TDEFIC Draft Section M Evaluation Criteria.doc

SECTION M, EVALUATION FACTORS FOR AWARD

M.1 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 competitive source selection and will be conducted in accordance with the Federal Acquisition Regulation (FAR) and applicable supplements. The Government has established a Source Selection Evaluation Board (SSEB) to evaluate proposals submitted in response to this Request for Proposal (RFP). Proposals will be evaluated by the SSEB using the evaluation factors and subfactors identified below. The source selected from this process will be the proposal representing the best value to the Government as determined by the Source Selection Authority (SSA).

M.2.2. The Contracting Officer will make a determination that a prospective Contractor is responsible or nonresponsible in accordance with FAR 9.1. A determination of nonresponsibility will result in the rejection of an offer and that offer may not be considered for award.

M.2.3. Unreasonable Proposals. Proposals which are unreasonable in terms of technical capability or which are unreasonably high or low in price will be deemed reflective of an inherent lack of technical competence or indicative of a failure to comprehend the proposed contractual requirements and will be rejected.

M.2.4. Evaluation Approach. The Government will evaluate:

M.2.4.1. The extent to which the proposal exhibits a clear understanding of the work requirements and the means required to fulfill the requirements.

M.2.4.2. The extent to which the proposal demonstrates an ability to meet or exceed the requirements defined in the RFP and the quality of service which is likely to result from implementation of an offeror’s proposed methods.

M.2.4.3. The feasibility of the offeror satisfactorily performing all RFP requirements within the total price proposed.

M.2.5. The Government anticipates award of a single, fixed price contract to the responsive, responsible offeror whose proposal represents the best overall value to the Government. If two or more proposals are determined essentially equal in terms of non-price factors, the Government may determine that price is the deciding factor. The Government may make trade-offs 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.

Factor 1 – Technical Approach

Subfactor 1 – Claims Processing

Subfactor 2 – Beneficiary/Provider Satisfaction/Customer Service

Subfactor 3 – Medical Management

Subfactor 4 - Management Functions

Subfactor 5 – Transition In

Factor 2 – Past Performance

Factor 3 – Price

Factor 4 – Small Business Subcontracting Participation

M.3.2. Of the four factors, Factor 1, Technical Approach is the most important factor. Factor 2, Past Performance, is the second most important factor. Factor 3, Price/Cost, is the least important factor. Factor 4 will be reviewed by the Contracting Officer and assigned an acceptable or unacceptable technical merit rating.

M.3.3. The five subfactors under Technical Approach are rated as follows: Subfactor 1-Claims Processing, Subfactor 2-Beneficiary/Provider Satisfaction/Customer Service, and Subfactor 3-Medical Management are of equal importance and the most important subfactors. Subfactor 4-Management Functions is less important than Subfactors 1, 2, and 3. Subfactor 5-Transition-In is the least important subfactor.

M.4. EVALUATION OF FACTOR 1 – TECHNICAL APPROACH

M.4.1. The Government will evaluate each subfactor under Factor 1 to determine a technical merit rating and a technical risk rating for each subfactor. The technical merit and technical risk ratings will be considered in determining the best value to the Government. Proposals will be evaluated on the basis of how well an offeror’s proposed procedures, methods, and delivery of services meet or exceed the Government’s minimum requirements. Where the Government has not specified a minimum standard, the Government will evaluate the offeror’s approach. The Government will consider offers that commit to higher performance standard(s) or exceed requirements except those listed in L.6.1.1. The Government will consider whether the higher performance standard or exceeded requirement is advantageous to the Government, providers, or beneficiaries. The Government reserves the sole right to determine whether a higher performance standard or exceeded requirement is advantageous to the Government. Each proposal will be evaluated separately and will be evaluated solely on its own merits. M.4.1.1. Technical Merit Rating

A technical merit rating will be assigned to each subfactor. The technical merit rating depicts how well the offeror meets or exceeds the requirement based on the evaluation criteria. In evaluating the offeror’s proposal, the Government will review the offeror’s compliance with the requirements, does the offeror demonstrate that it understands the requirements and does the offeror demonstrate a sound approach to accomplish the requirements. No contract will be awarded to any offeror who has a red technical merit rating in any subfactor. The following definitions will apply when assigning technical ratings:

· Strength – an aspect of an offeror’s proposal that has merit or exceeds specified performance or capability requirements in a way that 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.

· Acceptable Rating – proposal clearly meets the minimum requirements of the solicitation.

· Unacceptable Rating – proposal does not clearly meet the minimum requirements of the solicitation.

M.4.1.2. Technical Risk Evaluation

In addition to the evaluation for technical merit, the Government will evaluate the subfactors under Factor 1 for technical risk. Technical risk considers the potential for disruption of schedule, increased cost, degradation of performance, the need for increased Government oversight, or the likelihood of unsuccessful contract performance. As part of the Government evaluation, it will identify and assess risk based on the offeror’s proposal to successfully achieve the contract objectives and requirements. 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 a proposed approach, method, or process). One of the following Technical risk ratings will be assigned to each subfactor.

M.4.2. Subfactor 1 – Claims Processing

M.4.2.1. The proposal will be evaluated to determine whether the offer has proposed effective methods/processes to establish, maintain, and monitor a single claims processing system that meets contract requirements to include the receipt and transmission of HIPAA compliant transactions. The evaluation will include a determination that the proposed system will accurately: 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 offerors provider certification, jurisdiction determinations, receipt and control of both paper and electronic claims, mailroom activities, missing claim information/claim development and data entry shall also be evaluated.

M.4.2.2. The offeror’s proposal will be evaluated for sound processes/methods designed to ensure that claims processing timeliness standards will be met.

M.4.2.3. The offeror’s proposal will be evaluated for sound processes/methods to ensure that claims processing accuracy standards will be met.

M.4.3. Subfactor 2 – Beneficiary/ Provider Satisfaction/Customer Service M.4.3.1. The proposal will be evaluated to determine whether the offeror presents a sound approach for establishing and maintaining beneficiary and provider satisfaction throughout the period of performance. The proposal shall also be evaluated to ensure that comprehensive, readily accessible customer services are offered that include multiple, contemporary avenues of access. The offeror’s approach to providing these services so that beneficiary and provider satisfaction is achieved will be considered. Evaluation of proposed customer service functions will include the offeror’s approach to do so with knowledgeable, courteous, and responsive staff, including the offeror’s method to ensure accuracy in responding to beneficiary inquiries. Offeror proposed beneficiary and provider surveys will not be considered or evaluated.

M.4.3.2. The proposal will be evaluated based on how the offeror plans on addressing and responding to the need for beneficiary and provider education. This includes how education materials are developed and disseminated.

M.4.4. Subfactor 3 – Medical Management

M.4.4.1. The offeror’s proposal shall be evaluated to ensure that it will function as a multifunction Peer Review Organization (PRO) under this contract. Part of the PRO evaluation will include processes utilized when a lower level of care is more appropriate.

M.4.4.2. The offeror’s proposal will be evaluated to determine whether an effective medical case management program when TRICARE becomes primary payer is proposed for patient with high-cost conditions, specific diseases, and chronic/complex illnesses for which evidence based clinical management programs exist.

M.4.5. Subfactor 4 – Management Functions M.4.5.1. The offeror’s proposed staffing plan, including establishment and maintenance of experienced and qualified key personnel, will be evaluated to determine if it is reasonable in addressing all requirements and functions. The offeror’s proposed approach for employee retention and training will also be evaluated.

M.4.5.2. The offerors’ Quality Management/Quality Improvement program will be evaluated to determine if an effective internal quality management/quality improvement program is being offered to include quality control activities, quality assurance functions, organization responsibilities for quality management, and how identified quality problems will be monitored and resolved.

M.4.6. Subfactor 5 – Transition In

M.4.6.1. Transition In will be evaluated by considering the offeror’s approach to implementing the TDEFIC in a manner that ensures that all aspects of the program are fully operational according to the requirements of the RFP to include transitional activities. The offeror’s comprehensive implementation plans and proposed approach to minimizing disruption to beneficiaries and providers, and the timeline for reaching crossover agreements with the Medicare Coordination of Benefits Contractor (COBC) will be evaluated.

M.5 EVALUATION OF FACTOR 2 – PAST PERFORMANCE

M.5.1. The Government will evaluate past performance information, provided in accordance with Section L and other sources, to determine how well an offeror has performed in the past on recent relevant work that meets the requirements of this solicitation. 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. The past performance evaluation will result in an assessment 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. The Government will evaluate past performance deemed relevant in terms of scope and magnitude of effort and complexities as it relates to the five technical subfactors.

· First the Government will review the provided contract to see how closely their performance history relates to the functions of the five technical subfactors requirements for this solicitation (e.g., medical claims processing will be considered). Assessment of relevancy will be based on those functions the contractor or subcontractor will be performing on this solicitation. Secondly the Government will assess the relevancy of size based on the number of covered lives and the number of claims processed annually. Where a contract has fewer than one million covered lives (approximately 50% of TDEFIC covered lives) and processed fewer than 12 million claims annually (approximately 25% of TDEFIC claims annually), it will be considered less relevant than one where one million lives or more were covered and 12 million claims or more were processed annually. In cases where claims processing will not be a function for that contractor/subcontractor and the performance history does not include claims processing then only the number of covered lives will be utilized in determining the relevancy of size.

M.5.2.1. The Government will assign one of the following relevancy ratings to each contract provided by the offeror.

M.5.3. Once a relevancy rating has been determined the Government will review all available information to determine the quality of performance for each of the contracts. If an individual contract has been assessed as not relevant, no performance review will be conducted. The Government will identify any positive and/or negative findings noted during the review. The offeror will be notified of any adverse past performance information to which the offeror has not previously had an opportunity to respond.

M.5.4. The Government will then assess a performance confidence rating relative to the offeror’s ability to successfully perform the requirements of this solicitation. Past performance history not relevant to providing any of the services in this solicitation will not be considered relevant information for the purpose of determining the performance confidence rating. An offeror’s description of its past performance (both the 15 page summary narrative and the individual 4-page specific descriptions for the largest contracts), questionnaires completed by their clients, and any information developed by the Government, will be used to develop a performance confidence rating. The Government may utilize information obtained from the clients listed in the proposal, 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 others who may have useful and relevant information. The Government may also utilize its own internal records.

M.5.4.1. If an offeror has no past performance history relevant to providing the services required by the solicitation, the offeror’s past performance rating will be neutral and will not be evaluated favorably or unfavorably. This rating is neither negative nor positive. Neutral is merely indicative of a lack of prior performance in providing the service required by this solicitation. If an offeror with no relevant past performance submits relevant past performance information from a predecessor company, parent organization, consortium member, key personnel or subcontractors, this information will be considered in rendering a performance confidence level rating. This rating will be based on the relevance to providing the services required by this solicitation, and the amount of involvement the parent organization or consortium member will have in the operations of the offeror. When an offeror submits past performance information on its key personnel as stated in Sections L.7.7 and L.7.8, the Government will evaluate the key personnel information and then determine to what extent, if any, it will affect the performance confidence rating. This rating will be based on considerations such as the employee’s role in the company, the nature and quality of the services delivered, and the relevant amount of past performance the employee had related to providing the service required by this solicitation. 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 neutral if adequate, convincing and relevant past performance information is not available. 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(do) not have relevant past performance information, a performance confidence level of neutral will be assessed and will not be evaluated favorably or unfavorably.

M.5.5. The Government’s evaluation will consider the offeror’s past performance in compliance with its subcontracting goals. The Contracting Officer will analyze past Electronic Subcontracting Reporting System (eSRS) data and any related information from other sources and provide input to the assessment of the performance confidence rating relative to compliance.

M.5.6. The Contracting Officer will also evaluate past records for meeting monetary targets for Small Disadvantages Business participation expressed in terms of dollars for the total contract value if it was applicable to past contracts as required by FAR 19.1202-2, Applicability.

M.5.7. Each offeror will be assigned one of the following overall confidence ratings.

M.5.8. If an offeror is not assessed any Very Relevant or Relevant ratings on their top three contracts there is the potential the Government may still consider assessing them a Substantial Confidence based on other information as stated in M.5.4.

M.6. EVALUATION OF FACTOR 3 – PRICE

M.6.1. The total evaluated price will be the sum of all CLINs in Schedule B (i.e., cumulative prices for the Base and Option Period CLINs).

M.6.2. Reasonableness. The offeror’s proposal shall be evaluated for price reasonableness. The techniques and procedures described under FAR 15.404-1(b) price analysis will be the primary means of assessing price reasonableness. It is entirely at the Government’s discretion as to whether, and how, the data provided in accordance with L.8.2 and L.8.4 will be used in its assessment of price reasonableness.

M.6.3. The offeror’s proposal will be reviewed for compliance with the data submission requirements specified in Section L of the RFP. The assessment will consider the traceability of the pricing information provided to the proposed Schedule B prices. Proposals that do not include the required information or do not comply with the preparation instructions may be rejected.

M.6.4. Unbalanced Pricing. The offer will be reviewed for unbalanced pricing per FAR 15.404-1(g). Unbalanced pricing exists when, despite an acceptable total evaluated price, the price for one or more contract line items is significantly over or understated as indicated by the application of cost or price analysis techniques. Unbalanced pricing may indicate a proposal error and/or a misunderstanding of the contract requirements by the offeror. Based on the analysis performed, a determination will be made on the appearance of unbalanced or balanced pricing on each proposal.

M.7. Financial Viability

The Government will evaluate the offeror’s financial viability to ensure adequate financial resources to perform the prospective contract or demonstrate an ability to obtain adequate financial resources. Failure to provide a corporate guarantee, in accordance with L.9.7 may result in elimination of the offeror’s proposal for consideration for award.

M.8. SUBFACTOR 4 – SMALL BUSINESS SUBCONTRACTING PARTICIPATION: The Contracting Officer will review the Subcontracting Plan submitted under Volume I for compliance with the Federal Acquisition Regulation (FAR) 19.702, the clause FAR 52.219-9 entitled “Small Business Subcontracting Plan, and DFARS 252.219-7003, Small Business Subcontracting Plan (DoD) Contracts.

TMA TDEFIC HT9402-12-R-0005