TDEFIC Draft Section C Work Statement.doc

SECTION C, DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

OVERVIEW OF TRICARE PROGRAM. TRICARE is comprised of three health care options, Prime, Standard, and Extra. TRICARE Prime is similar to an HMO with a Point of Service Option and requires beneficiary enrollment. All Active Duty Service Members are TRICARE PRIME enrollees; they are required to receive all care either in the Military Treatment Facility or under special rules that apply to Active Duty healthcare this is further explained in the TRICARE Operations Manual, Chapter 16. Active Duty family members (except for E-1 to E-4 family members in Prime areas) may elect to enroll and are not required to pay an annual enrollment fee; other eligible beneficiaries pay an enrollment fee to enroll in TRICARE Prime. TRICARE Extra, which requires no enrollment, is an option in which the beneficiary may choose to use a provider in a TRICARE contractor-developed network, at a reduced cost-share for a particular instance of care, but is not restricted to use of the network. TRICARE Standard is a fee-for-service option, essentially the program formerly called Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), in which the beneficiary is free to use any authorized provider. The three options of TRICARE are described fully in 32 CFR Parts 199.17 and 199.18. The Military Health System (MHS) is organized into three TRICARE Regions within the United States and coverage extends overseas.

This contract applies to active duty family members, retired members, their spouses and children and their surviving family members subject to the provisions of Chapter 55, Title 10, U.S.C. of the Uniformed Services who have Medicare/TRICARE dual eligibility. The uniformed services include the U.S. Army, the U.S. Navy, the U.S. Air Force, the U.S. Marine Corps, the U. S. Coast Guard, the Commissioned Corps of the Public Health Service and the Commissioned Corps of the National Oceanic and Atmospheric Administration. Determination of a person's eligibility status is the responsibility of the Uniformed Services as reported on the Defense Enrollment Eligibility Reporting System (DEERS).

1.0. General: Section C includes two categories of outcome based statements: Objectives and Technical Requirements. The ‘objectives’ represent the outcomes for this contract and are supported by technical requirements. These requirements represent specific tasks, outcomes, and/or standards that, at a minimum, shall be achieved.

The purpose of this contract is to provide claims processing and associated customer support services for claims submitted by and on behalf of MHS beneficiaries who are eligible for both Medicare and TRICARE benefits, for services received in the United States, Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa and the Northern Mariana Islands. The contractor shall provide the expertise of medical and mental health care claims processing and its support services by incorporating and operating the best practices of the private sector in support of TRICARE. The contractor shall fulfill the objectives of the contract while complying with the scope and structure of TRICARE (benefits and beneficiary liabilities) and technical requirements as identified herein. The contractor shall deliver all services in a manner that supports the TRICARE fully integrated health care delivery and financing system for all MHS beneficiaries.

The TRICARE Dual Eligible Fiscal Intermediary Contractor (TDEFIC) shall also establish customer service activities that support the claims processing function and other administrative services traditionally associated with claims processing. Of critical importance is the contractor’s success in collaborating with and reaching agreements with the Centers for Medicare and Medicaid Services (CMS) Coordination of Benefits Contractor (COBC) to transfer Medicare processed claims to the contractor (“cross-over claims”) for secondary processing (TRICARE Operations Manual, Chapter 20, Section 2).

The contractor will be solely liable for any liability arising out of the performance of this contract. Consequently the Government will not reimburse the contractor for any lawsuits, claims, settlements, judgments or other legal or administrative actions or costs as a result of contract performance.

2.0. DOCUMENTS: The following documents, including the changes identified below, are herby incorporated by reference and made a part of the contract.

These documents form an integral part of this contract. Documentation incorporated into this contract by reference has the same force and effect as if set forth in full text. The manuals and CFR 199 are located at: http://manuals.tricare.osd.mil/.

Title 10, Untied States Code (U.S.C.), Chapter 55 32 Code of Federal Regulations (CFR), Part 199 TRICARE Policy Manual (TPM) 6010.57-M, February 1, 2008; through Change No. XX TRICARE Reimbursement Manual (TRM) 6010.58-M, February 1, 2008; through Change No. XX

TRICARE Systems Manual (TSM) 7950.2-M, February 1, 2008; through Change No. XX

TRICARE Operations Manual (TOM) 6010.56-M, February 1, 2008; through Change No. XX The TRICARE Manuals provide instruction, guidance and responsibilities in addition to the requirements set forth in the incorporated federal statutes and regulations and may not be interpreted in contradiction thereto. Among the manuals the TPM and the TRM are equal and take precedence over the TSM and TOM and the TSM takes precedence over the TOM.

3.0 DEFINITIONS. See 32 CFR 199.2 and the TRICARE Operations Manual, Appendix B.

4.0 GOVERNMENT FURNISHED PROPERTY AND SERVICES

4.1. In support of the government’s educational initiatives, the Government will furnish educational materials for use in informing any interested parties of the program. (Section C 7.0 TRN6)

4.2. Using the Defense Manpower Data Center’s (DMDC) Defense Eligibility Enrollment Reporting System (DEERS), the Government will furnish appropriate DEERS data for the contractor’s use to perform all eligibility checks. DEERS is the database of record for eligibility.

5.0 CONTRACTOR FURNISHED ITEMS. The contractor shall furnish all necessary items (e.g., facilities, labor, services, supplies, etc.) not provided by the Government (as specifically identified under Section C.4.0 paragraphs or elsewhere within the contract as Government furnished) for the satisfactory performance of this contract.

6.0 Objectives:

6.1. Provide timely and accurate delivery of claims processing and customer services.

6.2. Establish and maintain beneficiary and provider satisfaction at the highest level possible throughout the period of performance, through the delivery of a claims processing system as well as customer friendly program services.

6.3. Apply Case Management (CM) and Utilization Management (UM) techniques to reduce the cost of care for TRICARE primary pay cases.

6.4. Use an effective management approach to provide the necessary services, incorporating commercial practices when practicable.

6.4. Ensure all services and systems are fully operational at the start of health care delivery, and disruption to beneficiaries is minimized.

7.0 TECHNICAL REQUIREMENTS. The contractor must fulfill the following requirements, which are supplemented via the documents incorporated at paragraph 2.0.

Claims Processing (CP)

CP1: The contractor shall establish, maintain, and monitor a single database Automated Information System (AIS) in accordance with the DoD Architecture Framework. The AIS will provide the Government highly reliable and timely access to the data through a data repository.

CP2: The contractor shall establish, maintain, and monitor the AIS to ensure claims are processed in an accurate and timely manner and meet the functional requirements of claims processing as set forth in the technical requirements, the TOM, and the TSM. The contractor shall provide, maintain and monitor the AIS for purposes of providing claims payment record information, and making available the data required by this contract.

CP3: The contractor shall deny claims received more than 12 months after the date of service unless the requirements contained in 32 CFR 199.7 are met.

CP4: The contractor shall not pay claims without ensuring that the services rendered are TRICARE benefits.

CP5: The contractor's claims processing system shall accurately process claims in accordance with the TRICARE benefit policy as delineated in 32 CFR Part 199.4 and 199.5 and the TRICARE Policy Manual. Exception: The contractor is not required to have the claims auditing software described in the TRM, Chapter 1, Section 3.

CP6: Nationally recognized paper claim forms (UB-92, CMS 1500, and their successors) and the DD Form 2642 shall be accepted for processing. Standardized electronic transactions and code sets as required by the Administrative Simplification section of the Health Insurance Portability and Accountability Act (HIPAA) shall be accepted.

CP7: The contractor's claims processing system shall interface with and accurately determine eligibility and enrollment status based on the Defense Enrollment Eligibility Reporting System (DEERS) in accordance with the TRICARE Systems Manual, Chapter 3.

CP7.1. The contractor shall accept and utilize the DEERS file indicating the Medicare eligibility and effective dates for TRICARE beneficiaries for coordinating with the Medicare Coordination of Benefits Contractor (COBC) (TSM, Chapter 3, Section 1.4). DEERS sends the TDEFIC three record types (header and trailer records ‘single record types’ and a detail record ‘multiple records’) on a monthly basis via Network Data Mover (NDM) or on a Compact Disk (CD). The file layouts are located at Attachment J-10.

CP8: The contractor's claims processing system shall accurately process claims in accordance with the program preauthorization/authorizations requirements noted in TRICARE Policy Manual (TPM) Chapter 1, Section 7.1, and TRICARE Operations Manual (TOM), Chapter 7, Section 2, when TRICARE is primary payer and ensure that TRICARE preauthorizations/authorizations, are timely and accurately adjudicated based on the timeliness and quality standards of the TRICARE Operations Manual, Chapter 1, Section 3.

CP9: All providers who receive reimbursement under this contract shall be TRICARE-authorized providers in accordance with the criteria set forth in 32 CFR 199.6. The contractor shall verify all providers' authorized status through the TRICARE Management Activity centralized TRICARE Encounter Provider Records (TEPRV) (TSM, Chapter 2) or, if not listed, shall obtain and maintain documentary evidence to certify that the provider meets the criteria set forth in 32 CFR 199.6 and the TRICARE Policy Manual. EXCEPTIONS: The contractor is not required to verify the provider's authorized status if TRICARE is not the primary payer and Medicare has accepted the claim as from an authorized provider. The TRICARE Quality Monitoring Contractor (TQMC) will certify all Residential Treatment Centers (RTCs), Substance Use Disorder Rehabilitation Facilities (SUDRFs) and Psychiatric Partial Hospitalization Programs (PHPs) and the TDEFIC contractor shall accept such certification as valid. The contractor shall submit information on all providers authorized by the contractor, to the TRICARE Management Activity centralized TEPRV system in accordance with the provisions of the TRICARE Systems Manual CP10: The contractor shall ensure that TRICARE claims (including adjustments) are timely and accurately processed based on the timeliness and quality standards of the TRICARE Operations Manual, Chapter 1, Section 3.

CP11: The contractor's claims processing system shall correctly apply deductibles, co-payments, cost-shares, and catastrophic caps in accordance with the TRICARE benefit policy as delineated in 32 CFR sections 199.4, 199.5, 199.17, and 199.18 and the TRM.

CP12: The contractor's claim processing system shall accurately coordinate benefits with other health insurance to which the beneficiary is entitled as required by 32 CFR 199.8, the TRM and Section J-9).

CP13: Claims requiring additional information may be returned or developed for the missing information. The contractor shall ensure that all required information is requested with the initial return or development action and that no claim is returned/developed for information that could have been obtained internally or from DEERS. The contractor shall ensure that an adequate audit trail is maintained for all returned or development claims.

CP14: The contractor shall provide to each beneficiary and each participating provider an Explanation of Benefits (EOB) that meets the requirements of TOM Chapter 8, Section 8, and describes the action taken on claims. EOBs shall be suppressed when appropriate. EOBs may be provided electronically to the beneficiary at the beneficiary’s request in lieu of a paper EOB. The contractor may issue monthly summary EOBs to beneficiaries in lieu of individual EOBs. EOBs must clearly describe the action taken on each claim and provide information regarding appeal rights, to include the address for filing an appeal. The EOB must also provide information on the deductible and catastrophic cap status following processing; as well as sufficient information to allow a beneficiary to file a claim with a supplemental insurance carrier. The contractor shall, without charge to the beneficiary and within 5 calendar days of receiving a request (written, verbal, electronic) for an EOB from a beneficiary, regardless of their status, send the requested EOB. As a prerequisite to receive an EFT payment (Section CP17), the provider must accept the ASC X 12N 835 remittance advice.

CP15: The contractor shall not process a claim from any civilian provider practicing in an MTF under the Resource Sharing or Clinical Support Agreement programs.

CP16: The contractor shall accurately reimburse claims in accordance with applicable statutory (Chapter 55, Title 10, United States Code) and regulatory provisions (32 CFR 199.14), and implementing instructions in the TRM and the TOM, Chapter 20, Section 3. The Contractor shall offer providers the opportunity to receive payments by electronic fund transfer (EFT). If requested and the banking information is made available, provider payments shall be by EFT using a nationally recognized standard (e.g., ASC X12N 835). For payments made by mail or other means, the contractor shall offer providers, on a one time basis, an opportunity to receive future payments by EFT.

CP17: The contractor shall accurately capture and report TRICARE encounter data (TED) related to claims adjudication in accordance with the provisions of the TRICARE Systems Manual and shall ensure the TED timeliness and accuracy standards contained in this contract are achieved according to the TRICARE Operations Manual, Chapter 1, Section 3.

CP17.1: The contractor shall comply with the provisions of the TRICARE Operations Manual, Chapter 3, regarding financial administration.

CP18: The contractor shall utilize the Duplicate Claims System according to the requirements of the TOM, Chapter 9.

CP19: The contractor shall establish, maintain, and monitor information management capability, or interoperate with or use Government furnished AIS, to support aspects of the following TRICARE functions: claims processing, program administration, beneficiary services, finance, and other health insurance (OHI) and meet TRICARE objectives (paragraph 6.0). The AIS shall provide data to, and/or interoperate with the contractor data repository and ensure required elements are communicated between the contractor’s AIS and DEERS.

CP20: The contractor shall ensure that appeal requests are properly handled and timely pursued as defined in 32 CFR 199.10 and 32 CFR 199.15, following the instructions in the TRICARE Operations Manual, Chapter 12 and the standards in the TRICARE Operations Manual, Chapter 1, Section 3.

Medical Management (MM)

MM1: The contractor shall ensure that care provided, including mental health care, is medically necessary and appropriate and complies with the TRICARE benefits contained in 32 CFR 199.4 and 199.5. The contractor shall use best business practices consistent with TRICARE law, regulation and policy in reviewing and approving care and establishing medical management programs to carry out this activity to the extent authorized by law. The contractor shall be considered a multi-function Peer Review Organization (PRO) under this contract. The standards, rules, and procedures of the TRICARE PRO program (32 CFR 199.15) are applicable to claims where TRICARE is primary payer.

MM2: The Contractor shall operate case management programs designed to manage the health care of individuals with high-cost conditions, specific diseases, and chronic/complex illnesses for which evidence based clinical management programs exist. These programs shall be available to Medicare/TRICARE dual eligible beneficiaries when TRICARE becomes primary payer.

MM3: The Contractor’s utilization management and case management programs shall be accredited by a nationally recognized accrediting organization no later than 18 months after the start of health care delivery and shall be maintained throughout the contract and all exercised options. When this contract and the accrediting body have differing standards for the same activity, the higher standard shall apply.

Customer Service (CS)

CS1: The contractor shall establish twenty-four hour, seven days a week, nationally accessible (to include Hawaii, Alaska, and Puerto Rico) telephone service, without long distance charges. (TOM, Chapter 20, Section 4, Paragraph 1.1.) Although the use of automated response systems is permissible, callers shall be offered the option of speaking with a customer service representative during normal business hours as defined in TOM, Chapter 11, Section 7 and TOM, Chapter 20, Section 4.

CS2: The contractor shall comply with all the beneficiary and provider services standards in the TOM, Chapter 1, Section 3.

CS3: The contractor shall furnish the DoD TRICARE Operations Center, each TRICARE Regional Office, and all Health Benefits Advisors (HBAs), Beneficiary Counseling and Assistance Coordinators (BCACs), and Debt Collections Assistance Officers (DCAOs) located in each region with read only access to claims data. The contractor shall provide training, when requested, and ongoing customer support for this access.

CS4: General information services and responsive claims complaint resolution processes and follow up, shall be provided during normal business hours for each affected time zone, as defined in TOM Chapter 11, Section 7 and TOM Chapter 20, Section 4. Trained and professional staff shall provide pleasant, consistent, accurate, and responsive customer service during all contacts with beneficiaries and providers.

CS5: The contractor shall operate a telephone automated voice response that allows provider access to information on the status of claims filed by that provider, and patient access to information on the status of claims filed by or on behalf of that patient. This requirement is in addition to any Internet access offered by the contractor.

CS6: The contractor shall provide comprehensive, readily accessible customer services that includes multiple, contemporary avenues of access (e.g. e-mail, worldwide web, telephone, facsimile) for the beneficiary and provider. Customer services shall be delivered in a manner that achieves the objectives of this contract without charge to beneficiaries or providers. All technology based customer service (for instance World Wide Web based services) shall be provided using current, evidence-based information.

CS7: The contractor shall establish an approach for measuring whether the contractor’s customer services are achieving highly satisfied TRICARE beneficiaries and providers. The contractor shall have established methods and procedures to mitigate any identified negative trends and include reporting results to the government.

CS8: The contractor shall utilize an efficient and effective local and wide-area voice communication network to support customer service operations and other contract requirements that specify telephone usage and access.

CS9: The contractor is required to maintain a supply of the TRICARE Standard handbook, the TRICARE for Life handbook and all current educational material specific to dual eligibles produced by the Government. This information shall be furnished by the TDEFIC contractor upon request whether through mail or other delivery means. The contractor is not required to honor bulk requests, and may refer those requestors to the Government.

CS10: The contractor shall develop and implement an education plan for conducting targeted beneficiary and provider education. The contractor shall conduct targeted beneficiary and provider education, at least twice per contract option year related to specific issues that surface throughout the administration of this contract. Issues may be identified by the government or the contractor and all education efforts will be coordinated with Beneficiary Education and Support Branch (BE&S) in accordance with the MOU.

Management (MGT) MGT1: The contractor shall enter into a Data Sharing Agreement (DSA) for data obtained from DoD Systems and applications and comply with DoD 6025.18-R, DoD Health Information Privacy Regulation, HIPAA Privacy Rule, and DoD 5400.11-R DoD Privacy Program, by submitting a DSA to the TMA Privacy Office annually or until their contract is no longer valid as required in the TRICARE Systems Manual and TRICARE Operations Manual.

MGT1.1 Subcontractors and/or their agents working on behalf of the primary contractor that require the use of or access to individually identifiable information or protected health information under the provisions of this contract must comply with the DOD regulations identified in section MGT 1.

MGT2: The contractor shall develop and operate a continuous quality management program. The Quality Management Program shall demonstrate how the organization’s goals and objectives, leadership, structure and operational components are designed to achieve the goals of the TDEFIC program. The Quality Management Program shall cover every aspect of the contractor’s operations. The contractor shall also comply with the vulnerability assessment requirements of the TOM chapter 1, Section 4.

MGT3: The Contractor shall implement and maintain information security in its project, enterprise, or company-wide unclassified information technology system(s) in accordance with the requirements set forth in DOD Directive-Type Memorandum (DTM) 08-027, Security of Unclassified DoD Information on Non-DoD Information Systems, July 31, 2009 (incorporating Change 2, September 2, 2011). The Contractor shall, at a minimum, comply with the specified National Institute of Standards and Technology (NIST) Special Publication (SP) 800–53 security controls, Privacy Act Program Requirements (DoD 5400.11-R), the Personnel Security Program (DoD 5200.2-R) and OMB M-06-16, Protection of Sensitive Agency Information. In addition the contractor shall comply with DoD minimum security requirements as outlined in the TRICARE Systems Manual, Chapter 1, Section 1.1 (except for paragraphs 3.4 and 3.5 through 3.5.1.7). Government validation of the Contractor’s Checklist and Certification Form (Attachment J-7) is required prior to accessing DoD data or interconnectivity with the Government systems and testing. If a control is not implemented, the contractor shall prepare a written determination that explains how either the required security control is not applicable or how an alternative control or protective measure is used to achieve equivalent protection (sample form at attachment J-7). At the government’s discretion, the contractor will provide a NIST certification briefing at a designated Government location, presenting an overview of its certification efforts.

MGT3.1: The NIST requirements apply to the contractor, subcontractors/business partners that perform functions such as program/business management, where the program/business management function requires access to DoD systems and/or the use of DoD/TRICARE data, beneficiary enrollment eligibility verification, claims processing, etc. The NIST requirements do not apply to providers who provide health care to CHAMPUS/TRICARE-eligible beneficiaries and who do not have access to DoD systems or use of DoD/TMA data.

MGT4: The contractor shall comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements, specifically the administrative simplification provisions of the law and the associated rules and regulations published by the Secretary, Health and Human Services (HHS), the DoD Health Information Privacy Regulation (DoD 6025.18- R) the Health Insurance Portability and Accountability Act Security Compliance Memorandum (HA Policy 06-010), the Security Standards for the Protection of Electronic Protected Health Information and the requirements in the TOM, Chapter 19, and the TSM, Chapter 1.

MGT4.1: The contractor shall ensure that all electronic transactions comply with HIPAA rules and regulations and TMA requirements in the TSM, Chapter 1 and the TOM, Chapter 19.

MGT5: The contractor shall comply with the records management provisions of the TOM, Chapter 2.

MGT6: The contractor shall implement processes and procedures that ensure full compliance with the most current version of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry's Consumer Bill of Rights and Responsibilities (http://www.hcqualitycommission.gov/ ) and DoD Instruction 6000.14 (www.dtic.mil/whs/directives MGT7: The contractor shall establish and maintain experienced and qualified key personnel and sufficient staffing and management support to meet the requirements of this contract and comply with all management standards in the TRICARE Operations Manual, Chapter 1, Section 4.

MG 8: All beneficiary records used in any way by the contractor must be protected as required by the Freedom of Information Act, the Privacy Act of 1974, the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act, and the Health Insurance Portability and Accountability Act of 1996. The contractor shall comply with the HHS Privacy Regulation Training and Education requirements of the TOM, Chapter 1, Section 5. Beneficiary records must be protected, in terms of privacy and security, during use, transmission, storage, destruction, and handling. All beneficiary records used during the execution of this contract must be maintained, transferred, stored, and destroyed in accordance with the TRICARE Operations Manual, Chapter 2. Beneficiary records can not be used for any other purpose not related to the contract.

MGT9: The contractor shall participate in meetings with Government representatives. Meetings are held at the discretion of the Government. Attendance at these meetings shall be at no additional cost to the Government. The contractor shall participate in all required meetings as determined by the Government regardless of how they are held (in person, via teleconference, by video-teleconference, or through electronic conferences within the TMA web site). The frequency and scheduling of meetings will vary depending on the topic.

MGT10: Audits and contract performance evaluations by Government staff will be conducted periodically at the location(s) of the contractor's operations and/or subcontractor(s’) operations. These reviews will include all aspects of the contractor's performance under the terms of the contract. The contractor shall make available all personnel, facilities, and documentation required in the conduct of such reviews or investigations by TMA staff or other authorized Government agencies and staff. Upon request by the Contracting Officer, the contractor shall provide a lockable office space, equipped with desks, conference table and chairs at a contractor operated facility determined by the government, for any short or long term on-site auditors. The contractor shall also furnish local and long distance telephone capability. Results of these audits and/or evaluations will be furnished to the contractor in writing.

MGT11: The contractor shall ensure that instances of fraud and abuse, as defined in 32 CFR 199.9, are minimized, promptly identified and aggressively pursued and resolved.

MGT11.1: In accordance with 32 CFR 199.9, the TOM, Chapter 13 and Chapter 20, Section 4.0, the contractor shall ensure appropriate identification and referral of potential cases of fraud and/or abuse, and provide support in the Government's investigation and resolution of potential fraud and/or abuse cases, including provider exclusions, suspensions, termination, and reinstatements. NOTE: The TOM, Chapter 13, Section 1, paragraph 1.4.1 requiring contractors to have commercial anti-fraud software does not apply to this contract.

MGT 12: The contractor shall comply with the provisions of the TRICARE Operations Manual, Chapter 7 regarding coordination and interaction with the TRICARE Quality Monitoring Contractor (TQMC).

Transition (TRN) TRN1: Upon the award of the contract, the contractor shall comply with the start-up and transitional requirements of the TRICARE Operations Manual, Chapter 20, Section 5.

TRN2: The contractor shall provide ongoing collaboration with the Government to ensure that the appropriate Government personnel, as identified in the Transition Plan, are kept informed of start up and transition progress. The frequency, type, and nature of communication shall be based on the task and involvement of the Government. Any commonly utilized form of business communication (e.g. telephonic, email) is acceptable to the Government.

TRN3: The contractor will mail no later than 45 days before start of work an introductory letter to all beneficiary households with a claims activity in the 12 months prior to the mailing of the letter.

TRN4: The contractor shall execute a Memorandum of Understanding (MOU) with all TRICARE Managed Care Support Contractors (MCSCs) sixty (60) calendar days prior to the start of services. The MOU shall include, but is not limited to provider file update coordination, customer service coordination, marketing and education and program integrity. The MOU shall be coordinated with the Contracting Officer and the Contracting Officer’s Representative.

TRN5: The contractor shall meet with and establish a Memorandum of Understanding (MOU) with TMA Beneficiary Education and Support Directorate (BE&S), within 60 calendar days of contract award. The MOU will establish the review and approval process for education materials, and identify desired education materials required by either TMA or the contractor. The MOU will identify the process for requesting additional educational materials. The MOU shall also address the ordering and bulk shipment of materials. The MOU shall be effective within 30 days of the meeting between TMA/BE&S and the contractor. The content of the MOU will be coordinated with the Contracting Officer and the Contracting Officer’s Representative.

TRN6: TRICARE Management Activity (TMA) BE&S will design, develop and print all educational materials. BE&S will collaborate with the contractor in the development of content for all educational materials. The Memorandum of Understanding between the contractor and BE&S will specify timeframes required to support design, development, printing and distribution of marketing and education materials. All materials shall be coordinated with the Contracting Officer prior to approval by the Marketing and Education Oversight Committee (MEC) and release for printing. BE&S will ship all materials to the contractor; the contractor is responsible for all storage, handling and distribution of printed materials.

TRN7: The contractor shall develop a process to ensure access to all data associated with MHS beneficiaries is available to the Government and to the contractor's customer service personnel at program start-up and through the phase-out of the contract. A process will be established for transfer of this data and be in place and operational prior to the end of the contract.

TRN8: At the conclusion of this contract, the contractor shall meet with and provide to the successor contractor and/or the Government the information necessary to facilitate a seamless transition in accordance with the TRICARE Operations Manual, Chapter 20, and any additional information agreed to by the parties.

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TMA TDEFIC HT9402-12-R-0005