeoff best-value process in the Defense Federal Acquisition Regulation Supplement (DFARS) 215.3, Source Selection; Director, Defense Procurement and Acquisition Policy (DPAP) memorandum dated March 4, 2011, Department of Defense Source Selection Procedures; and this Section. This source selection process allows for a tradeoff between non-price factors and price and allows the Government to accept other than the lowest priced proposal or other than the highest technically rated proposal to achieve a best-value contract award.

M.2.2. To be eligible for award, offerors are required to meet all solicitation requirements, including but not limited to Instructions to Offerors, terms and conditions, technical requirements, and the evaluation factors and criteria below. Failure to comply with the terms and conditions of the solicitation may result in the offeror being removed from consideration for award.

M.2.3. Evaluation Approach. The Government will evaluate:

a. The extent to which the proposal exhibits a clear understanding of the TDEFIC requirements and a sound approach to fulfill the solicitation requirements.

b. The extent to which the proposal demonstrates an ability to meet or exceed the requirements defined in the solicitation and the quality of service expected to result from implementation of an offeror’s proposed methods.

c. The probability of the offeror satisfactorily performing all solicitation requirements based on the risk assessment and past performance.

M.2.4. The Government anticipates awarding a single requirements contract with fixed-unit prices to the responsive, responsible offeror whose proposal represents the best overall value to the Government. The Government may make tradeoffs among the factors when determining which offer constitutes the best value to the Government.

M.3. EVALUATION FACTORS AND RELATIVE VALUES

M.3.1. The Government shall evaluate each proposal against the following factors and subfactors.

a.

Factor 1, Technical Approach:

(1) Subfactor 1, Claims Processing;

(2) Subfactor 2, Beneficiary and Provider Customer Service and Satisfaction;

(3) Subfactor 3, Management Functions;

(4) Subfactor 4, Transition Activities;

(5) Subfactor 5, Small Business Subcontracting Participation, b.

Factor 2, Past Performance; and c.

Factor 3, Price.

M.3.2. Relative Importance of Factors. Of the three factors, Price is the most important factor. Technical Approach is less important than Price but more important than Past Performance. Past Performance is the least important factor. The non-price factors, when combined, are significantly more important than price (FAR 15.101).

M.3.3. Of the five subfactors under Technical Approach:

M.3.3.1.

Subfactor 1, Claims Processing, and Subfactor 2, Beneficiary and Provider Customer Service and Satisfaction, are of equal importance and the most important subfactors.

M.3.3.2.

Subfactor 3, Management Functions, and Subfactor 4, Transition Activities, are of equal importance and less important than Subfactors 1 and 2. Subfactors 3 and 4 are more important than Subfactor 5.

M.3.3.3.

Subfactor 5, Small Business Subcontracting Participation, is the least important subfactor.

M.4. EVALUATION OF NON-PRICE FACTOR 1, TECHNICAL APPROACH

M.4.1. The Government will evaluate Subfactors 1-4 under Factor 1 to determine a technical rating and a technical risk rating for each subfactor. Each technical proposal will be evaluated separately and will be evaluated solely on its own merits. The Government will consider the technical rating and technical risk rating in determining the best value to the Government. The Government will evaluate each proposal to determine how well an offeror’s proposed approach meets or exceeds the Government’s requirements. When an offeror proposes to exceed a solicitation requirement (except those listed in Section L, Instructions, Conditions, and Notices to Offerors, paragraph L.6.1.4), the Government will consider whether exceeding the requirement is advantageous to the Government. The Government reserves the sole right to determine whether exceeding a requirement is advantageous to the Government.

M.4.1.1. Technical Rating. The Government will assign a technical rating to each Subfactor 1-4. The technical rating represents how well the offeror’s proposed approach meets or exceeds the solicitation requirement based on the evaluation criteria. In evaluating the offeror’s proposal, the Government will review the offeror’s compliance with the requirements to determine if the offeror demonstrated it understands the solicitation requirements and a sound approach to achieve the solicitation requirements. No award will be made to any offeror who receives an Unacceptable (red) technical rating in any subfactor. The following definitions will apply when assigning technical ratings to Subfactors 1-4:

· Strength: An aspect of an offeror’s proposal that has merit or exceeds specified requirements in a way that the Government determines will be advantageous to the Government during contract performance.

· Weakness: A flaw in the proposal that increases the risk of unsuccessful contract performance. See FAR 15.001.

· Significant Weakness: A flaw in the proposal that appreciably increases the risk of unsuccessful contract performance. See FAR 15.001.

· Deficiency: A material failure of a proposal to meet a Government requirement or a combination of significant weaknesses in a proposal that increases the risk of unsuccessful contract performance to an unacceptable level. See FAR 15.001.

The Government will use the technical ratings below to rate Subfactors 1-4.

Technical Ratings

M.4.1.2. Technical Risk Evaluation In addition to the technical evaluation, the Government will evaluate each Subfactor 1-4 for technical risk. The Government will assess the level of risk based on the degree to which the offeror’s proposed technical approach may cause the potential for disruption of schedule, increased costs, degradation of performance, the need for increased Government oversight, or the likelihood of unsuccessful contract performance. The risk evaluation includes, but is not limited to, the proposed approach, method, or process of completing tasks and the demonstrated experience in performing tasks (including experience in performing their proposed approach, method or process).The Government will assign one of the technical risk ratings below to Subfactors 1-4.

Technical Risk Ratings

M.4.2. Subfactor 1, Claims Processing M.4.2.1. The Government will evaluate each offeror's approach to provide timely and accurate processing of claims and to establish, maintain, and monitor a single claims processing system that meets the solicitation requirements to include the receipt and transmission of HIPAA compliant transactions through claims history retention. The offeror's proposal will be evaluated for effective processes and methods that will ensure TMA claims processing accuracy and timeliness standards will be met.

M.4.2.1.1. The Government will evaluate whether the proposed approach 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 Government will evaluate 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,

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

M.4.3. Subfactor 2, Beneficiary and Provider Customer Service and Satisfaction M.4.3.1. The Government will evaluate whether the offeror presents an effective approach for customer service and providing accurate, comprehensive customer information with knowledgeable, courteous, and responsive staff via multiple, contemporary avenues of access.

M.4.3.2. The Government will evaluate whether the offeror presents an effective approach for establishing and maintaining beneficiary and provider satisfaction at the highest level possible and in a manner that meets the solicitation requirements throughout the period of performance. The Government will not evaluate offeror-proposed beneficiary and provider surveys.

M.4.3.3. The Government will evaluate whether the offeror proposes an effective approach to identify and respond to beneficiary and provider education needs consistent with the solicitation. This includes coordinating with BE&S on how education materials are developed and disseminated.

M.4.4. Subfactor 3, Management Functions M.4.4.1. The Government will evaluate whether the offeror’s proposal demonstrates an effective management approach for establishing and maintaining staff, facilities, systems, and infrastructure to achieve the solicitation requirements, incorporating best business practices when practicable.

M.4.4.1.1. The Government will evaluate whether the offeror’s proposal demonstrates an effective approach for establishing and maintaining experienced and qualified personnel with appropriate skill sets, including management positions, at a level suitable for achieving the requirements. The Government will also evaluate the offeror’s approach for staff training and retention.

M.4.4.1.2. In order to determine whether the offeror’s proposal demonstrates effective management functions and integrates all contractor activities, the Government will evaluate the offeror’s workflow integration, organizational structure, lines of authority, decision points/persons, availability and maintenance of documented process, procedures, instructions, subcontractor management, and performance quality monitoring and reporting.

M.4.4.1.3. The Government will evaluate the offeror’s proposed approach for quality management/quality improvement to determine whether the approach will ensure the solicitation requirements are met.

M.4.5. Subfactor 4, Transition Activities M.4.5.1. The Government will evaluate whether each proposal describes an effective, comprehensive transition approach and timeline to meet the solicitation requirement so the offeror’s TDEFIC services and systems will be fully operational prior to the beginning of Option Year 1.

M.4.5.2. The Government will also evaluate the offeror's proposed approach to determine if it minimizes service disruption to beneficiaries and providers, and meets the timeline for commencing claims processing/customer service.

M.4.6. Subfactor 5, Small Business Subcontracting Participation: The Government will assign the ratings below to Subfactor 5. The Government will not assess any strengths for this evaluation.

· Acceptable Rating: Proposal clearly meets the minimum Small Business requirements of the solicitation.

· Unacceptable Rating: Proposal does not clearly meet the minimum Small Business requirements of the solicitation.

M.4.6.1. The Government will evaluate the offeror’s Subcontracting Plan submitted under Volume I for the submission requirements identified under FAR 19.702, Statutory requirements; FAR 19.704, Subcontracting plan requirements; FAR 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). The CO will assess whether the Subcontracting Plan addresses each of the 11 required elements described in FAR 19.704.

M.4.6.2. Large Businesses: The Government will assign a rating of Acceptable or Unacceptable to Subfactor 5 (DoD Source Selection Procedures, paragraph 3.1.3.4. Small Business Evaluation). To be Acceptable, an offeror’s subcontracting plan must meet the requirements of FAR 19.7 and demonstrate offeror’s good faith efforts to maximize small business participation and evidence of its commitment to implement the proposed small business participation goals below.

TRICARE MANAGEMENT ACTIVITY 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%

M.4.6.3. Small Business Exception to Subcontracting Plan: If the offeror identified itself as a small business, the Government will evaluate the small business offeror as "Acceptable" after verifying the offeror’s small business status against the offeror’s representations and certifications and the acceptability of any proposed teaming arrangement.

M.5. EVALUATION OF FACTOR 2, PAST PERFORMANCE

M.5.1. The past performance evaluation will result in an evaluation of the offeror’s probability of meeting the solicitation requirements. One performance confidence assessment rating will be assigned for each offeror after evaluating the offeror’s past performance.

M.5.2. Recency: The Government will evaluate the offeror’s past performance information in accordance with Section L, Instructions, Conditions, and Notices to Offerors, and this Section to determine how well an offeror has performed in the past on recent relevant work similar to the solicitation requirements. The Government will only consider relevant past performance information for ongoing contracts and contracts concluded within the last three years as defined in L.7.1.1. The Government will consider the entire period of performance of the contract to include the transition-in and phase out periods in comparing the efforts of the contract with the scope and magnitude of effort required for the TDEFIC contract.

M.5.3. Relevancy: Relevancy is a measure of the extent of similarity between the service/support effort, complexity, contract type, and other comparable attributes of past performance examples and the source solicitation requirements; and a measure of the likelihood that the past performance is an indicator of future performance.

M.5.3.1. The Government will evaluate the offeror’s past performance to determine each contract’s relevancy in terms of the scope of services, support effort, complexity, contract type, and other comparable attributes compared to the TDEFIC solicitation requirements.

M.5.3.2. The Government will evaluate the magnitude of the offeror’s past performance effort based on the number of covered lives and the number of claims processed annually. The TDEFIC has an estimated 2.1 million lives and processes approximately 48 million claims annually.

M.5.3.3. The Government will assign one of the following relevancy ratings to each contract provided by the offeror.

Past Performance Relevancy Ratings

M.5.4. Quality: Once the Government determines a relevancy rating for each past performance contract, the Government will review the offeror’s past performance information to determine the quality of performance for each contract. If the Government identifies any negative findings to which the offeror has not had the opportunity to respond, the Government may notify the offeror of the findings and allow the offeror to comment on these negative findings. If the Government assessed an individual contract as “Not Relevant,” the Government will not conduct a quality review for that contract.

M.5.5. Performance Confidence Assessment: Based on the recency, relevancy, and quality, the Government will then assess a performance confidence assessment rating relative to the offeror’s ability to successfully perform the requirements of this solicitation. When assessing the offeror’s performance confidence rating, the Government will use the offeror’s past performance proposal, past performance questionnaires, and additional information the Government obtains from the offeror’s clients listed in the proposal. The Government may also use relevant past performance information from other customers known to the Government, consumer protection organizations, Past Performance Information Retrieval System (PPIRS), Federal Awardee Performance and Integrity Information System (FAPIIS), Electronic Subcontract Reporting System (eSRS), and other sources of useful and relevant information including the Government’s own internal records. Past performance history deemed “Not Relevant” will not be considered when determining the performance confidence rating.

M.5.5.1. If an offeror has no past performance relevant to the TDEFIC solicitation, the Government will assess an “Unknown Confidence” (neutral) performance confidence rating and the Government may not evaluate the offeror’s past performance favorably or unfavorably (see FAR 15.305 (a)(2)(iv)).

M.5.5.1.1. If an offeror with no relevant past performance submits relevant past performance information from a predecessor company, a parent organization or consortium member, this information will be considered in rendering a performance confidence level rating. This rating will be based on the amount of past performance, its relevance to providing the services required by this solicitation, and the amount of involvement the parent organization or consortium member will have in the daily operations of the offeror.

M.5.5.1.2. When an offeror submits past performance information on its key personnel as stated in Section L, Instructions, Conditions, and Notices to Offerors, paragraphs L.7.7, the Government will evaluate the key personnel information to determine to what extent, if any, it will affect the performance confidence rating. In evaluating key personnel past performance, the Government will consider the key person’s role in the company, the nature and quality of the services delivered, and the relevant amount of past performance the key person had related to providing the service required by this solicitation.

M.5.5.1.3. Regardless of whether the past performance data relates to a parent organization, consortium member, or an employee or group of employees, the Government may still render a performance confidence level of Unknown Confidence (Neutral) if an offeror does not have adequate, convincing and relevant past performance information.

M.5.5.1.4. If information about consortium members, predecessor companies or key personnel is not available, the Government may use relevant past performance information of subcontractors with a significant functional role in performing the contract. If the subcontractor(s) does not have relevant past performance information, the Government will assess an Unknown Confidence rating.

M.5.5.2. Each offeror will be assigned one of the performance confidence ratings below.

Performance Confidence Assessments

M.6. EVALUATION OF FACTOR 3, PRICE

M.6.1. Total Evaluated Price: The total evaluated price is the sum of all priced CLINs/SLINs in Section B, Supplies or Services and Prices/Costs, for the Transition Base Period and each of the six option periods. Since Transition-out will occur only once during the contract Period of Performance, the offeror’s highest priced Transition-out CLIN will be included and used in calculating the total evaluated price.

M.6.2. Reasonableness. The Government will use the proposal analysis techniques discussed in FAR § 15.404-1 in determining reasonableness. Price analysis will be the primary technique used in the government’s price evaluation.

M.6.3. Unbalanced Pricing. The Government will evaluate each offeror’s price proposal for unbalanced pricing per FAR 15.404-1(g).

M.6.4. Evaluation of Options: In accordance with FAR 52.217-5, Evaluation of Options; and FAR 52.217-8, Option to Extend Services, the price evaluation is inclusive of the evaluation of options required for any extension of services resulting from the Government’s unilateral right to exercise FAR 52.217-8. The Government may choose to exercise the Extension of Services at the end of any performance period (base or option periods), utilizing the rates of that performance period.

TDEFIC, HT9402-12-R-0005, Section M