TDEFIC Draft Section L Instructions to Offerors.doc

SECTION L, INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS

L.1. SOLICITATION PROVISIONS

L.1.1. 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 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. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es): http://www.acquisition.gov/far: or http://farsite.hill.af.mil/: or http://www.acq.osd.mil/dpap/dars/dfarspgi/current/index.html

(End of Provision)

L.1.2. 52.215-1 INSTRUCTIONS TO OFFERORS—COMPETITIVE ACQUISITION (JAN 2004)

(Reference 15.209)

L.1.3. 52.215-16 FACILITIES CAPITAL COST OF MONEY (JUN 2003)

(Reference 15.408)

L.1.4. 52.222-24 PREAWARD ON-SITE EQUAL OPPORTUNITY COMPLIANCE EVALUATION (FEB 1999) (Reference 22.810)

L.1.5. 252.225-7003 REPORT OF INTENDED PERFORMANCE OUTSIDE THE UNITED STATES AND CANADA—SUBMISSION WITH OFFER (OCT 2010) (Reference 225.7204) L.1.6. 252.226-7001 UTILIZATION OF INDIAN ORGANIZATIONS, INDIAN-OWNED ECONOMIC ENTERPRISES, AND NATIVE HAWAIIAN SMALL BUSINESS CONCERNS (SEP 2004) (Reference 226.104)

L.1.7. 52.215-20 REQUIREMENTS FOR CERTIFIED COST OR PRICING DATA AND DATA OTHER THAN CERIFIED COST OR PRICING DATA (OCT 2010) (Reference 15.408(1))

L.1.8. 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 will 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.1.9. 52.204-6 DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER (APR 2008)

L.1.10. 252.225-7031 SECONDARY ARAB BOYCOTT OF ISRAEL (JUN 2005)

L.1.11. 52.237-1 SITE VISIT (APR 1984)

L.1.12. 52.215-22 LIMITATIONS ON PASS-THROUGH CHARGES –IDENTIFICATION OF SUBCONTRACT EFFORT

L.1.13. 252.209-7001 DISCLOSURE OF OWNERSHIP OR CONTROL BY THE GOVERNMENT OF A TERRORIST COUNTRY (JAN 2009)

L.1.14. 52.222-46 EVALUATION OF COMPENSATION FOR PROFESSIONAL EMPLOYEES (FEB 1993)

(a) Recompetition of service contracts may in some cases result in lowering the compensation (salaries and fringe benefits) paid or furnished professional employees. This lowering can be detrimental in obtaining the quality of professional services needed for adequate contract performance. It is therefore in the Government’s best interest that professional employees, as defined in 29 CFR 541, be properly and fairly compensated. As part of their proposals, offerors will submit a total compensation plan setting forth salaries and fringe benefits proposed for the professional employees who will work under the contract. The Government will evaluate the plan to assure that it reflects a sound management approach and understanding of the contract requirements. This evaluation will include an assessment of the offerors ability to provide uninterrupted high-quality work. The professional compensation proposed will be considered in terms of its impact upon recruiting and retention, its realism, and its consistency with a total plan for compensation. Supporting information will include data, such as recognized national and regional compensation surveys and studies of professional, public and private organizations, used in establishing the total compensation structure.

(b) The compensation levels proposed should reflect a clear understanding of work to be performed and should indicate the capability of the proposed compensation structure to obtain and keep suitably qualified personnel to meet mission objectives. The salary rates or ranges must take into account differences in skills, the complexity of various disciplines, and professional job difficulty. Additionally, proposals envisioning compensation levels lower than those of predecessor Contractors for the same work will be evaluated on the basis of maintaining program continuity, uninterrupted high-quality work, and availability of required competent professional service employees. Offerors are cautioned that lowered compensation for essentially the same professional work may indicate lack of sound management judgment and lack of understanding of the requirement.

(c) The Government is concerned with the quality and stability of the work force to be employed on this contract. Professional compensation that is unrealistically low or not in reasonable relationship to the various job categories, since it may impair the Contractor’s ability to attract and retain competent professional service employees, may be viewed as evidence of failure to comprehend the complexity of the contract requirements.

(d) Failure to comply with these provisions may constitute sufficient cause to justify rejection of a proposal.

(End of Provision)

L.1.15. 52.216-1 TYPE OF CONTRACT (APR 1984)

The Government contemplates award of a Fixed Price contract resulting from this solicitation.

(End of Provision)

L.1.16. 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 Contracting Officer (addressed as follows) by obtaining written and dated acknowledgment of receipt from the Contracting Officer (as indicated in Block 10 of the SF33), TRICARE Management Activity, Contract Management Division, 16401 East Centretech Parkway, Aurora, CO 80011-9066.

(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.1.17. NOTICE OF AVAILABILITY OF INDEPENDENT REVIEW. In accordance with FAR 33.103, offerors are hereby advised that they may request an independent review of their agency protest. Independent review of an agency protest regarding this solicitation and/or proposed award resulting from this solicitation is only available as an appeal of the contracting officer’s agency protest decision. An official at a level above the contracting officer will be designated, as needed, within the TRICARE Management Activity to conduct any independent reviews requested. The designated independent reviewer will be an official who has not had previous personal involvement in the procurement, if practicable.

Agency Level protests or requests for independent review should clearly state that they are an agency-level protest, or request for independent review, in their subject line and /or early in the text of the document(s). The cover letter and/or outside wrapper for requests for independent review should clearly indicate that the attached or enclosed contents are a request for an independent review, so that the Contracting Officer can promptly forward the request to the designated independent review official.

(Note: TMA’s Agency Level Protest process gives a higher level appellate review of the Contracting Officer’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. This section provides general guidance for preparing proposals as well as specific instruction on the format and content of the proposal. Offerors are cautioned to follow the information in a form that will facilitate proposal evaluation. The offeror’s proposal must include all data and information requested in this solicitation and must be submitted in accordance with these instructions. The offer shall be compliant with the requirements as stated in the solicitation and applicable attachments. Nonconformance with the instructions provided in the solicitation and this section may result in an unfavorable proposal evaluation or rejection of the proposal. The proposal shall be clear, concise, and include sufficient detail for effective evaluation and for substantiating the validity of stated claims.

L.2.2. Proposals will be evaluated on written information submitted by offerors. Only one contract award will result from this solicitation. Exceptions taken as to inclusion of specific requirements in the resultant contract shall not be considered. Offerors shall submit only one proposal. Alternate proposals will not be accepted or evaluated by the Government. If an offeror submits more than one proposal, the Government will not evaluate any proposal from that offeror.

L.2.3. The proposal should not simply rephrase or restate the Government’s requirements, but 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 and experience. The Government will base its evaluation on the information presented, plus any additional past performance information obtained by the Government from other sources.

L.2.4. ORGANIZATIONAL CONFLICTS OF INTEREST

L.2.4.l. The Offeror's attention is directed to FAR, Subpart 9.5, "Organizational and Consultant

Conflicts of Interest."

L.2.4.2. For the purpose of these provisions, the term "Offeror" means the offeror, its subsidiaries, affiliates, partners, marketing consultants, as defined by FAR, Subpart 9.501, or any of its successors or assignees.

L.2.4.3. It is the position of TMA that the following companies, due to the nature of their performance with TMA, have an actual or potential organizational conflict of interest, which must be avoided, neutralized, or mitigated: Lockheed-Martin, Axiom Resource Management, Inc., Irving Burton and Associates, ER Williams, AECOM, and Kennell and Associates.

L.2.4.4. The Offeror is hereby notified that an actual or potential conflict of interest may exist with Covered DoD officials, as defined by DFARS 252.203-7000. The Offeror shall not knowingly provide compensation to a former Covered DoD official within 2 years after the official leaves DoD service, without first determining that the official has sought and received, or has not received after 30 days of seeking, a written opinion from the appropriate DoD ethics counselor regarding the applicability of post-employment restrictions to the activities that the official is expected to undertake on behalf of the Offeror. Additionally, the Offeror must disclose all intended employees on solicitation that are potential Covered DoD Officials, and get approval from the Contracting Officer prior to the involvement of Covered DoD Officials in the development of a response to the solicitation or a mitigation plan.

L.2.4.5. The offeror shall represent in writing within 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 organizational conflict of interest, as described in FAR, Subpart 9.5. In the event an actual or potential organizational conflict of interest exists, the offeror shall submit a mitigation plan to the Contracting Officer, no later than 15 calendar days prior to the proposal due date, that effectively demonstrates how the offeror will mitigate any actual or potential organizational conflict of interest while supporting this contract and any other TMA contract. As a part of the proposal, the offeror shall provide the Contracting Officer with information of previous or ongoing work that is in any way associated with this solicitation.

L.2.4.6. The Contracting Officer will review all mitigation plans to determine whether award to the offeror is consistent with FAR, Subpart 9.5. If the Contracting Officer determines that no conflict would arise or that the mitigation plan adequately protects the interest of the

Government, the offeror will be eligible for award. If the Contracting Officer 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.2.4.7. The above restrictions shall be included in all subcontracts, teaming arrangements, and other agreements calling for performance of work which is subject to the organizational conflict of interest restrictions identified in these provisions.

L.2.4.8. The offeror acknowledges the full force and effect of these provisions. The above provisions may be modified or deleted at the discretion of the Government. 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 pursue any remedy permitted by law, regulation or the terms and conditions of this solicitation.

L.2.5. Offerors shall submit proposals to the Contracting Officer at the address indicated below. The proposals are to be in electronic and hard copy format (see L.4.). Hardcopies and CDs shall be submitted to:

Mr. Scott Lamond, Contracting Officer TRICARE Management Activity ATTN: COD-A Ref: RFP HT9402-12-R-0005 16401 East Centretech Parkway Aurora, CO 80011-9066

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

Offerors shall apply all appropriate markings including those prescribed in accordance with FAR 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.

Identify Proprietary data which is to be protected in accordance with FAR 2.101 and 3.104.

L.3. GENERAL INFORMATION

L.3.1. The Contracting Officer and the Contract Specialist are the sole points of contact for this procurement. Questions regarding the solicitation or other concerns are to be submitted electronically to the Contracting Officer/Specialist via the TMA contracting website at http://www.tricare.osd.mil/contracting/healthcare/solicitations/index.cfm.

L.3.2. The remarks, explanations, and answers provided by Government representatives whether orally, or in writing, shall not change or qualify any of the terms or conditions of the solicitation. The solicitation can only be changed by a formal written amendment issues by the Contracting Officer.

L.3.3. Data on eligible beneficiaries, electronic and paper claims quantities, administrative support services workload volumes is located in exhibits to Section L (Exhibits L-1 and L-2). This historical data is for informational purposes only.

L.3.4. Offerors may access the TRICARE Manuals through 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 parts/volumes, individually titled as indicated below. Hard copies of each Part/Volume shall be contained in a separate three-ring binder, and provided with the appropriate number of copies. The total number of copies includes the original (e.g., 5 copies = original + 4 copies).

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. The set may be submitted on one CD if size permits. For the 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 Reader (OCR) format is acceptable for all volumes except for Volume IV. Volume IV shall only be submitted in Word or Excel format. Each CD shall be labeled as stated in L.2.5. 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. Electronic versions shall be exact duplicates of the paper copy proposals in both content and format. Documents such as previously printed materials, graphics or any other documents that cannot be submitted in electronic form are exempt, but if provided in hard copy, it will be considered in the page count.

L.4.3. Paper Copies. Paper copy proposals shall be exact duplicates of the electronic versions in both content and format. Paper copies shall be separated by Volume, each in a 3-ring binder and identified with the offeror’s name, volume number, volume title, proposal date and solicitation number. A separate binder is required for each Volume. All paper copy proposal narrative 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, not smaller than 12 points; however, smaller fonts on areas of the proposal that will not easily accommodate 12 point font and limited to 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. Proposals shall be printed double-sided only with non-duplicative, sequential page numbers at the bottom of each printed page. Only Volume IV Price may be printed single-sided. Each page will also include the offeror’s name, and solicitation number. In instances where the paper copy differs from the electronic copy, the paper copy shall 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. The following table, with a breakout of the page limitations cross-referenced to the specific paragraph of Section L, is provided for your convenience. If a paragraph is not listed in this table, but there is a requirement for information to be submitted in the proposal, then a page limitation is not applicable.

L.4.5. Proposals will be reviewed for completeness and compliance with the RFP and preparation instructions. If an offeror (1) fails or refuses to assent to or commit to any of the requirements, terms and conditions of the RFP, (2) proposes additional terms and conditions of this RFP, or (3) fails to submit any of the information required by this RFP, then TMA may consider the offer to be unacceptable, which could make the offer ineligible for contract award. Offerors shall not include price information anywhere in the proposal package, other than in the price/cost volume, and prices in Completed Schedule B. All pages of each proposal shall be appropriately numbered and identified with the solicitation number.

L.4.6. If the Contracting Officer issues an Evaluation Notice (EN) (i.e., clarification questions) the offeror shall follow the EN instructions provided by the Contracting Officer.

L.4.7. If the Contracting Officer requests final proposal revisions, the offeror shall follow the final proposal revision instructions provide by the Contracting Officer.

L.4.8. If an offeror believes that the requirements in these instructions contain an error, omission, or are otherwise unsound, the offeror shall immediately notify the Contracting Officer in writing with supporting rationale.

L.4.9. An offeror’s proposal will not be incorporated into the awarded contract as a whole; however, the Government may incorporate portions of the proposal.

L.4.10. In accordance with Federal Acquisition Regulation Subpart 4.8 Government Contract Files, the agency’s contracting office will retain one copy of all unsuccessful proposals. Unless the offeror requests otherwise in writing, the agency’s contracting office will destroy extra copies of unsuccessful proposals. TMA’s Acquisition Policy & Pricing Branch may retain one copy of the price volumes. TMA’s Office of General Counsel (OGC) may retain their copies.

L.4.11. Offerors shall use the quantity figures for each CLIN that were provided by the Government (in Section B of the solicitation), when submitting their proposal. The provision of this data does not represent a commitment on the part of the Government that these quantities will actually occur over the course of the contract.

L.4.12. Organization Chart. The offeror shall submit their anticipated organizational structure and must include the prime Contractor and first tier subcontractors. The organizational structure shall include addresses and telephone numbers. 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), a clear description of the organizational relationships must be disclosed. A copy shall be placed in each volume of the proposal. The organization chart shall not exceed 3 pages and will not count against any of the other page limitations indicated in L.4.4.

L.5. VOLUME I – REQUEST FOR PROPOSAL

L.5.1. Volume I shall contain the signed original of all documents requiring signature of the offeror. Use of reproduction of the signed original is authorized in the second copy. All certifications and representations, to include Section K, required by the solicitation shall be completed and provided in Volume I. The provision in Section K, FAR 52.204-8, Annual Representations and Certifications, must be completed and submitted with the proposal. An online Representations and Certifications Application is available at https://orca.bpn.gov/.

L.5.2. Offerors shall submit a completed original Section B (Supplies or Services and Prices/Costs) in Volume I and a copy shall be provided in Volume IV. Offerors are instructed to price the appropriate line item and sub-line items in Section B. Offers submitted in response to this solicitation shall be in terms of U.S. dollars. Offers received in other than U.S. dollars shall be rejected. Quantities identified by the Government are estimates based on TRICARE historical data.

L.5.3. Offerors must complete, sign, and date their offer at blocks 12 through 18 of the Standard Form 33. Source selection procedures and the evaluation of offers received in response to the solicitation are projected to require up to 180 calendar days to complete. As a result of this, the Government requires that the Minimum Acceptance Period identified in item 12 of the Standard Form 33 be a minimum of 180 calendar days.

L.5.4. The Contractor’s point of contact information for paragraph G.1.1.1 shall be included in Volume I.

L.5.5. Offerors shall include the Subcontracting Plan (see Section L.11).

L.6. VOLUME II – TECHNICAL PROPOSAL

L.6.1. The offeror shall submit a written technical proposal which demonstrates the offeror’s understanding of the requirements, and provides an effective and efficient technical solution for the prospective contract. The proposal shall also include a separate list of those elements of the offer that exceed the Government’s minimum requirements including performance standards that exceed the minimum standard or additionally offered performance standards. The separate list shall have a clear cross reference to where each offered element is located in the technical proposal. The technical proposal shall clearly describe each element offered and demonstrate how the offeror will meet the higher standards or exceed minimum requirements and why it is advantageous to the Government. The exceeded requirements or standards that exceed minimums may be incorporated into the contract, if the Government also determines that it exceeds requirements/standards and finds it to be advantageous. Accordingly, for each offered element that exceeds minimum requirements/standards, the offeror shall include adequate language that may be incorporated into the contract as an enforceable provision. The Government, at its sole discretion, may not incorporate each and every offered requirement or standard that exceeds the minimum requirement.

L.6.1.1. The Government will not assess a “strength” to any enhancement to the following Government standards or requirements (TRICARE Operations Manual 6010.56-M, February 1, 2008, Chapter 1, Section 3):

Claims Processing Cycle-paragraph 1.6.

TEDs Timeliness-100% of initial submission vouchers transmitted to TMA within five calendar days-paragraph 1.8.

Filing-paragraph 2.1.

Availability of Information-paragraph 2.2.

Walk-ins-paragraph 3.3.

Telephone Blockage Rates-paragraph 3.4.

Telephones answered within two rings by ARU-paragraph 3.4.

Telephones transferred to ARU within 20 seconds-paragraph 3.4.

Expedited Preadmission/Preprocedure Reconsiderations-paragraph 4.1.

Grievances-paragraph 5.0.

L.6.1.2. 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. The proposal should clearly describe the technical solution and overall approach to the solicitation requirements and address all of the subfactors identified in Sections L.6.2. through L.6.6. which will be evaluated against the criteria specified within Section M of this solicitation. 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 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 the overall past performance rating as described in Section M.6. The price/cost proposal, past performance information, and financial information shall not be addressed in the technical proposal volume, and no part of the technical proposal shall incorporate by reference portions of other volumes of the proposal.

L.6.1.3. The technical proposal shall not exceed 200 pages inclusive of the exhibits, illustrations attachments, flow diagrams, data dictionaries, figures, charts, and any other non-narrative inclusion. The offeror may use cross-reference rather than resorting to redundancies in the presentation (i.e., a cross reference to another paragraph within the technical volume, cross references to the other volumes is not allowed). Electronic versions shall be exact duplicates of the paper copy proposals beginning with the first piece of paper of Volume II of the technical proposal, which shall be regarded as page one. Pages in excess of 200 (starting at page 201) will be destroyed without review. The Table of Contents, the index, and tabs separating sections of the volume will not be counted as long as they do not contain proposal content.

FACTOR 1 – TECHNICAL APPROACH

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. This 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; determine the appropriate allowable payment amount; coordinate and apply Medicare and Other Health Insurance (OHI) benefits; and correctly apply deductible, co-pay/cost-share and catastrophic cap provisions. The offeror shall also address provider certification, jurisdiction determinations, receipt and control of both paper and electronic claims, mailroom activities, missing claim information/claim development and data entry.

L.6.2.2. 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. 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 the first two option periods (1.75% for the remaining option periods); and the claim occurrence error rate shall not exceed 3% for all types of TED records.

L.6.3. SUBFACTOR 2 – BENEFICIARY/PROVIDER SATISFACTION/CUSTOMER SERVICE

L.6.3.1. The offeror shall comprehensively describe its customer service program for achieving highly satisfied beneficiaries to include the types of 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. 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 quality of service will be ensured, including accuracy in responding to beneficiary inquiries. Offeror proposed beneficiary and provider surveys will not be considered, although the Government survey results may be used in the offeror’s approach.

L.6.3.2. The offeror will describe the process for developing and distributing provider and beneficiary education materials, to include mode and frequency.

L.6.4. SUBFACTOR 3 – MEDICAL MANAGEMENT

L.6.4.1. The offeror shall describe its medical management program for primary pay claims. The offeror shall describe how it will ensure that care provided is medically necessary, at the appropriate level and complies with the TRICARE benefit policy. The offeror shall describe how it will perform duties as a multifunction Peer Review Organization (PRO) under this contract and how it will follow all standards, rules and procedures of 32 CFR 199.15.

L.6.4.2. The offeror shall describe how it will operate a case management program when TRICARE becomes primary payer to manage the health care of beneficiaries with high-cost conditions, specific diseases, and chronic complex illnesses for which evidence based clinical management programs exist. The description shall include patient selection criteria.

L.6.5. SUBFACTOR 4 – MANAGEMENT FUNCTIONS

L.6.5.1. The offeror shall describe how it will establish and maintain experienced and qualified key personnel in order 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. In an Excel format, the offeror shall provide a staffing chart for each option period of the contract. At a minimum, the staffing chart shall be broken down in areas identified in Exhibit L-3, Staffing Chart of the solicitation. (Note: The staffing chart can be a separate attachment to the proposal and does not count towards the page limitation for the written technical proposal.)

L.6.5.2. The offeror shall describe its Quality Management/Quality Improvement Program, which, at a minimum, includes the major components of the program: quality control activities, quality assurance functions, organization responsibilities for quality management, and how identified quality problems will be monitored and resolved.

L.6.6. SUBFACTOR 5 – TRANSITION IN

L.6.6.1. The offeror shall provide how they will ensure that services and systems are fully operational at the start work date. The offeror shall provide a description of and timeline for all major start-up activities that complies with the TRICARE Operations Manual 6010.56-M, February 1, 2008, Chapter 20, Section 5. The description shall specifically address how the offeror will minimize disruption to beneficiaries. This should include a description of and timeline for establishing crossover agreements with the Medicare Coordination of Benefits Contractor.

L.7. VOLUME III – PAST PERFORMANCE INFORMATION

FACTOR 2 – PAST PERFORMANCE

L.7.1. This section applies to the Prime Contractor and its first-tier subcontractors, if any. The term “Prime Contractor”, for the purpose of submitting past performance information, includes an entity that is a consortium of entities. For purposes of this contract, a first-tier subcontractor is a company with a direct contractual relationship with the offeror and whose total contract price exceeds $25,000,000 for option periods one through five. Additionally a first-tier subcontractor is a company who provides core claims processing function whose estimated costs exceeds $1,000,000 for option periods one through five. A first-tier subcontractor does not include providers, related functions such as data entry or copying for core claims processing functions, nor does it include subcontractors performing functions not relevant to core claims functions.

L.7.1.1. The Government will only consider relevant past performance information for ongoing contracts and contracts that have concluded within the last three years. The last three years is defined as three years as of 60 calendar days prior to the initial proposal due-date. The Government will consider the entire period of performance of the contract to include the transition-in and phase-out periods. All relevant past performance shall be submitted.

L.7.1.2. The Government may, at its option, 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. Past performance data will be used to assess performance risk.

L.7.2. The offeror shall provide a summary narrative, not to exceed 15 pages, of the past performance that the prime contractor and first tier subcontractor(s) has in performing work that is relevant to this solicitation. The Table of Contents and tabs separating sections of the volume will not be counted as long as they do not contain proposal content. All relevant past performance shall be addressed. The offeror is required to explain what aspects of their past performance are deemed relevant in scope of services as it relates to the five technical subfactors and claims processing requirements for this solicitation. The offeror shall specifically indicate whether or not they have performed the five technical subfactors. The offeror shall provide their total number of covered lives and total annual number of claims processed. 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.

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 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/or its first-tier subcontractor, must state if it has fewer than three contracts that are relevant to this solicitation. The offeror shall not include contracts from its own subsidiaries, subcontractors, or other team members. A separate description shall be provided for each client not to exceed four pages per client. For each contract, the offeror shall provide the following information regarding the customer:

· A verified point of contact for the customer (name, title, address, phone number, email address) who will be able to discuss the offeror’s performance and contract standards/requirements and functions with the Government.

· Start and end dates of the contract

· Total dollar value of the contract

· Number of covered lives

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

· A clear explanation of the functions performed and what aspects of the contract are deemed relevant to this solicitation as it relates to the five technical subfactors.

· 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.7.4. If the offeror, or its first tier subcontractor(s), were formed or are being re-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, the offeror shall submit its largest five contracts for its parent organization or each member of the consortium and provide the same information that is required for the largest five contracts as described in L.7.3 and L.7.5. The offeror must document in their summary narrative (see 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. The offeror shall describe what resources of the five largest contracts, if any, will be shared with the offeror (e.g., claims processing, networks, customer service). Relevant past performance may be downgraded if there is no evidence of the connection or commitment of resources from the entity with relevant past performance to the entity that will be performing the work.

L.7.5. The offeror and each of its first-tier subcontractor(s) shall submit a completed past performance questionnaire for each of the contracts required in L.7.3. (See section J, Attachment J-8). The offeror shall not include contracts from their own subsidiaries, subcontractors, or other team members. It is the offeror’s responsibility to have the questionnaire completed by the referenced client. The questionnaire shall be completed by the most cognizant office of the contract or, if it is a Government contract, the Procuring Contracting Officer or Contracting Officer’s Representative. The offeror shall submit the completed questionnaires in its Volume III, Past Performance Proposal. The submitted questionnaires must include the signature, name and title of the person completing the questionnaire. The Government may, at its option, contact the offeror’s references to discuss the offeror’s past performance.

L.7.6. Many companies have acquired, been acquired by, or otherwise merged with other companies, and/or reorganized their divisions, business groups, of subsidiary companies. If an offeror provides past performance information that was rendered by a predecessor company, the offeror must include a “roadmap” describing all such changes in the organization of the offeror in order to facilitate the relevancy determination. The offeror shall describe in the summary narrative (see L.7.2.) how the past performance efforts of a predecessor company are relevant to this solicitation.

L.7.7. Any offeror without past performance history relevant to this solicitation shall submit information relating to key personnel in the entity who have relevant past performance history. Offerors shall specifically identify relevant past performance efforts for each individual cited, the nature of the history and the results of the individuals efforts. Key personnel information shall not exceed 1 page per person. Resumes do not constitute past performance.

L.7.8. Offerors with relevant past performance history may, but are not required, to submit key personnel information as stated in L.7.7. Based on corporate changes in business relationships as outlined in L.7.6, it may be necessary for the offeror to submit this information in order to show commitment of resources.

L.7.9. The offeror shall submit a record of its compliance with FAR 52.219-8 Utilization of Small Business concerns and 52.219-9, Small Business Subcontracting Plan including past SF294/SF295, if applicable, for the past two years on current or past Government contracts. There is no page limit for this information.

L.7.9.1. The offeror shall also include past records of monetary targets for Small Disadvantaged Business participation in terms of dollars for the total contract value (if applicable as required by FAR 19.202-1). There is no page limit for this information.

L.7.10. If the offeror, or its first-tier subcontractors, has had any contracts 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 customer, its address, the cognizant contracting official, and his/her telephone number. For any contract terminated for default or cause, the offeror shall provide what actions have been taken to prevent similar failures from reoccurring.

L.8. VOLUME IV – PRICE PROPOSAL

FACTOR 3 – PRICE

L.8.1. Price Reasonableness. These instructions are to assist you in submitting information required to evaluate the reasonableness of your offer. Offers should be sufficiently detailed to facilitate examination, evaluation, and comparison of the proposed price with other proposed prices received in response to the solicitation. The offeror shall submit Volume IV in accordance with L.4.1. The electronic cost proposal shall duplicate the hardcopy version and shall only be in Microsoft Word or Excel. All files shall be read only. Submitted files shall contain all formulas, calculations, and worksheet/workbook links used to compute the proposed amounts; the formulae, calculations, and links shall not be hidden. Print image files or those files/worksheets containing only values are not acceptable.

L.8.2. Data other than certified cost or pricing data shall be submitted to support the proposed prices. This data may be used by the Contracting Officer to assist in determining the proposed prices to be fair and reasonable. Such data may include the identical types of data as certified cost or pricing data, consistent with Table 15-2 of FAR 15.408, but without the certification. The data may also include, for example, any information reasonably required to explain the offeror’s estimating process, including, but not limited to: (1) The judgmental factors applied and the mathematical or other methods used in the estimate, including those used in projecting from known data; and (2) The nature and amount of any contingencies included in the proposed price. The types and formats of the data submitted are left up to the offeror to prepare and present in support of its proposed prices as reasonable. An unrealistically low proposed price could be considered by the Government as an indication that the offeror does not understand the solicitation technical requirements or the risk associated with its proposal.

L.8.2.1. Transition-In/Phase-In. Offerors shall propose a firm-fixed-price (FFP) for transition-in services. This price shall include all costs anticipated during the 12 month transition-in period to accomplish the transition-in requirements detailed in Section C.

L.8.2.2. Claims Processing. Offerors shall propose separate fixed claims processing rates for electronic and paper claims for each option period. These rates shall include all costs associated with receiving, inputting, adjudication, and end-of-processing activities for claims. Costs for customer service, appeals, marketing, advertising, management, or overhead not associated with adjudicating the claim shall not be included in the claim rate.

L.8.2.3. Transition – Out. Offerors shall propose a firm-fixed-price (FFP) for each option period for transition-out activities. This price shall include all costs associated with transitioning the prospective contract following completion in accordance with Section C requirements. SubCLINs (fill-in) are applicable only if the incumbent (on a contract award resulting from this RFP) is the successful offeror of a future follow-on contract for claims processing and associated customer support and administrative services. The Government will not pay transition-out costs to an incumbent receiving a follow-on contract. As such SubCLINS (fill-in) are Not Separately Priced (NSP).

L.8.2.4. For all CLINSs/SLINs, the unit price (to two decimal places) multiplied by the estimated quantity for each respective CLIN/SLIN shall equal the extended amount in Schedule B, with no rounding.

L.8.3. Proposed Prices Broken Down By Major Cost Element for Each CLIN/SLIN. The offeror shall include Excel worksheets detailing the price build-up by major cost element. At a minimum, the offeror shall provide its full Time Equivalents (FTEs) man-loading/staffing, identifying the labor categories, direct labor rates, annual productive hours per employee, labor costs, fringe benefits (rate and amount), overhead (rate and amount), Other Direct Costs, G&A expenses (rate and amount), proposed profit (rate and amount), Facilities Capital Cost of Money (if applicable), and total price. All calculations shall be fully disclosed with explanations for how the amounts were derived; the proposal data shall allow for replication and validation of the calculations, with clear tracking of key figures among the support schedules. The offeror shall follow its accounting policies and procedures, (if any) disclosure statement, business practices, and proposal strategy in preparing its submission.

L.8.3.1. Price/Cost Narrative. The offeror’s proposal shall include a Price/Cost Proposal Narrative discussing its proposed prices by cost element. The offeror shall provide the bases for the proposed costs by major cost element, including the rationale and assumptions used for the estimates. The proposal shall identify any judgmental factors applied and the nature of any contingencies included in the proposed costs. The estimated cost to the Government shall reflect the use of prudent judgment and sound business practices, including, but not limited to, compliance with governing regulations concerning estimating and accounting for costs.

L.8.3.1.1. Direct Labor Rates. The offeror shall note whether the proposed direct labor rates are actual rates, actuals with added escalation, estimates, or the results of a compensation survey. The labor rates should be time phased. If the wage or salary rates change during the contract performance periods/option periods, they may be proposed as weighted amounts. The offeror should disclose the weighting. The worksheet may be modified to show the different rates and the weighted result.

L.8.3.1.2. Indirect Rates/Fringe Benefits. The offeror shall note whether the basis and source of the indirect rates: current/previous fiscal year, budgeted/projection, or Forward Pricing Rate Submission. The proposed rates should reflect the offeror’s cost structure and accounting practices. For example, some contractors do not have a separate fringe benefits rate, it is included in the overhead; if this is the case, the fringe benefit rate would not have to be proposed as a separate figure. Another example: If the offeror does not have a Facilities Cost of Money rate, one does not have to be proposed. The indirect rates should be time phased. If the rates change during the contract performance periods/option periods, they may be proposed as weighted amounts. The offeror should disclose the weighting. The worksheet may be modified to show the different rates and the weighted results.

L.8.3.1.3. Staffing/Man Load

L.8.3.1.3.1 Labor Categories. The offeror shall provide brief descriptions discussing the duties of the proposed labor categories, tasks performed. There is no limit to the number of labor categories that may be entered.

L.8.3.1.3.2. Full Time Equivalents (FTEs).